Histology of nervous system

Present by/Dr .Ahmed Makki Hamid

 Structure of the nervous system
 It is formed of two distinct cell types:
1. Neurons
 Excitable cells.
 Initiate and transmit nerve impulses.
2. Neuroglia cells
 Non excitable cells.
 Support and protect the neurons.
 Neuron
 Neuron is the functional and structural unit of central
nervous system.
 Characteristics of neuron
 Neurons have a high metabolic rate.
 Neurons have extreme longevity.
 Neurons typically are non-mitotic.
 Structure of neuron
 Cell body (soma, perikaryon).
 Dendrites.
 Axon.
 Functions of neuron
 Responsible for control,
information processing, storage,
retrieval and internal communication.
 Cell body (soma, perikaryon)
 Cell membrane
 It is very thin.
 Nucleus
 Large.
 Regular round or oval.
 Situated fairly centrally.
 The nucleus has very thick nuclear
membrane and very clear nucleolus.
 Cytoplasm
 Rough endoplasmic reticulum (RER) – Nissl’s bodies.
 Golgi apparatus & lysosome.
 Mitochondria.
 No centrioles.
 Neurofibrils.
 Glucogen.
 Melanin pigments.
 Lipofuscin granules.
 Fat droplets.
Cell body (soma, perikaryon)
 Axon
 Axon is single and uniform in diameter.
 Length of axons is variable: some reach up to 100 cm.
 Axon originates from a short pyramid-like structure called the
axon hillock.
 Axoplasm contains mitochondria, microtubules, neurofilaments,
and transport vesicles, but very few polyribosomes or cisternae of
RER.
 Axon lacks Nissl’s granules but rich in neurofibirls.
 The plasma membrane of the axon is termed axolemma.
 The cytoplasm of the axon is
termed the axoplasm.
 Collaterals arise from the axon.
 Axon and collaterals end in fine
processes called axon terminals.
 Dendrites
 Dendrites are the numerous elongated processes
extending from the perikaryon.
 Dendrites increase the receptive area of the neuron.
 Dendrites do not maintain a constant diameter.
 The regions of the dendrites closest to the perikaryon are
usually larger, than those farther away.
 Dendrites contain most of the organelles as
in the perikaryon except the Golgi apparatus.
 Nissl bodies are present.
 Dendrites have large numbers
of horny spines, which are now
known to be areas of synaptic contact.
 Classifications of neurons
 Neurons are classified based on:
 Structural classification
 Functional classification
 Structural classification of neurons
1. According to the number of processes extending from
the cell body
 Unipolar neuron has a single process.
 Bipolar neurons have two processes.
 Pseudounipolar neuron have one process but divided into 2
 Multipolar neurons have three or more processes.
Structural classification of neurons
2. According to the shape of cell body
 Setallate cells.
 Pryamidal cells.
 Pyriform cells.
Structural classification of neurons
3. According to the length of their axon
 Golgi type 1.
 They have long axons.
 Golgi type 2.
 They have short axons.
Functional classification of neurons
 Sensory afferent neurons
 Transmit nerve impulses from receptor to CNS.
 Motor efferent neurons
 Transmit nerve impulses from CNS to effectors.
 Interneurons (association neurons)
 Facilitate communication between sensory and motor
neurons.
 Neuroglia (Glial ) cells
 Characteristics of neuroglia cells
 They are occur within both the CNS and the PNS.
 They are smaller than neurons.
 They are capable of mitosis.
 They do not transmit nerve impulses.
 General functions of neuroglia
 Physically protect neurons.
 Helping to nourish neurons.
 Provide a supporting framework for all the nervous tissue.
 Participation in the blood-brain-barrier (astrocytes).
 Formation of the myelin sheath of axons
(oligodendrocytes and Schwan’s cells).
 Isolation of junctional surfaces of synapses.
 Secrete CSF (ependymal cells).
 Secrete enkephalin to influence neural activities.
 Helping to repair processes following damage or injury to
nerves.
 Types of glial cells
 Two types in PNS:
 Schwann cells.
 Satellite cells.
 Four types in the CNS:
 Astrocytes.
 Oligodendrocytes.
 Microglia.
 Ependymal cells.
 Schwann cells or neurolemmocytes
 Each cell surrounds multiple unmyelinated PNS axons.
with a single layer of its plasma membrane.
 Each cell produces part of the myelin sheath surrounding
an axon in the PNS.
