SAMENVATTING – NEUROANATOMIE, -FYSIOLOGIE EN PATHOLOGIE
INHOUD
1. De 3 functies van het zenuwstelsel ................................................................................................................. 6
2. Anatomische opdeling van het zenuwstelsel .................................................................................................. 7
3. Het perifeer zenuwstelsel kunnen we verder opdelen in somatisch en autonoom zenuwstelsel ................. 7
1. Zenuwweefsel ................................................................................................................................................. 8
2. Neuronen ........................................................................................................................................................ 8
A. Algemene bouw van een neuron ............................................................................................................... 8
B. Actiepotentialen reizen langs het axon ..................................................................................................... 9
C. Neuronen staan via synapsen met elkaar in contact ................................................................................. 9
D. Er bestaan 3 types neuronen ..................................................................................................................... 9
3. Neuroglia ....................................................................................................................................................... 10
A. Neuroglia in het CZS ................................................................................................................................. 10
I. Astrocyten ........................................................................................................................................... 10
II. Oligodendrocyten ................................................................................................................................ 10
B. Neuroglia in het PZS ................................................................................................................................. 11
4. Witte en grijze stof ........................................................................................................................................ 11
A. Grijze stof ................................................................................................................................................. 12
B. Witte stof ................................................................................................................................................. 12
1. Prikkelgeleiding binnen een neuron ............................................................................................................. 14
A. Depolarisatie ............................................................................................................................................ 14
B. Repolarisatie en hyperpolarisatie ............................................................................................................ 14
C. Samenvatting ........................................................................................................................................... 15
2. De synaps ...................................................................................................................................................... 15
A. Bouw van een synaps ............................................................................................................................... 15
B. Enkele begrippen ..................................................................................................................................... 16
C. Verloop van prikkeloverdracht ter hoogte van synaps ............................................................................ 16
D. Het type neurotransmitter bepaalt het effect in de postsynaptische cel ................................................ 16
I. Exciterende neurotransmitters ........................................................................................................... 17
II. Inhiberende neurotransmitters ........................................................................................................... 17
3. Neurotransmitters: toepassing ..................................................................................................................... 17
1. Belangrijkste hersengebieden ....................................................................................................................... 18
2. De ventrikels ................................................................................................................................................. 19
3. Cerebrum of grote hersenen......................................................................................................................... 19
A. Cerebrale cortex....................................................................................................................................... 19
I. De hersenkwabben .............................................................................................................................. 20
1
, II. Algemene functies van de cerebrale cortex ........................................................................................ 20
III. Motorische gebieden ........................................................................................................................... 21
IV. Sensorische gebieden .......................................................................................................................... 22
B. Cerebrale witte stof ................................................................................................................................. 23
C. Basale kernen ........................................................................................................................................... 23
4. Diencephalon (tussenhersenen) ................................................................................................................... 24
A. Epithalamus ............................................................................................................................................. 25
B. Thalamus .................................................................................................................................................. 25
C. Hypothalamus .......................................................................................................................................... 25
D. Het limbisch systeem ............................................................................................................................... 25
5. Hersenstam (truncus cerebri) ....................................................................................................................... 26
A. Middenhersenen (mesencephalon) ......................................................................................................... 27
B. Pons.......................................................................................................................................................... 27
I. Formatio reticularis ............................................................................................................................. 28
C. Medulla oblongata ................................................................................................................................... 28
6. Kleine hersenen............................................................................................................................................. 29
7. De meninges.................................................................................................................................................. 29
A. Dura mater ............................................................................................................................................... 30
B. Arachnoïd mater ...................................................................................................................................... 30
C. Pia mater .................................................................................................................................................. 30
8. Het cerebrospinaal vocht .............................................................................................................................. 30
9. Het ruggenmerg ............................................................................................................................................ 33
10. Spinale reflexen........................................................................................................................................ 35
1. Introductie..................................................................................................................................................... 36
2. De spinale zenuwen ...................................................................................................................................... 36
A. Plexussen ................................................................................................................................................. 37
3. De hersenzenuwen ....................................................................................................................................... 37
A. Nervus olfactorius (N I) ............................................................................................................................ 38
B. Nervus opticus (N II)................................................................................................................................. 39
C. Nervus oculomotorius (N III) .................................................................................................................... 39
D. Nervus trochlearis (N IV) .......................................................................................................................... 39
E. Nervus trigeminus (N V) ........................................................................................................................... 39
F. Nervus abducens (N VI) ............................................................................................................................ 40
G. Nervus facialis (N VII) ............................................................................................................................... 40
H. Nervus vestibulocochlearis (N VIII) .......................................................................................................... 41
I. Radix cochlearis ................................................................................................................................... 41
II. Radix vestibularis ................................................................................................................................. 42
2
, I. Nervus glossopharyngeus (N IX) .............................................................................................................. 42
J. Nervus vagus (N X) ................................................................................................................................... 43
