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tures: the frontal lobe cortex, the insular cortex, and the amygdaloid and adjacent nuclei The ventromedial prefrontal and cingulate cortices function as the highest levels of autonomic integration Stimulation of one frontal lobe may evoke changes in temperature and sweating in the contralateral arm and leg; massive lesions here, which usually cause a hemiplegia, may modify the autonomic functions in the direction of either inhibition or facilitation Lesions involving the posterior part of the superior frontal and anterior part of the cingulate gyri (usually bilateral, occasionally unilateral) result in loss of voluntary control of the bladder and bowel (see page 393) Most likely a large contingent of these bers terminates in the hypothalamus, which, in turn, sends bers to the brainstem and spinal cord The descending spinal pathways from the hypothalamus are believed to lie ventromedial to the corticospinal bers The insular cortex receives projections from the NTS, the parabrachial nucleus of the pons, and the lateral hypothalamic nuclei Direct stimulation of the insula produces cardiac arrhythmias and a number of other alterations in visceral function The cingulate and hippocampal gyri and their associated subcortical structures (substantia innominata and the amygdaloid, septal, piriform, habenular, and midbrain tegmental nuclei) have been identi ed as important cerebral autonomic regulatory centers Together they have been called the visceral brain (see Chap 25) Of particular importance in autonomic regulation is the amygdala, the central nucleus of which is a major site of origin of projections to the hypothalamus and brainstem The anatomy and the effects of stimulation and ablation of the amygdala have been discussed in Chap 25, in relation to the neurology of emotion In addition to the aforementioned central relationships, it should be noted that important interactions between the autonomic nervous system and the endocrine glands occur at a peripheral level The best-known example is in the adrenal medulla A similar relationship pertains to the pineal gland, in which norepinephrine (NE) released from postganglionic bers that end on pineal cells stimulates several enzymes involved in the biosynthesis of melatonin Similarly, the juxtaglomerular apparatus of the kidney and the islets of Langerhans of the pancreas may function as neuroendocrine transducers insofar as they convert a neural stimulus (in these cases adrenergic) to an endocrine secretion (renin, glucagon, and insulin, respectively) The numerous autonomic-endocrine interactions are elaborated in the next chapter Finally, there is the essential role that the hypothalamus plays in the initiation and regulation of autonomic activity, both sympathetic and parasympathetic Sympathetic responses are most readily obtained by stimulation of the posterior and lateral regions of the hypothalamus, and parasympathetic responses from the anterior regions The descending sympathetic bers are largely or totally uncrossed, although their pathway or pathways have not been sharply de ned According to Carmel, bers from the caudal hypothalamus at rst run in the prerubral eld, dorsal and slightly rostral to the red nucleus, and then ventral to the ventrolateral thalamic nuclei; then they descend in the lateral tegmentum of the midbrain, pons, and medulla to synapse in the intermediolateral cell column of the spinal cord Consistent with this schema, a case described by Luhan and Pollack demonstrated that a small infarct in the territory of supply of the superior cerebellar artery, just posterior to the medial lemniscus, caused an ipsilateral Horner syndrome In the medulla, the descending sympathetic pathway is located in the posterolateral retro-olivary area, where it is frequently involved in lateral medullary infarctions In the cervical cord, the.

If we look at one of the Web items we worked on in a former chapter we can start to really work through some of the ideas and concepts discussed in this chapter and see if we are following all of the important points while building a dynamic and focused dashboard So, in the following illustration we can see the column charts that we used in the previous section and let s discuss what is going on within the chart Now, the chart itself is in pretty good shape so let s also assume that we have agreed upon the KPIs so that our focus is on reviewing the finer points of the display and presentation

bers run in the posterior angle of the anterior horn (Nathan and Smith) According to the latter authors, some of the bers supplying sudomotor neurons run outside this area but also remain ipsilateral Jansen and colleagues, by the use of viral vectors in rodents, were able to label certain neurons of the hypothalamus and the ventral medulla that stimulated sympathetic activity in both the stellate ganglion and the adrenal gland They hypothesized that this dual control underlies the ght-or- ight response, as described in 25 By contrast, the pathways of descending parasympathetic bers are not known Afferent projections from the spinal cord to the hypothalamus have been demonstrated in animals and provide a potential route by which sensation from somatic and possibly visceral structures may in uence autonomic responses

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The function of the autonomic nervous system in its regulation of the visceral organs is to a high degree independent When the autonomic nerves are interrupted, these organs continue to function (the organism survives), but they are no longer as effective in maintaining homeostasis and adapting to the demands of changing internal conditions and external stresses It was learned long ago that most viscera have a double nerve supply, sympathetic and parasympathetic, and that in general these two parts of the autonomic nervous system exert opposite effects For example, the effects of the sympathetic nervous system on the heart are excitatory and those of the parasympathetic inhibitory However, some structures sweat glands, cutaneous blood vessels, and hair follicles receive only sympathetic postganglionic bers, and the adrenal gland, as indicated above, has only a preganglionic sympathetic innervation Also, some parasympathetic neurons have been identi ed in sympathetic ganglia Neurohumoral Transmission All autonomic functions are mediated through the release of chemical transmitters The modern concept of neurohumoral transmission had its beginnings in the early decades of the twentieth century In 1921, Loewi discovered that stimulation of the vagus nerve released a chemical substance ( Vagustoff ) that slowed the heart Later this substance was shown by Dale to be acetylcholine (ACh) Also in 1921, Cannon reported that stimulation of the sympathetic trunk released an epinephrinelike substance, which increased the heart rate and blood pressure He named this substance sympathin, subsequently shown to be noradrenaline, or NE Dale found that ACh had pharmacologic effects similar to those obtained by stimulation of parasympathetic nerves; he designated these effects as parasympathomimetic These observations placed neurochemical transmission on solid ground and laid the basis for the distinction between cholinergic and adrenergic transmission in the autonomic nervous system The most important of the autonomic neurotransmitters are ACh and NE ACh is synthesized at the terminals of axons and stored in presynaptic vesicles until it is released by the arrival of nerve impulses ACh is released at the terminals of all preganglionic bers (in both the sympathetic and parasympathetic ganglia) as well as at the terminals of all postganglionic parasympathetic and a few special postganglionic sympathetic bers, mainly those subserving sweat glands (Of course, ACh is also the chemical transmitter of nerve impulses to the skeletal muscle bers) Parasympathetic postganglionic function is mediated by two distinct.

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