 Functions of Schwann cells.
 Satellite cells
 Satellite cells are small which form a thin, intimate glial
layer around each large neuronal cell body in the ganglia
of the PNS.
 Satellite cells exert a trophic or supportive effect on these
neurons, insulating, nourishing, and regulating their
microenvironments.
Function glial & Schwann cells
 Astrocytes (Astroglia)
 Astrocytes (Gr. astro-, star + kytos, cell) are
unique to the CNS, have a large number
of long radiating, branching processes.
 Proximal regions of the astrocytic processes are reinforced
with bundles of intermediate filaments made of glial
fibrillary acid protein (GFAP).
 Distally the processes lack GFAP, are not readily seen by
microscopy, and form a vast network of delicate terminals
contacting synapses and other structures.
 Terminal processes of a single astrocyte
typically occupy a large volume and
associate with over a million synaptic
sites and often terminate in "pedicels" on blood capillaries
and contribute to the blood-brain barrier.
 Types of astrocytes
 There are two types of astrocytes:
1. Protoplasmic astrocytes
 These are present in the gray matter
of the brain and spinal cord.
2. Fibrous astrocytes
 These are present in the white matter of the CNS.
 Oligodendrocytes
 Oligodendrocytes (Gr. oligos, small, few + dendron, tree
+ kytos, cell) extend many processes.
 It usually appear as small cells with rounded, condensed
nuclei and unstained cytoplasm.
 They are the predominant glial cells in white matter of the
CNS.
 Function: form myelin sheath in the CNS.
 Microglia (policeman of the brain)
 Less numerous than oligodendrocytes or astrocytes but
nearly as common as neurons in some CNS regions,
microglia are small cells with actively mobile processes
evenly distributed throughout gray and white matter.
 They have elongated bodies, elongated nuclei with dense
chromatin and relatively few processes.
 Microglia
 Unlike other glial cells microglia migrate, with their
processes scanning the neuropil and removing damaged
or effete synapses or other fibrous components.
 Microglial cells also constitute the major mechanism of
immune defense in the CNS, removing any microbial
invaders and secreting a number of immunoregulatory
cytokines.
 Microglia do not originate from
neural progenitor cells like other
glia, but from circulating blood
monocytes, belonging to the same
family as macrophages and other antigen-presenting cells.
 Ependymal cells
 Ependymal cells are columnar or cuboidal cells that line
the fluid-filled ventricles of the brain and the central canal
of the spinal cord.
 In some CNS locations, the apical ends of ependymal
cells have cilia, which facilitate the movement of
cerebrospinal fluid (CSF), and long microvilli, which are
likely involved in absorption.
 Ependymal cells
 Modified ependymal cells and associated capillaries form
choroid plexuses of the brain ventricles which are the
main source of the CSF.
 Ependymal cells are joined apically by apical junctional
complexes similar to those of epithelial cells.
 However, unlike a true epithelium there is no basal lamina.
 Instead, the basal ends of ependymal cells are elongated
and extend branching processes into the adjacent neuropil.
Function glial cells of the CNS
 Central nervous system
 The central nervous system consists of the brain
(subdivided into the cerebrum, cerebellum, diencephalon,
and brain stem) and the spinal cord.
 The CNS is surrounded by three connective
tissue membranes called meninges.
 Many structural features of CNS tissues show
organized areas of white matter and gray matter.
 The main components of white matter are myelinated
axons, often grouped together as tracts, astrocytes,
oligodendrocytes and microglia are also present.
 Gray matter contains abundant neuronal cell bodies,
dendrites, astrocytes and microglial cells, and is where
most synapses occur.
Spinal cord
Meninges of the spinal cord
Meninges of the brain
 Peripheral nervous system
 The main components of the peripheral nervous system
are:
 Nerves.
 Ganglia.
 Nerve endings (receptors).
 Nerves
 Nerves are main components of the PNS.
 Sensory (afferent) nerves convey sensory information to
the CNS.
 Motor (efferent) nerves convey motor impulses from the
CNS to the muscles and glands.
 Mixed nerves: both sensory and motor.
 Axons terminate as they contact other neurons, muscle
cells, or gland cells.
 An axon transmits a nerve impulse at a specialized
junction with another neuron called synapse.
Structure of peripheral nerve trunk
 A nerve is a cable-like bundle of parallel axons.
 Three connective tissue wrappings.
1. Endoneurium
 Delicate layer of loose connective tissue.
