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Early treatment with to evaluate the spaces between vertebral antibiotics can significantly improve out- discs of the spinal column toprol xl 100mg heart attack stent. The films are then read and interpreted by a Bell’s Palsy radiologist (physician who specializes in radiology) order toprol xl 100 mg line blood pressure bottom number 90. Sudden partial or complete paralysis of one side of the face is characteristic of Electromyography (EMG) and Nerve Bell’s palsy (Salinas, 2002). Individuals Conduction Velocity Studies may experience a sagging eyebrow, inabil- ity to close their eye, and drooping of one Electromyography is a procedure used to side of the mouth. Bell’s palsy occurs evaluate the electrical activity of certain when a nerve running from the brain to muscles and is helpful in the diagnosis of the face becomes inflamed. It may be per- 112 CHAPTER 3 CONDITIONS OF THE NERVOUS SYSTEM: PART II formed by a physician, physical therapist, independence as long as possible. A small there has been permanent damage to the needle that is attached to an electrode is nervous system, such as that caused by inserted into the muscle being examined, head injury or spinal cord injury, treat- and the electrical activity of the selected ment is directed toward rehabilitation muscle is recorded both at rest and dur- and prevention of complications. Nerve conduction studies are In many instances, treatment of nerv- often performed in conjunction with ous system disorders involves helping EMG and are helpful in diagnosing con- individuals to compensate for neurologi- ditions affecting peripheral nerves. For the cal deficits or to learn alternative methods nerve conduction portion of the proce- of performing routine tasks. Assistive dure, a stimulating electrode that delivers devices such as canes, braces, and wheel- a mild electrical charge is placed on the chairs may be indicated for individuals skin over a nerve. Other means of over a muscle records the activity of the assistance for individuals with neurolog- nerve distally at the nerve-muscle junc- ical disorders that interfere with motor tion. EMG makes it possible to identify function are “help animals,” such as dogs defects in the transmission of impulses or monkeys that have been especially from nerves to muscles. It may be used in trained to retrieve various items or to per- the diagnosis of a number of neuromus- form other tasks that are difficult or cular disorders and peripheral nerve impossible for an individual with a neu- injuries. GENERAL ISSUES IN NERVOUS Psychosocial Issues in Conditions of SYSTEM CONDITIONS the Nervous System Conditions of the nervous system have Psychological Issues widespread effects. Physical deficits can prevent individuals with such disorders Adjustment to any chronic condition or from performing even routine self-care. Individuals Problems with speech can alter the way with neurological disorders may face par- individuals communicate. Emotional abil- ticular challenges because their disorders ity may cause difficulty in social relation- affect many different functional areas. Cognitive deficits may interfere with all disabling conditions, psychologi- with work as well as everyday activities cal reactions are individually determined, such as managing finances, performing based in part on the way the individual household tasks, or carrying out self-care has dealt with life problems in the past. Individuals with traumatic brain injury, Symptoms of some conditions of the stroke, or multiple sclerosis may have cog- nervous system, such as epilepsy, can be nitive and emotional impairments as well controlled with medication. Other condi- as impairment of motor function as a tions, such as multiple sclerosis and direct consequence of their injury or con- Parkinson’s disease, involve progressive dition. Because they need to learn com- deterioration, and treatment focuses on pensatory strategies for a number of controlling symptoms, preventing com- activities and social interactions, psycho- plications, and promoting function and logical adaptation to the disorder be- General Issues in Nervous System Conditions 113 comes multifaceted. It is often difficult to Reactions may include hostility, anger, or determine the degree to which behavioral withdrawal. If the accident was the available treatment is limited and direct- fault of a third party, they may feel chron- ed mainly toward controlling symptoms ic anger toward the offender or may turn or preventing complications. In individuals with these conditions may some instances, the quest for retribution feel they have little control over the con- becomes a negative force, eroding the dition or their future. When conditions individual’s life as he or she continually are progressively debilitating, as in multi- seeks some sort of justice. Individ- Under these circumstances, they may uals may harbor resentment over the experience a helpless rage or bitterness dependency imposed by the condition. The uncertainty about whether reaction may vary from overdependence disability will be minimal or will progress to overcompensation, in which they take to severe disability can produce stress and unnecessary risks to test or prove their hardship. Learning to accept nec- reaction to using a wheelchair, viewing essary assistance from others for basic it instead as a symbol of the inability to needs, such as feeding, personal hygiene, walk. In other instances, even though and bowel and bladder care, requires the disability experienced is minimal, reconstituting views of privacy and self- they may grieve over the lost ability to reliance.