K. Nervus accessorius (N XI) ......................................................................................................................... 43
L. Nervus hypoglossus (N XII)....................................................................................................................... 43
M. Samenvatting ........................................................................................................................................... 44
1. NAH ............................................................................................................................................................... 47
A. Definitie NAH ........................................................................................................................................... 47
2. Traumatisch hersenletsel (THL) of traumatic brain injury (TBI) .................................................................... 47
A. Epidemiologie .......................................................................................................................................... 47
B. Oorzaken .................................................................................................................................................. 47
C. Casus Rob ................................................................................................................................................. 48
D. Pathofysiologie......................................................................................................................................... 48
I. Primair hersenletsel ............................................................................................................................. 48
II. Secundair hersenletsel ........................................................................................................................ 48
E. Ernst van letsel ......................................................................................................................................... 49
I. GCS....................................................................................................................................................... 49
II. Duur van de coma of bewustzijnsdaling .............................................................................................. 49
III. PTA ....................................................................................................................................................... 49
F. Ziektebeelden .......................................................................................................................................... 49
G. Prognose .................................................................................................................................................. 50
H. Vegetatieve toestand ............................................................................................................................... 50
I. Gevolgen .................................................................................................................................................. 50
I. Sensomotorische problemen .............................................................................................................. 50
II. Epilepsie............................................................................................................................................... 50
III. Zenuwschade ....................................................................................................................................... 50
IV. Intellectuele schade ............................................................................................................................. 51
V. Gestoord geheugen ............................................................................................................................. 51
VI. Gedragsproblemen .............................................................................................................................. 51
VII. Praxiestoornissen ............................................................................................................................ 51
VIII. Perseveratie .................................................................................................................................... 51
IX. Spraak- en taalstoornissen .................................................................................................................. 51
X. Agnosie ................................................................................................................................................ 51
XI. Attentiestoornissen ............................................................................................................................. 52
3. CVA ................................................................................................................................................................ 52
A. Definitie.................................................................................................................................................... 52
B. Fysiologie van de hersenendoorbloeding ................................................................................................ 52
C. Incidentie ................................................................................................................................................. 52
3
, D. Classificatie .............................................................................................................................................. 53
E. Focale cerebrale ischemie ........................................................................................................................ 53
I. Risicofactoren ...................................................................................................................................... 53
II. Prognose .............................................................................................................................................. 53
III. Gevolgen en stoornissen op lichamelijk vlak ....................................................................................... 54
IV. Behandeling ......................................................................................................................................... 54
F. Hersenbloedingen .................................................................................................................................... 54
4. Epilepsie ........................................................................................................................................................ 54
A. Gegeneraliseerd begin ............................................................................................................................. 55
I. Gegeneraliseerd tonisch-klonisch insult .............................................................................................. 55
II. Absences .............................................................................................................................................. 55
5. Extrapiramidale ziekten ................................................................................................................................ 56
A. Het extrapiramidaal systeem (EPS) .......................................................................................................... 56
B. De ziekte van Parkinson ........................................................................................................................... 56
I. Casus .................................................................................................................................................... 56
II. Definitie ............................................................................................................................................... 56
III. Etiologie ............................................................................................................................................... 57
IV. Epidemiologie ...................................................................................................................................... 57
V. Fysiopathologie.................................................................................................................................... 57
VI. Klinisch beeld ....................................................................................................................................... 57
VII. Behandeling..................................................................................................................................... 58
C. Prognose .................................................................................................................................................. 58
6. Multiple sclerose (MS) .................................................................................................................................. 58
A. Introductie ............................................................................................................................................... 58
I. Verkenningsvraag ................................................................................................................................ 58
II. Casus .................................................................................................................................................... 59
B. Definitie.................................................................................................................................................... 59
C. De myeline-schede: even opfrissen ......................................................................................................... 59
D. Epidemiologie .......................................................................................................................................... 59
E. Etiologie ................................................................................................................................................... 59
F. Verloop..................................................................................................................................................... 59
I. Klinische sybtypes ................................................................................................................................ 59
G. Symptomen .............................................................................................................................................. 60
I. Klinisch beeld ....................................................................................................................................... 61
II. Beginsymptomen ................................................................................................................................. 61
III. Motorische stoornissen van de piramidale baan ................................................................................ 61
IV. Cerebellaire symptomen en hersenstam symptomen ........................................................................ 61