2. Perineurium
 A cellular and fibrous connective tissue layer
 Wraps groups of axons into fascicles.
3. Epineurium
 A superficial connective tissue covering.
 It is thick layer of dense irregular fibrous connective
tissue encloses entire nerve.
 This 3 connective tissue provides support and protection.
Structure of peripheral nerve trunk
Structure of peripheral nerve trunk
Structure of small nerve
 Myelin sheath
 Myelin sheath is a fatty tubular covering around the axons
 It composed mainly of lipid bilayers and membrane
proteins (lipoprotein complex).
 The lipids are about 80% which are:
 Cholesterol.
 Fatty acids.
 Phospholipids.
 Myelin sheath is formed by:
 Schwan’s cells in the PNS.
 Oligodendrocytes in the CNS.
 The myelin sheath is white in color.
 It is interrupted by at interval by the Node of Ranviar
and myelin clefts or Schmidt-Lantermann’s clefts.
 Functions of myelin sheath
 It protects the axon.
 It accelerates conduction of nerve impulse.
 It also isolates nerve impulses.
Formation of myelination by neurolemmocyte
Formation of myelination by oligodendrocytes
Classification of peripheral nerve fibers
 Peripheral nerves are classified in many ways:
 According to function.
 According to area of innervation.
 According to diameter and velocity of conduction.
 According to presence of myelin sheath.
 According to function
 Efferent or motor fibers
 Carry impulses from the spinal cord or brain to peripheral
structures like muscles or glands.
 Afferent or sensory fibers
 Carry impulses from peripheral organs to the brain or
spinal cord.
 According to area of innervation
 According to the area of innervation, the nerve fibers
classified into the following types:
1. General somatic fibers: supplying structure developed
from somites i.e whole body except the head.
 These fibers may be afferent (sensory) or efferent (motor).
2. General visceral fibers: supplying viscera i.e autonomic
system.
 These fibers may be afferent (sensory) or efferent (motor).
Somatic and visceral fibers
 According to area of innervation
 Therefore there are 4 types of nerve fibers:
1. General somatic afferent (GSA) fibers: carrying
general sensations from the skin, skeletal muscles and
joints i.e pain, temperature, touch and proprioception .
2. General somatic efferent (GSE) fibers: carrying motor
supply to the skeletal muscles.
3. General visceral afferent (GVA) fibers: carrying
visceral sensations (e.g. from GIT , Blood vessels …etc).
4. General visceral efferent (GVE) fibers: (autonomic
fibers both sympathetic and parasympathetic fibers) are
motor to smooth muscle of blood vessels and viscera and
secretomotor to exocrine glands.
 According to area of innervation
 In the region of the head , there are the organs of special
senses and structures developed from the visceral arches.
 These structures are supplied by special nerve fibers as
follows:
1. Special somatic afferent (SSA) fibers: are concerned
with sensations of vision, hearing and equilibrium.
2. Special visceral afferent (SVA) fibers: are concerned
with the sensation of taste and smell.
3. Special visceral efferent (SVE) fibers: are concerned
with the motor supply to the striated muscles developed
from the visceral arches i.e. muscles supplied by the 5 th,
7th, 9th,10th and 11th cranial nerves.
According to presence of myelin sheath
Nerve fibers divided according to their covering sheath into:
 Naked nerve fibers
 Without myelin and without neurolemmocyte.
 It is present in terminal parts of axons at its motor-end plate in
the muscles.
 Myelinated nerve fibers
1. Covered with myelin and without neurolemmocyte
 It is present in the nerve axons in white matter.
2. Covered with myelin sheath and covered with
neurolemmocyte
 It is present in the peripheral somatic axons outside of spinal
cord.
 Non myelinated nerve fibers
 Covered with neurolemmocyte but without myelin sheath.
 It is present in postganglionic fibers of the autonomic nervous
According to diameter and velocity of conduction
 Motor nerve fibers are classified into:
 A (myelinated) (subdivided into α, β, γ, δ).
 B (myelinated).
 C (unmyelinated).
 Sensory nerve fibers are classified into:
 I (myelinated) (subdivided into a,b).
 II (myelinated).
 III (myelinated).
 IV (unmyelinated).
 Nerve impulse conduction
 A nerve impulse is the rapid movement of an electrical
charge along a neuron’s plasma membrane.
