Brain brainstem

Central nervous Brain/brainstem Excitation (early) Depression (late) Headache, malaise, dizziness, confusion, manic or bizarre behavior Depression, then loss of consciousness, respiratory depression, diaphragm paralysis... 

The opioids produce analgesia by binding to various opioid receptors in the brain, brainstem, and spinal cord, thus mimicking the effects of endogenous opioid peptides (endorphins). Opioids appear to affect both the sensation of noxious stimulation (pain) and the emotional component of subjective distress (suffering). 

Neiurosarcoidosis may present as an acute explosive illness or in a slow, chronic fashion (143). Any part of the nervous system may be affected including the cranial nerves, meninges (Fig. 11), pituitary gland, hypothalamus, parenchyma of the brain, brainstem (Fig. 12), spinal cord (Fig. 13), subependymal layer of the ventricular system, peripheral nerves, and blood vessels supplying the nervous structures (143). 

Neuropathic pain is damage to the nervous system itself due to disease or trauma which could either be refened to as peripheral, which is caused by damage to nerves, or central, which is caused by damage to the brain, brainstem, or spinal cord. 

The raphe nuclei are a cluster of nuclei found in the brainstem, where they are located in the medial portion of the formatio reticularis, the raphe. (The raphe is the junction of the left and right brainstem hemisphere, hence the name raphe=seam). Serotonergic nerve cells in the CNS originate from the raphe nuclei, i.e., their rostral portion, and because of their wide-ranging projections appear to supply serotonin (5HT) to the rest of the brain. 

The distribution of endosulfan and endosulfan sulfate was evaluated in the brains of cats given a single intravenous injection of 3 mg/kg endosulfan (Khanna et al. 1979). Peak concentrations of endosulfan in the brain were found at the earliest time point examined (15 minutes after administration) and then decreased. When tissue levels were expressed per gram of tissue, little differential was observed in distribution among the brain areas studied. However, if endosulfan levels were expressed per gram of tissue lipid, higher initial levels were observed in the cerebral cortex and cerebellum than in the spinal cord and brainstem. Loss of endosulfan was most rapid from those areas low in Upid. Endosulfan sulfate levels peaked in the brain at 1 hour postadministration. In contrast, endosulfan sulfate levels in liver peaked within 15 minutes postadministration. The time course of neurotoxic effects observed in the animals in this study corresponded most closely with endosulfan levels in the central nervous system tissues examined. 

The sensitivity and specificity of DWI depend to some extent on the technique being used and the amount of imaging time that can be dedicated to the DWI sequence. DWI pulse sequences typically require between approximately 30 seconds and 4 minutes of imaging time to image the entire brain and achieve sensitivity and specificity approaching 100% (Fig. 2.2). The rare infarcts that are not apparent on DWI are usually very small and are often located in the brainstem. 

Figure 1.8 Some basic neuronal systems. The three different brain areas shown (I, II and III) are hypothetical but could correspond to cortex, brainstem and cord while the neurons and pathways are intended to represent broad generalisations rather than recognisable tracts. A represents large neurons which have long axons that pass directly from one brain region to another, as in the cortico spinal or cortico striatal tracts. Such axons have a restricted influence often only synapsing on one or a few distal neurons. B are smaller inter or intrinsic neurons that have their cell bodies, axons and terminals in the same brain area. They can occur in any region and control (depress or sensitise) adjacent neurons. C are neurons that cluster in specific nuclei and although their axons can form distinct pathways their influence is a modulating one, often on numerous neurons rather than directly controlling activity, as with A . Each type of neuron and system uses neurotransmitters with properties that facilitate their role...

Figure 8.2 The distribution of noradrenergic neurons in the brain. The cell bodies are clustered in nuclei (A1 A7) in the pons/medulla regions of the brainstem and their axons project both rostrally and caudally to most regions of the neuraxis. The major nucleus is the locus coeruleus...

The best-understood sites of action of morphine are at spinal and brainstem/ midbrain loci, producing both the wanted and unwanted effects of the opioid. The spinal actions of opioids and their mechanisms of analgesia involve (1) reduced transmitter release from nociceptive C-fibres so that spinal neurons are less excited by incoming painful messages, and (2) postsynaptic inhibitions of neurons conveying information from the spinal cord to the brain. This dual action of opioids can result in a... 

