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Efferent impulses from motor neuron produce contraction of extrafusal fibers and develop muscle tone antibiotic nerve damage discount terramycin 250mg with visa. Some of these centers increase the muscle tone by sending facilitatory impulses while other centers decrease the muscle tone by inhibitory impulses bacteria helicobacter pylori generic terramycin 250 mg otc. Supraspinal facilitatory centers Supraspinal centers virus 57 order terramycin on line amex, which increase the muscle tone: 1. Supraspinal inhibitory centers Supraspinal centers, which decrease the muscle tone: 1. Alpha motor neurons in turn, send impulses to extrafusal fibers of the muscle through spinal nerve fibers (efferent fibers) 6. These impulses produce partial contraction of the muscle fibers resulting in development of muscle tone (response). When the frequency of discharge from gamma motor neurons increases, the activity of muscle spindle is increased and muscle tone also increases. Regulation of Muscle Tone Though the muscle tone is developed by discharges from gamma motor neurons, it is maintained continuously Chapter 157 t Posture and Equilibrium 915 from cerebral cortex stimulate both motor neurons and motor neurons simultaneously. Stimulation of -motor neurons causes contraction of intrafusal fibers, which leads to increase in muscle tone. Role of cerebellum and basal ganglia It is interesting to find that cerebellum and basal ganglia influence the muscle tone without sending direct fibers to motor neurons. These parts of brain influence the muscle tone indirectly through brainstem centers. Role of brainstem centers Brainstem centers which influence the motor neurons are in reticular formation, red nucleus and vestibular nucleus. These centers modulate the discharge from motor neurons by receiving signals from cerebral cortex, cerebellum and basal ganglia. This reflex is normally present and serves particularly to maintain the body in an upright position. General Static Reflexes or Righting Reflexes General static reflexes are otherwise called righting reflexes because these reflexes help to maintain an upright position of the body. Righting reflexes help to govern the orientation of the head in space, position of the head in relation to the body and appropriate adjustment of the limbs and eyes in relation to the position of the head, so that upright position of the body is maintained. When a cat, held with its back downwards, is allowed to fall through the air, it lands upon its paws, with the head and body assuming the normal attitude in a flash. A fish resists any attempt to turn it from its normal position and if it is placed in water upon its back, it flips almost instantly into the normal swimming position. Righting reflexes consist of a chain of reactions, which occur one after another in an orderly sequence. First four reflexes are easily demonstrated on a thalamic animal or a normal animal, which is blindfolded. Labyrinthine righting reflexes acting on the neck muscles When a thalamic animal (rabbit) is suspended by holding at the pelvic region, its head turns up, until it assumes its normal position. It is because of reflexes arising from labyrinth, the sensory organ concerned with equilibrium of head, in regard to the position of the body. Turning the body of animal through air into different positions is followed by compensatory movements of the head. After extirpation of labyrinths, the head shows no compensatory movements when the rabbit is suspended. These centers send motor impulses to the different groups of skeletal muscles so that appropriate movements occur to maintain the posture. Neck righting reflexes acting on the body It is noticed that during labyrinthine righting reflexes, the head raises up to normal position. Now, the contraction of neck muscles produces proprioceptive impulses, which act on the body and rotate the body in relation to position of head. This reflex is well noticed, if the animal is laid down in resting position upon its side on a table.

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Part of vermis on the upper surface of cerebellum is known as superior vermis and the part on lower surface of cerebellum is called inferior vermis infection from root canal discount 250 mg terramycin with visa. Nodulus is continued on either side as an elongated and somewhat lobulated structure called flocculus antibiotics for uti augmentin buy terramycin 250mg visa. Posterior Lobe Posterior lobe consists of lobulus simplex bacteria no estomago generic terramycin 250 mg without prescription, declive, tuber, pyramid, uvula, paraflocculi and the two portions of hemispheres, viz. Flocculonodular Lobe Flocculonodular lobe includes nodulus and the lateral extension on either side called flocculus. Lobulus ansiformis or ansiform lobe, which is the larger portion of cerebellar hemisphere 2. Lobulus paramedianus or paramedian lobe, which is the smaller portion of cerebellar hemisphere. Paleocerebellum Paleocerebellum is the phylogenetically oldest part of cerebellum. Paleocerebellum proper, which includes lingula, central lobe, culmen, lobulus simplex, pyramid, uvula and paraflocculi. Vestibulocerebellum Vestibulocerebellum includes flocculonodular lobe that forms the archicerebellum. Spinocerebellum Spinocerebellum includes lingula, central lobe, culmen, lobulus simplex, declive, tuber, pyramid, uvula and paraflocculi and medial portions of lobulus ansiformis and lobulus paramedianus. Corticocerebellum Corticocerebellum includes lateral portions of lobulus ansiformis and lobulus paramedianus. Each layer of gray matter is uniform in structure and thickness, throughout the cerebellum. Molecular or Plexiform Layer Molecular or plexiform layer is the outermost layer of cortex having the cells arranged in two strata. In addition to stellate and basket cells, the molecular layer contains the following structures: i. Parallel fibers, which are the axons of granule cells, present in granular layer ii. Cell junctions in molecular layer Molecular layer contains the following cellular junctions: i. Dendrites of stellate cells and basket cells synapse with parallel fibers, which are the axons of granule cells ii. However, the axon of basket cell descends down into the Purkinje layer and forms the transverse