 A nerve impulse is also known as an action potential,
because a nerve impulse is caused by an actual voltage
(potential) change that moves along the plasma membrane
of the axon.
 The nerve impulse’s ability to travel along an axon is
affected by myelination.
 Nerve impulse conduction
 The nodes of Ranvier can change in voltage occur across
the plasma membrane and result in the movement of a
nerve impulse.
 In a myelinated axon, the nerve impulse seems to “jump”
from nodes of Ranvier to nodes of Ranvier, a process
called saltatory conduction.
 In an unmyelinated axon, the nerve impulse must travel
the entire length of the axon membrane, a process called
continuous conduction.
 Nerve impulse conduction
 A myelinated axon produces a faster nerve impulse
because only the exposed membrane regions are affected
as the impulse jumps toward the end of the axon.
 In an unmyelinated axon, a nerve impulse takes longer to
reach the end of the axon because every part of the
membrane must be affected by the voltage change.
 Thus, a myelinated axon also requires less energy in the
form of ATP than does an unmyelinated axon.
 Synapse
 Synapse is the point of contact between the processes of
neurons.
 They are two part synapse:
1. Presynaptic neurons
 Transmit nerve impulses
toward a synapse.
2. Postsynaptic neurons
 Conduct nerve impulses
away from the synapse.
 Main types of synapses
 Two types:
1. Electrical synapses
 Gap junctions.
2. Chemical synapses
 Use neurotransmitters.
 Electrical synapses
 Electrical synapses are not very common in mammals.
 In humans, these synapses occur primarily between
smooth muscle cells where quick, uniform innervation is
essential.
 Electrical synapses are also located in cardiac muscle.
 Chemical synapses
 Most numerous type of synapse.
 Facilitates interactions:
 Between neurons.
 Between neurons and effectors.
 At the chemical synapses:
 Presynaptic membrane releases a signaling molecule
called a neurotransmitter, such as acetylcholine (ACh).
 Other types of neurons use other neurotransmitters.
 The release of neurotransmitter can cause either excitation
or inhibition at the postsynaptic membrane.
 Postsynaptic membrane contains receptors for
neurotransmitters.
 Structure of the synapses
1. Terminal bouton.
2. Pre synaptic membrane.
3. Synaptic cleft.
4. Post synaptic membrane.
5. Gemmules or spines.
 Functions of the synapse
 The synapses in the human
body are chemical synapses.
which involve the release of
neurotransmitters, which
combine with receptors on
the post-synaptic membrane
and result in the transmission
of the impulse.
Structure of the synapses
Main events during activity of synapse
Types of synapses (based on contacts)
1. Axoaxonic synapse.
2. Axosomatic synapse.
3. Axodendritic synapse.
4. Dendrodendritic synapse.
 Neurotransmitters substances
 It is small messenger molecules that communicate cells of
the nervous system with each other at synapses.
 It released from the plasma membrane of the presynaptic
cell and then binds to receptor proteins on the plasma
membrane of the postsynaptic cell.
 A unidirectional flow of information and communication.
Neuronal pools(neuronal circuits or pathways)
 Billions of interneurons within the CNS are grouped in
complex patterns called neuronal pools (or neuronal
circuits or pathways).
 Neuronal pools are defined based upon function, not
anatomy, into four types of circuits:
 Converging.
 Diverging.
 Reverberating.
 Parallel-after-discharge.
 A pool may be localized, or its neurons may be distributed
in several different regions of the CNS.
Neuronal pools (neuronal circuits or pathways)
 Ganglia
 Ganglia are typically ovoid structures containing
aggregation of neuronal cell bodies and their surrounding
glial satellite cells supported by delicate connective tissue
and surrounded by a denser capsule which lies outside the
CNS.
 There are two types of ganglia according the direction of
the nerve impulse:
 Sensory ganglia
 Autonomic ganglia
 Sensory ganglia
 Sensory ganglia receive afferent impulses that go to CNS.
 Sensory ganglia are associated with both cranial nerves
(cranial ganglia) and the dorsal roots of the spinal nerves
(spinal ganglia).
 The ganglia are surrounded by a fairly thick connective
tissue capsule.
 Cells are unipolar (pseudounipolar) neurons.
 Each perikaryon is surrounded by a layer of glial cells
(satellite cells).
 Autonomic ganglia
 Found in the autonomic nervous system.
 Found as dilatations of autonomic nerves and may be
encapsulated.
 Ganglia are seen in the walls of organs (intramural) and
lack a capsule.