This peptide itself has no selectivity for the two CCK receptors, CCK-A and B, which have so far been established to stimulate IP3/DAG while, like substance P, can close potassium channels to increase neuronal activity. The CCK-B receptor is thought to predominate in the CNS but species differences may make this interpretation difficult. It has a wide distribution in the CNS but is also found in the gut whereas the CCK-A receptor is more restricted but is found in the hypothalamus, hippocampus and in the brainstem. There are high levels of the natural peptide, CCK-8 in cortex, hippocampus, hypothalamus, ventral tegmentum, substantia nigra, brainstem and spinal cord. CCK is one of the most abundant peptides in the brain and CCK co-exists with dopamine, substance P, 5-HT and vasopressin. Interestingly, in the dopamine areas, CCK co-exists in the mesolimbic pathways but in the nigrostriatal projections, the peptide and... 

Association of Pain, neuropathic pain is defined as pain initiated or caused by a primary lesion, dysfunction in the nervous system". Neuropathy can be divided broadly into peripheral and central neuropathic pain, depending on whether the primary lesion or dysfunction is situated in the peripheral or central nervous system. In the periphery, neuropathic pain can result from disease or inflammatory states that affect peripheral nerves (e.g. diabetes mellitus, herpes zoster, HIV) or alternatively due to neuroma formation (amputation, nerve transection), nerve compression (e.g. tumours, entrapment) or other injuries (e.g. nerve crush, trauma). Central pain syndromes, on the other hand, result from alterations in different regions of the brain or the spinal cord. Examples include tumour or trauma affecting particular CNS structures (e.g. brainstem and thalamus) or spinal cord injury. Both the symptoms and origins of neuropathic pain are extremely diverse. Due to this variability, neuropathic pain syndromes are often difficult to treat. Some of the clinical symptoms associated with this condition include spontaneous pain, tactile allodynia (touch-evoked pain), hyperalgesia (enhanced responses to a painful stimulus) and sensory deficits. 

Jacobs, B.L. Gannon, P.J. and Azmitia, E.C. Atlas of the serotonergic cell bodies in the cat brainstem An immunocytochemical analysis. Brain Res Bull 13 1-32, 1984. 

Warenycia MW, Goodwin LR, Benishin CG, et al. 1989a. Acute hydrogen sulfide poisoning Demonstration of selective uptake of sulfide by the brainstem by measurement of brain sulfide levels. Biochem Pharmacol 38 973-981. 

The central nervous system (CNS) consists of the brain and spinal cord. The peripheral nervous system (PNS) consists of 12 pairs of cranial nerves that arise from the brainstem and 31 pairs of spinal nerves arising from the spinal cord. These peripheral nerves carry information between the CNS and the tissues of the body. The PNS consists of two divisions ... 

Afferent neurons lie predominantly in the PNS (see Figure 6.1). Each has a sensory receptor activated by a particular type of stimulus, a cell body located adjacent to the spinal cord, and an axon. The peripheral axon extends from the receptor to the cell body and the central axon continues from the cell body into the spinal cord. Efferent neurons also lie predominantly in the PNS. In this case, the cell bodies are found in the CNS in the spinal cord or brainstem and the axons extend out into the periphery of the body where they innervate the effector tissues. By way of convergence, the centrally located cell bodies may receive inputs from several different regions of the brain that will influence their activity. 

The brain is the integrative portion of the nervous system that serves to receive, process, and store sensory information and then plan and orchestrate the appropriate motor response. It is divided into several anatomically and functionally distinct regions (see Table 6.2). The forebrain consists of the cerebrum, basal ganglia, thalamus, and hypothalamus. The midbrain, along with the pons and the medulla of the hindbrain, composes the functional region referred to as the brainstem. The cerebellum is also considered a component of the hindbrain but is functionally distinct from the brainstem. 

The functional region known as the brainstem consists of the midbrain, and the pons and medulla of the hindbrain. It is continuous with the spinal cord and serves as an important connection between the brain and spinal cord because all sensory and motor pathways pass through it. The brainstem consists of numerous neuronal clusters or centers, each of which controls vital, life-supporting processes. 

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