fiber, that ends on the soma of Purkinje cells. Dendrites of Golgi cells situated in inner granular layer enter the molecular layer and end on parallel fibers. Purkinje Layer Purkinje layer is situated in between outer molecular layer and inner granular layer. Dendrites of these cells ascend through the entire thickness of molecular layer and arborize there. Axons of the basket cells form the transverse fibers, which descend down and end on the soma of Purkinje cells. Axons of Purkinje cells descend into the white matter and terminate on the cerebellar nuclei and vestibular nuclei via cerebellovestibular tract. Granular Layer Granular layer is the innermost layer of cerebellar gray matter and it is in between Purkinje layer and the cerebellar white matter. Total number of interneurons in this layer is about half the number of all neurons in the whole nervous system. Axon of granule cell ascends into molecular layer and forms the parallel fiber, which synapses with dendrites of Purkinje cells, stellate cells, basket cells and Golgi cells. Dendrites of granule cells and the axon and few dendrites of a Golgi cell synapse with Mossy fiber. The synaptic area of these cells is called glomerulus and it is encapsulated by the processes of glial cells. Afferent Fibers to Cerebellar Cortex Cerebellar cortex receives afferent signals from other parts of brain through two types of nerve fibers: 1. Climbing fibers Climbing fibers arise from the neurons of inferior olivary nucleus, situated in medulla and reach the cerebellum via olivocerebellar tract. Inferior olivary nucleus relays the output signals from motor areas of cerebral cortex and the proprioceptive signals from different parts of the body to the cerebellar cortex via climbing fibers.

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Frequently accompanied by nausea antibiotic resistant bronchitis purchase terramycin with amex, postural unsteadiness antibiotic zyvox cost purchase terramycin 250mg otc, and gait ataxia; may be provoked or worsened by head movement antibiotic during pregnancy purchase terramycin 250 mg visa. Physiologic vertigo results from unfamiliar head movement (seasickness) or a mismatch between visual-proprioceptive-vestibular system inputs (height vertigo, visual vertigo during motion picture chase scenes). Distinguishing between these causes is the essential first step in diagnosis (Table 40-1). The nystagmus does not change direction with a change in direction of gaze, it is usually horizontal with a torsional component and has its fast phase away from the side of the lesion. The pt senses spinning motion away from the lesion and tends to have difficulty walking, with falls towards the side of the lesion, particularly in the darkness or with eyes closed. Acute unilateral labyrinthine dysfunction may be caused by infection, trauma, or ischemia. Often no specific etiology is uncovered, and the nonspecific term acute labyrinthitis (or vestibular neuritis) is used to describe the event; herpes simplex virus type 1 infection has been implicated. The attacks are brief and leave the patient for some days with a mild vertigo: recurrent episodes may occur. Psychogenic vertigo should be suspected in pts with chronic incapacitating vertigo who also have agoraphobia, panic attacks, a normal neurologic exam, and no nystagmus. Central Vertigo Identified by associated abnormal brainstem or cerebellar signs such as dysarthria, diplopia, dysphagia, hiccups, other cranial nerve abnormalities, weakness, or limb ataxia; depending on the cause, headache may be present. Central vertigo may be chronic, mild, and is usually unaccompanied by tinnitus or hearing loss. If the vertigo persists more than a few days, most authorities advise ambulation in an attempt to induce central compensatory mechanisms, despite the short-term discomfort to the patient. Recurrent episodes of migraine-associated vertigo should be treated with antimigraine therapy (Chap. Some data suggest that glucocorticoids improve the likelihood of recovery in vestibular neuritis. Food and Drug Administration approved, but most are not approved for the treatment of vertigo. Additional assessments include testing of pupils, eye movements, ocular alignment, and visual fields. Slit-lamp examination can exclude corneal infection, trauma, glaucoma, uveitis, and cataract. Ophthalmoscopic exam to inspect the optic disc and retina often requires pupillary dilation using 1% topicamide and 2. Visual field mapping by finger confrontation localizes lesions in the visual pathway (Fig. The goal is to determine whether the lesion is anterior, at, or posterior to the optic chiasm. A scotoma confined to one eye is caused by an anterior lesion affecting the optic nerve or globe; swinging flashlight test may reveal an afferent pupil defect. Homonymous visual field loss signals a retrochiasmal lesion affecting the optic tract, lateral geniculate body, optic radiations, or visual cortex. Neuroimaging is recommended for any pt with a bitemporal or homonymous hemianopia. Prolonged occlusion of the central retinal artery results in classic fundus appearance of a milky, infarcted retina with cherry-red fovea. Any pt with compromise of the retinal circulation should be evaluated promptly for stroke risk factors. Vertebrobasilar insufficiency or emboli to the posterior circulation can be confused with amaurosis fugax, because many pts mistakenly ascribe symptoms to their left or right eye, when in fact they are occurring in the left or right hemifield of both eyes. Interruption of blood flow to the visual cortex causes sudden graying of vision, occasionally with flashing lights or other symptoms that mimic migraine. Pts should be questioned about the precise pattern and duration of visual loss and other neurologic symptoms such as diplopia, vertigo, numbness, or weakness. Malignant hypertension can cause visual loss from exudates, hemorrhages, cotton-wool spots (focal nerve fiber layer infarcts), and optic disc edema. In central or branch retinal vein occlusion, the fundus exam reveals engorged, phlebitic veins with extensive retinal hemorrhages. In age-related macular degeneration, characterized by extensive drusen and scarring of the pigment epithelium, leakage of blood or fluid from subretinal neovascular membranes can produce sudden central visual loss.