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Most of the catecholamine released into the synapse (up glia serve a comparable role by taking up catecholamines to 80%) is rapidly removed by uptake into the presynaptic and degrading them enzymatically by glial MAO and neuron order toprol xl 50 mg mastercard blood pressure pulse 95. Unlike uptake 2 in the PNS cheap toprol xl 50mg overnight delivery prehypertension during third trimester, glial uptake of cate- ter enters the synaptic vesicles and is made available for re- cholamines has many characteristics of uptake 1. In peripheral noradrenergic synapses (the sympa- The catecholamines differ substantially in their interac- thetic nervous system), the neuronal uptake process tions with receptors; DA interacts with DA receptors and NE described above is referred to as uptake 1, to distinguish it and EPI interact with adrenergic receptors. Up to five sub- from a second uptake mechanism, uptake 2, localized in types of DA receptors have been described in the CNS. Of the target cells (smooth muscle, cardiac muscle, and gland these five, two have been well characterized. In contrast with uptake 1, an active are coupled to stimulatory G proteins (G ), which activates transport, uptake 2 is a facilitated diffusion mechanism, adenylyl cyclase, and D2 receptors are coupled to inhibitory which takes up the sympathetic transmitter NE, as well as G proteins (G ), which inhibit adenylyl cyclase. Activationi the circulating hormone EPI, and degrades them enzymat- of D2 receptors hyperpolarizes the postsynaptic membrane ically by MAO and COMT localized in the target cells. A third subtype of DA the CNS, there is little evidence of an uptake 2 of NE, but receptor postulated to modulate the release of DA is local- 54 PART I CELLULAR PHYSIOLOGY ized on the cell membrane of the nerve terminal that releases 5-Hydroxytryptamine is stored in vesicles and is re- DA; accordingly, it is called an autoreceptor. The major Adrenergic receptors, stimulated by EPI and NE, are lo- mode of removal of released 5-HT is by a high-affinity, cated on cells throughout the body, including the CNS and sodium-dependent, active uptake mechanism. There are the peripheral target organs of the sympathetic nervous several receptor subtypes for serotonin. Activation results in an in- as either or , based on the rank order of potency of cat- crease in sodium and potassium ion conductances, leading echolamines and related analogs in stimulating each type. The remaining well-characterized receptor sub- The analogs used originally in distinguishing - from - types appear to operate through second messenger sys- adrenergic receptors are NE, EPI, and the two synthetic tems. Both glutamate (GLU) and der: ISO was most potent and EPI either more potent or aspartate (ASP) serve as excitatory transmitters of the equal in potency to NE. These dicarboxylic amino acids are important sub- guished these two classes of receptors: -receptors were strates for transaminations in all cells; but, in certain neu- stimulated by PE, whereas -receptors were not. Serotonin or 5-hydroxytryptamine (5-HT) is leased by exocytosis, stimulate specific receptors in the the transmitter in serotonergic neurons. Since mission in these neurons is similar in several ways to that GLU and ASP are readily interconvertible in transamina- described for catecholaminergic neurons. Tryptophan hy- tion reactions in cells, including neurons, it has been diffi- droxylase, a marker of serotonergic neurons, converts tryp- cult to distinguish neurons that use glutamate as a transmit- tophan to 5-hydroxytryptophan (5-HTP), which is then converted to 5-HT by decarboxylation (Fig. Glutamate (5-HT) is synthesized by the hydroxylation of (GLU) is synthesized from -ketoglutarate by tryptophan to form 5-hydroxytryptophan (5-HTP) and the de- enzymatic amination. Upon release into the synaptic cleft, GLU carboxylation of 5-HTP to form 5-HT. The removal of GLU is prima- synaptic cleft, 5-HT can bind to a variety of serotonergic recep- rily by transport into glial cells, where it is converted into gluta- tors on the postsynaptic cell. Glutamine, in turn, is transported from glial cells to the when 5-HT is transported back into the presynaptic terminal for nerve terminal, where it is converted to glutamate by the enzyme repackaging into vesicles. CHAPTER 3 The Action Potential, Synaptic Transmission, and Maintenance of Nerve Function 55 ter from those that use aspartate. Three of these, named for the syn- compounded by the fact that GLU and ASP stimulate thetic analogs that best activate them—kainate, common receptors. Accordingly, it is customary to refer to quisqualate, and N-methyl-D-aspartate (NMDA) recep- both as glutamatergic neurons. Activation of the kainate and quisqualate re- mitochondrial conversion of -ketoglutarate derived ceptors produces EPSPs by opening ion channels that in- from the Krebs cycle (Fig. Activation of the NMDA 2 vesicles and released by exocytosis, where it activates spe- receptor increases Ca conductance. This receptor, how- 2 cific receptors to depolarize the postsynaptic neuron. Thus, the NMDA receptor can be thought of transmitter by re-storage in vesicles and re-release. Cal- cells (particularly astrocytes) contain a similar, high-affin- cium gating through the NMDA receptor is crucial for the ity, active transport mechanism that ensures the efficient development of specific neuronal connections and for neu- removal of excitatory neurotransmitter molecules from ral processing related to learning and memory. Glia serves to recycle the excess entry of Ca through NMDA receptors during is- transmitter by converting it to glutamine, an inactive chemic disorders of the brain is thought to be responsible storage form of GLU containing a second amine group. The inhibitory amino At least five subtypes of GLU receptors have been de- acid transmitters -aminobutyric acid (GABA) and glycine scribed, based on the relative potency of synthetic analogs (GLY) bind to their respective receptors, causing hyperpolar- CLINICAL FOCUS BOX 3. When transmission in glu- Intracellular free calcium is an activator of calcium-de- tamatergic neurons functions normally, very low concen- pendent proteases, which destroy microtubules and other trations of EAA appear in the synapse at any time, prima- structural proteins that maintain neuronal integrity.