 They differ from spinal ganglia in that the neurons are
multipolar.
 The perikarya are smaller, have fewer satellite cells and
are more evenly distributed.
 Neural plasticity
 In adult mammals after an injury, the neuronal circuits
may be reorganized by the growth of neuronal processes,
forming new synapses to replace ones lost by injury.
 Thus, new communications are established with some
degree of functional recovery.
 This neural plasticity and reformation of processes are
controlled by several growth factors produced by both
neurons and glial cells in a family of proteins called
neurotrophins.
Response of the neuron to an injury
 If an injury to a nerve fiber occurs:
1. The proximal segment: that maintains its continuity with
the perikaryon will not degenerate.
2. The distal segment: that will be separated from the nerve
cell body will undergo Wallerian degeneration.
3. The perikaryon: will undergo retrograde degeneration.
Wallarian degeneration (antegrade degeneration)
 Definition: it is the degeneration that occurs in the distal
segment of a nerve fiber following its injury.
 The degeneration takes place in the axon and myelin
sheath but not in Schwann cells.
 Nerve fibers and myelin degenerate totally and
phagocytosed by the macrophages from the surrounding
connective tissue.
 Retrograde degeneration
 Definition: it is the degeneration of the perikaryon after
injury of its nerve fiber.
 It includes:
 Dissolution of Nissl substance (chromatolysis) with
subsequent decrease in cytoplasmic basophilia.
 Swelling of perikaryon.
 The cell draws its processes and becomes
spherical, with migration of the nucleus
to the periphery of the cell body.
 Fragmentation and disappearance of the
neurofibrils, Golgi apparatus and mitochondria.
 Regeneration of the nervous tissue
1. If an injury occurs in the perikaryon:
 The nerve cell will die and never be replaced (static cell).
2. If an injury occurs in the
nerve fibers of PNS:
 The retrograde degeneration stop and neurons can regenerate as
nerve fibers can regenerate due to the presence of Schwann cells.
 In sever injury: failure of regeneration and death of the nerve
cell body.
3. If an injury occurs in the
nerve fibers of CNS:
 Usually cannot regenerate because inability of oligodendrocytes
and microglia cells to phagocytose myelin debris quickly and the
restriction of large numbers of migrating macrophages by the
blood–brain barrier and death of the neurons occur.
Response to neuronal injury within PNS and CNS
Main changes in an injured nerve fiber
 Receptors
 Receptors (recipio = to receive) are structures that detect
stimuli.
 They range in complexity from the relatively simple
dendritic ending of a sensory neuron to complex sense
organs.
 Receptors in the body monitor both external and internal
environmental conditions and conduct information about
those stimuli to the central nervous system.
 We are aware of some specific stimuli, other stimuli never
reach our consciousness.
 Receptors
 All receptors act as transducers, which are structures that
transform the energy of one system (e.g., heat) into a
different form of energy (e.g., a nerve impulse).
 Receptors may be either tonic or phasic.
 Receptive field of the receptors
 The receptive field of a receptor is the entire area through
which the sensitive ends of the receptor cell are
distributed.
 There is an inverse relationship between the size of the
receptive field and our ability to identify the exact
location of a stimulus.
 Properties of receptors
1. Excitability.
2. Specificity.
3. Adaptation.
 Classification of receptors
 The receptors can be classified according to four criteria:
1. Distribution of receptors.
2. Location of stimulus.
3. Types of stimulus (modality of stimulus, or stimulating
agent).
4. Structure of receptors.
 1. Distribution of receptors
 Receptors can be classified based on their distribution in
the body as part of the general senses or the special
senses.
 2. Location of stimulus
 According to location of stimulus there are three types of
receptors:
 Exteroceptors.
 Interoceptors.
 Proprioceptors.
 3. Types of stimulus
According to types of stimulus there are sex types of
receptors:
 Mechanoreceptor.  Chemoreceptor.
 Thermoreceptor.  Baroreceptors.
 Photoreceptor.  Nociceptors.
 4. Structure of receptors
 There are two types of receptors according to structure:
1. Non-capsulated receptors:
 Free nerve endings.
 Merkel’s discs.
 Hair follicle receptors.
2. Capsulated receptors:
 Meissner’s corpuscles.
 Krause’s end bulb.
 Pacinian corpuscles.
 Ruffini corpuscles.
 Neuromuscular spindles.
 Neurotendinous spindles.