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INHOUD
1. De 3 functies van het zenuwstelsel ................................................................................................................. 6
2. Anatomische opdeling van het zenuwstelsel .................................................................................................. 7
3. Het perifeer zenuwstelsel kunnen we verder opdelen in somatisch en autonoom zenuwstelsel ................. 7
1. Zenuwweefsel ................................................................................................................................................. 8
2. Neuronen ........................................................................................................................................................ 8
A. Algemene bouw van een neuron ............................................................................................................... 8
B. Actiepotentialen reizen langs het axon ..................................................................................................... 9
C. Neuronen staan via synapsen met elkaar in contact ................................................................................. 9
D. Er bestaan 3 types neuronen ..................................................................................................................... 9
3. Neuroglia ....................................................................................................................................................... 10
A. Neuroglia in het CZS ................................................................................................................................. 10
I. Astrocyten ........................................................................................................................................... 10
II. Oligodendrocyten ................................................................................................................................ 10
B. Neuroglia in het PZS ................................................................................................................................. 11
4. Witte en grijze stof ........................................................................................................................................ 11
A. Grijze stof ................................................................................................................................................. 12
B. Witte stof ................................................................................................................................................. 12
1. Prikkelgeleiding binnen een neuron ............................................................................................................. 14
A. Depolarisatie ............................................................................................................................................ 14
B. Repolarisatie en hyperpolarisatie ............................................................................................................ 14
C. Samenvatting ........................................................................................................................................... 15
2. De synaps ...................................................................................................................................................... 15
A. Bouw van een synaps ............................................................................................................................... 15
B. Enkele begrippen ..................................................................................................................................... 16
C. Verloop van prikkeloverdracht ter hoogte van synaps ............................................................................ 16
D. Het type neurotransmitter bepaalt het effect in de postsynaptische cel ................................................ 16
I. Exciterende neurotransmitters ........................................................................................................... 17
II. Inhiberende neurotransmitters ........................................................................................................... 17
3. Neurotransmitters: toepassing ..................................................................................................................... 17
1. Belangrijkste hersengebieden ....................................................................................................................... 18
2. De ventrikels ................................................................................................................................................. 19
3. Cerebrum of grote hersenen......................................................................................................................... 19
A. Cerebrale cortex....................................................................................................................................... 19
I. De hersenkwabben .............................................................................................................................. 20
1
, II. Algemene functies van de cerebrale cortex ........................................................................................ 20
III. Motorische gebieden ........................................................................................................................... 21
IV. Sensorische gebieden .......................................................................................................................... 22
B. Cerebrale witte stof ................................................................................................................................. 23
C. Basale kernen ........................................................................................................................................... 23
4. Diencephalon (tussenhersenen) ................................................................................................................... 24
A. Epithalamus ............................................................................................................................................. 25
B. Thalamus .................................................................................................................................................. 25
C. Hypothalamus .......................................................................................................................................... 25
D. Het limbisch systeem ............................................................................................................................... 25
5. Hersenstam (truncus cerebri) ....................................................................................................................... 26
A. Middenhersenen (mesencephalon) ......................................................................................................... 27
B. Pons.......................................................................................................................................................... 27
I. Formatio reticularis ............................................................................................................................. 28
C. Medulla oblongata ................................................................................................................................... 28
6. Kleine hersenen............................................................................................................................................. 29
7. De meninges.................................................................................................................................................. 29
A. Dura mater ............................................................................................................................................... 30
B. Arachnoïd mater ...................................................................................................................................... 30
C. Pia mater .................................................................................................................................................. 30
8. Het cerebrospinaal vocht .............................................................................................................................. 30
9. Het ruggenmerg ............................................................................................................................................ 33
10. Spinale reflexen........................................................................................................................................ 35
1. Introductie..................................................................................................................................................... 36
2. De spinale zenuwen ...................................................................................................................................... 36
A. Plexussen ................................................................................................................................................. 37
3. De hersenzenuwen ....................................................................................................................................... 37
A. Nervus olfactorius (N I) ............................................................................................................................ 38
B. Nervus opticus (N II)................................................................................................................................. 39
C. Nervus oculomotorius (N III) .................................................................................................................... 39
D. Nervus trochlearis (N IV) .......................................................................................................................... 39
E. Nervus trigeminus (N V) ........................................................................................................................... 39
F. Nervus abducens (N VI) ............................................................................................................................ 40
G. Nervus facialis (N VII) ............................................................................................................................... 40
H. Nervus vestibulocochlearis (N VIII) .......................................................................................................... 41
I. Radix cochlearis ................................................................................................................................... 41
II. Radix vestibularis ................................................................................................................................. 42
2
, I. Nervus glossopharyngeus (N IX) .............................................................................................................. 42
J. Nervus vagus (N X) ................................................................................................................................... 43