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The largest concentration of end feet occurs beneath the pial surface antibiotics for acne inflammation order cheapest terramycin, where they surround the brain and spinal cord to infection map cheap terramycin 250mg form a membrane-like structure called the glia limitans bacteria 3 types purchase terramycin 250mg otc. Smaller neuroglial cells with fewer processes and more deeply stained nuclei are oligodendrocytes, of which there are two types. Interfascicular oligodendrocytes occur mainly in the fiber tracts that form the white matter of the brain and spinal cord. Perineuronal satellite oligodendrocytes are restricted to the gray matter and are closely associated with the cell bodies of neurons. Large numbers of microtubules form parallel arrays that run throughout the cytoplasm of the cell body and into its processes. Schwann cells are not present in the central nervous system; oligodendrocytes serve as the myelinforming cells for this region. Myelinated nerve fibers of the central nervous system have nodes of Ranvier, but unlike peripheral myelinated fibers, they do not show incisures. Nodes in the central nervous system are bare, while those of the peripheral nervous system are partly covered by extensions of cytoplasm from adjacent Schwann cells into the paranodal area. The myelin sheath begins just beyond the initial segment of the axon, a few microns from the axon hillock, and ensheathes the rest of the axon to near its end. Each internodal segment of a nerve fiber in the central nervous system is formed by a single cytoplasmic process from a nearby oligodendrocyte, which wraps around the axon. Unlike Schwann cells of the peripheral nervous system, a single oligodendrocyte provides the internodal segments of the myelin sheath for several separate, but adjacent axons (Fig. In some regions, as in the optic nerve, a single oligodendrocyte may be responsible for the internodal segments on 40 to 50 axons. Because perineuronal satellite oligodendrocytes lie close to the perikarya of neurons, it has been proposed that oligodendrocytes influence the metabolism and nutrition of neurons. In addition, glia appear to be involved in calcium homeostasis and in the recycling of certain types of neurotransmitters. In the central nervous system, perineuronal satellite and interfascicular oligodendrocytes have the same relationship to perikarya and their axons as that which exists between satellite cells and Schwann cells of peripheral nerve fibers. Schwann cells and satellite cells could be considered as neuroglial elements of the peripheral nervous system. Microglia have extensive ramifying processes, a characteristic phenotype that suggests they may be dendritic antigen-presenting cells. In areas of damage or disease, they are thought to proliferate and become phagocytic and are supplemented by monocytes from the blood that transform into additional macrophages. As material is phagocytosed, the cells enlarge and then are called Gitterzellen, or compound granular corpuscles. Monocytes appear to be the precursors of microglial cells, which thus are part of the mononuclear system of phagocytes with ultimate derivation from the bone marrow. The ependyma lines the central canal of the spinal cord and ventricles of the brain. It consists of a simple epithelium in which the closely packed cells vary from cuboidal to columnar. The luminal surfaces of the cells show large numbers of microvilli and, depending on the location, may show cilia. Adjacent cells are united by desmosomes and zonula adherens; zonula occludens generally are not seen. Hence, cerebrospinal fluid in the central canal and ventricles can pass between ependymal cells to enter the parenchyma of the central nervous system. The bases of ependymal cells have long, threadlike processes that branch, enter the substance of the brain and spinal cord, and may extend to the external surface, where they contribute end feet to the glia limitans. The ependyma forms a secretory epithelium in the ventricles of the brain, where it is in direct contact with a highly vascular region of the pia mater; the tela choroidea. The modified ependyma called choroid epithelial cells and the tela choroidea form the choroid plexus, which produces cerebrospinal fluid. Unlike those in other regions of the ependyma, cell apices here are joined by zonula occludens, which prevent passage of material between cells.

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