 Free nerve endings
 Structure
 They are formed of non myelilated sensory nerve fibers.
 Site
 Present in epidermis of skin, stratified squamous
epithelium of the cornea, conjunctiva, oral cavity, dental
pulp, periosteum and perichondrium.
 Function
 They respond primarily to high and low temperatures,
fine touch, pain, and itching, but also function as tactile
receptors.
 Merkel’s discs
 Structure
 They are formed of non myelinated nerve discs under
certain specialized epithelial cells of the epidermis.
 Site
 Present in skin of palm, sole, lip and external genitalia.
 Function
 Function as tonic receptors for sustained light touch and
for sensing an object’s texture.
 Hair follicle receptors (root hair plexuses)
 Structure
 They arc formed of non myelinated nerve fibers which
form a plexus of nerve fibers around the roots and shafts
of the hair follicles.
 Site
 Present around hair follicle.
 Functions
 They are responsible for the
sensation of hair movements.
 Meissner’s corpuscles
 Structure
 They are elliptical structure covered by a capsule formed
of fibroblasts and collagen fibers and its central area
consists of flattened Schwann cells that form several
irregular lamellae through which one or two unmyelinated
endings of myelinated nerve fibers follow spiral paths in
the corpuscle.
 Sites
 Present in the dermal papillae of
non-hairy skin of the palm, sole,
fingers, toes, eyelid, nipples, glans
penis and clitoris.
 Meissner’s corpuscles
 Functions
 Reception of light touch sensation.
 Enables an individual to distinguish between two points
when they are placed close together on the skin (two point
tactile discrimination).
 Krause’s end bulbs
 Structure
 They are simpler encapsulated, ovoid structures, with
extremely thin, collagenous capsules penetrated by a
sensory fiber.
 Sites
 Present in the C.T. dermis of the external genitalia, in the
lip, tongue and conjunctiva of the eye.
 Functions
 They sense low-frequency vibrations.
 Pacinian corpuscles
 Structure
 They are large oval structures, approximately 0.5 mm by
1 mm, with an outer capsule and 15-50 thin, concentric
lamellae of flattened Schwann cells and collagen
surrounding a highly branched, unmyelinated axon.
 Pacinian corpuscles
 Sites
 They are present in the dermis of skin especially in the
palm and sole, nipples, tips of fingers, breast and external
genitalia, striated muscles, tendons, joints, walls of large
B.V, wall of urinary bladder, stomach and rectum, C.T. of
the pancreas, mesentry and serous membranes and also in
certain glands as the thymus.
 Functions
 They respond to changes in
position, coarse touch, pressure
(sustained touch), vibration sense,
tactile localization, tactile discrimination and stereognosis
(Knowing things by touch)..
 Ruffini corpuscles
 Structure
 They are fusiform in shape and consist of bundles of
elongated collagen fibers and fluid enclosed in a capsule
with associated nerve fibers which ramify among the
collagen fibers.
 Sites
 Present in the dermis and hypodermis of skin especially in
the plantar surface of the feet.
 Function
 They are mechanoreceptors,
for stretch (tension) or twisting
(torque) in the skin.
Neuromuscular spindles (muscle spindles)
 Structure.
 Site.
 Functions.
 Neurotendinous spindles
 Structure.
 Site.
 Functions.
 Autonomic nervous system
 The ANS is classified into three divisions:
1. Sympathetic division.
3. Parasympathetic division.
3. Enteric division.
 Clinically significant types of pain
 Phantom pain is a sensation associated with a body part
that has been removed.
 Following the amputation of an appendage, the patient
often continues to experience pain that feels like it is
coming from the removed part.
 The stimulation of a sensory neuron pathway from the
removed limb anywhere on the remaining intact portion
of the pathway propagates nerve impulses and conducts
them to the CNS, where they are interpreted as originating
in the amputated limb.
 This so-called phantom limb syndrome.
 Clinically significant types of pain
 Referred pain occurs when impulses from certain viscera
are perceived as originating not from the organ, but in
dermatomes of the skin.
 Numerous cutaneous and visceral sensory neurons
conduct nerve impulses through the same ascending tracts
within the spinal cord.
 Clinically significant types of pain
 Referred pain
 As a result, impulses conducted along ascending
pathways may be localized incorrectly.
 Consequently, the sensory cortex in the brain is unable to
differentiate between the actual and false sources of the
stimulus.
Common sites of referred pain
Thank you