K. Nervus accessorius (N XI) ......................................................................................................................... 43
L. Nervus hypoglossus (N XII)....................................................................................................................... 43
M. Samenvatting ........................................................................................................................................... 44
1. NAH ............................................................................................................................................................... 47
A. Definitie NAH ........................................................................................................................................... 47
2. Traumatisch hersenletsel (THL) of traumatic brain injury (TBI) .................................................................... 47
A. Epidemiologie .......................................................................................................................................... 47
B. Oorzaken .................................................................................................................................................. 47
C. Casus Rob ................................................................................................................................................. 48
D. Pathofysiologie......................................................................................................................................... 48
I. Primair hersenletsel ............................................................................................................................. 48
II. Secundair hersenletsel ........................................................................................................................ 48
E. Ernst van letsel ......................................................................................................................................... 49
I. GCS....................................................................................................................................................... 49
II. Duur van de coma of bewustzijnsdaling .............................................................................................. 49
III. PTA ....................................................................................................................................................... 49
F. Ziektebeelden .......................................................................................................................................... 49
G. Prognose .................................................................................................................................................. 50
H. Vegetatieve toestand ............................................................................................................................... 50
I. Gevolgen .................................................................................................................................................. 50
I. Sensomotorische problemen .............................................................................................................. 50
II. Epilepsie............................................................................................................................................... 50
III. Zenuwschade ....................................................................................................................................... 50
IV. Intellectuele schade ............................................................................................................................. 51
V. Gestoord geheugen ............................................................................................................................. 51
VI. Gedragsproblemen .............................................................................................................................. 51
VII. Praxiestoornissen ............................................................................................................................ 51
VIII. Perseveratie .................................................................................................................................... 51
IX. Spraak- en taalstoornissen .................................................................................................................. 51
X. Agnosie ................................................................................................................................................ 51
XI. Attentiestoornissen ............................................................................................................................. 52
3. CVA ................................................................................................................................................................ 52
A. Definitie.................................................................................................................................................... 52
B. Fysiologie van de hersenendoorbloeding ................................................................................................ 52
C. Incidentie ................................................................................................................................................. 52
3
, D. Classificatie .............................................................................................................................................. 53
E. Focale cerebrale ischemie ........................................................................................................................ 53
I. Risicofactoren ...................................................................................................................................... 53
II. Prognose .............................................................................................................................................. 53
III. Gevolgen en stoornissen op lichamelijk vlak ....................................................................................... 54
IV. Behandeling ......................................................................................................................................... 54
F. Hersenbloedingen .................................................................................................................................... 54
4. Epilepsie ........................................................................................................................................................ 54
A. Gegeneraliseerd begin ............................................................................................................................. 55
I. Gegeneraliseerd tonisch-klonisch insult .............................................................................................. 55
II. Absences .............................................................................................................................................. 55
5. Extrapiramidale ziekten ................................................................................................................................ 56
A. Het extrapiramidaal systeem (EPS) .......................................................................................................... 56
B. De ziekte van Parkinson ........................................................................................................................... 56
I. Casus .................................................................................................................................................... 56
II. Definitie ............................................................................................................................................... 56
III. Etiologie ............................................................................................................................................... 57
IV. Epidemiologie ...................................................................................................................................... 57
V. Fysiopathologie.................................................................................................................................... 57
VI. Klinisch beeld ....................................................................................................................................... 57
VII. Behandeling..................................................................................................................................... 58
C. Prognose .................................................................................................................................................. 58
6. Multiple sclerose (MS) .................................................................................................................................. 58
A. Introductie ............................................................................................................................................... 58
I. Verkenningsvraag ................................................................................................................................ 58
II. Casus .................................................................................................................................................... 59
B. Definitie.................................................................................................................................................... 59
C. De myeline-schede: even opfrissen ......................................................................................................... 59
D. Epidemiologie .......................................................................................................................................... 59
E. Etiologie ................................................................................................................................................... 59
F. Verloop..................................................................................................................................................... 59
I. Klinische sybtypes ................................................................................................................................ 59
G. Symptomen .............................................................................................................................................. 60
I. Klinisch beeld ....................................................................................................................................... 61
II. Beginsymptomen ................................................................................................................................. 61
III. Motorische stoornissen van de piramidale baan ................................................................................ 61
IV. Cerebellaire symptomen en hersenstam symptomen ........................................................................ 61
4