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Wernicke’s area: from Karl Wernicke buy generic toprol xl 100mg on line arrhythmia bat pony, German neurologist purchase toprol xl 25mg on line arteria y vena poplitea, 1848–1905 Van De Graaff: Human V. Nervous Tissue and the © The McGraw−Hill Anatomy, Sixth Edition Coordination Central Nervous System Companies, 2001 372 Unit 5 Integration and Coordination Pituitary stalk FIGURE 11. DIENCEPHALON The cerebral cortex discriminates pain and other tactile stimuli, The diencephalon is a major autonomic region of the brain that but the thalamus responds to general sensory stimuli and pro- consists of such vital structures as the thalamus, hypothalamus, vides crude awareness. The thalamus probably plays a role in the epithalamus, and pituitary gland. Objective 17 Describe the location and structure of the pituitary gland. It forms the floor and part of the lateral walls of the bral hemispheres of the telencephalon. Despite its small size, the hypothalamus performs mus, hypothalamus, epithalamus, and pituitary gland. Thalamus The hypothalamus acts as an autonomic nervous center in accelerating or decelerating certain body functions. These hormones and their functions are discussed in chap- organ, with each portion positioned immediately below ter 14. The principal autonomic and limbic (emotional) the lateral ventricle of its respective cerebral hemisphere (see functions of the hypothalamus are as follows: figs. The principal function of the thalamus is to act as a relay center for all sensory impulses, except smell, to the cere- 1. Specialized masses of nuclei relay the incoming impulses nate pattern of contraction, impulses from the hypothala- to precise locations within the cerebral lobes for interpretation. Impulses from the posterior hypothalamus pro- duce a rise in arterial blood pressure and an increase of the thalamus: L. Nervous Tissue and the © The McGraw−Hill Anatomy, Sixth Edition Coordination Central Nervous System Companies, 2001 Chapter 11 Nervous Tissue and the Central Nervous System 373 posite effect. Rather than traveling directly to the heart, Epithalamus impulses from these regions pass first to the cardiovascular centers of the medulla oblongata. The epithalamus is the posterior portion of the diencephalon that forms a thin roof over the third ventricle. Specialized nuclei within the of the roof consists of a vascular choroid plexus, where cere- anterior portion of the hypothalamus are sensitive to changes brospinal fluid is produced (see fig. It is thought to have a neuroendocrine through sweating and vasodilation of cutaneous vessels of the function. A below-normal blood temperature causes the hypo- pineal gland, is a tract of commissural fibers that connects the thalamus to relay impulses that result in heat production and right and left superior colliculi of the midbrain (see fig. Specialized Pituitary Gland osmoreceptors in the hypothalamus continuously monitor The rounded, pea-shaped pituitary gland, or cerebral hypoph- the osmotic concentration of the blood. It is attached to the hypothalamus by the production of antidiuretic hormone (ADH) by the hypo- funnel-shaped pituitary stalk and is supported by the sella turcica thalamus and its release from the posterior pituitary. The pituitary, which has an same time, a thirst center within the hypothalamus produces endocrine function, is structurally and functionally divided into feelings of thirst. The feeding center is a specialized portion of the lat- (see chapter 14). Low levels of these substances in Knowledge Check the blood are partially responsible for a sensation of hunger elicited from the hypothalamus. List the body systems and functions over which the hypo- thalamus also receives sensory impulses from the abdomi- thalamus has some control. What mus has both a sleep center and a wakefulness center that are the two portions of the pituitary gland? Specialized sexual center nuclei within the superior portion of the hypothalamus respond to sexual MESENCEPHALON stimulation of the tactile receptors within the genital or- The mesencephalon contains the corpora quadrigemina, con- gans. The experience of orgasm involves neural activity cerned with visual and auditory reflexes, and the cerebral pedun- within the sexual center of the hypothalamus. A number of nuclei within the hypothalamus that help control posture and movement. The hypothalamus pro- duces neurosecretory chemicals that stimulate the anterior The brain stem contains nuclei for autonomic functions of the and posterior pituitary to release various hormones.

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