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11.9: Case Study Conclusion: Memory and Chapter Summary

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• Suzanne Wakim & Mandeep Grewal
• Butte College

Case Study Conclusion: Fading Memory

Figure \(\PageIndex{1}\) illustrates some of the molecular and cellular changes that occur in Alzheimer’s disease (AD), which Rosa was diagnosed with at the beginning of this chapter, after experiencing memory problems and other changes in her cognitive functioning, mood, and personality. These abnormal changes in the brain include the development of amyloid plaques between brain cells and neurofibrillary tangles inside of neurons. These hallmark characteristics of AD are associated with the loss of synapses between neurons, and ultimately the death of neurons.

After reading this chapter, you should have a good appreciation for the importance of keeping neurons alive and communicating with each other at synapses. The nervous system coordinates all of the body’s voluntary and involuntary activities. It interprets information from the outside world through sensory systems and makes appropriate responses through the motor system, through communication between the PNS and CNS. The brain directs the rest of the nervous system and controls everything from basic vital functions such as heart rate and breathing to high-level functions such as problem-solving and abstract thought. The nervous system is able to perform these important functions by generating action potentials in neurons in response to stimulation and sending messages between cells at synapses, typically using chemical neurotransmitter molecules. When neurons are not functioning properly, lose their synapses, or die, they cannot carry out the signaling that is essential for the proper functioning of the nervous system.

AD is a progressive neurodegenerative disease, meaning that the damage to the brain becomes more extensive as time goes on. Figure \(\PageIndex{2}\) illustrates how the damage progresses from before AD is diagnosed (preclinical AD), to mild and moderate AD, and finally to severe AD.

You can see that the damage starts in a relatively small location towards the bottom of the brain. One of the earliest brain areas to be affected by AD is the hippocampus. The hippocampus is important for learning and memory. This explains why many of Rosa’s symptoms of mild AD involve deficits in memory, such as trouble remembering where she placed objects, recent conversations, and appointments.

As AD progresses, more of the brain is affected, including areas involved in emotional regulation, social behavior, planning, language, spatial navigation, and higher-level thought. Rosa is beginning to show signs of problems in these areas, including irritability, lashing out at family members, getting lost in her neighborhood, problems finding the right words, putting objects in unusual locations, and difficulty in managing her finances. You can see that as AD progresses, damage spreads further across the cerebrum, which you now know controls conscious functions such as reasoning, language, and interpretation of sensory stimuli. You can also see how the frontal lobe, which controls executive functions such as planning, self-control, and abstract thought, becomes increasingly damaged.

Increasing damage to the brain causes corresponding deficits in functioning. In moderate AD, patients have increased memory, language, and cognitive deficits compared to mild AD. They may not recognize their own family members, and may wander and get lost, engage in inappropriate behaviors, become easily agitated, and have trouble carrying out daily activities such as dressing. In severe AD, much of the brain is affected. Patients usually cannot recognize family members or communicate and are fully dependent on others for their care. They begin to lose the ability to control their basic functions, such as bladder and bowel control and proper swallowing. Eventually, AD causes death, usually as a result of this loss of basic functions.

For now, Rosa only has mild AD is still able to function relatively well with care from her family. The medication her doctor gave her has helped improve some of her symptoms. It is a cholinesterase inhibitor, which blocks an enzyme that normally degrades the neurotransmitter acetylcholine. With more of the neurotransmitter available, more of it can bind to neurotransmitter receptors on postsynaptic cells. Therefore, this drug acts as an agonist for acetylcholine, which enhances communication between neurons in Rosa’s brain. This increase in neuronal communication can help restore some of the functions lost in early Alzheimer’s disease and may slow the progression of symptoms.

But medication such as this is only a short-term measure and does not halt the progression of the underlying disease. Ideally, the damaged or dead neurons would be replaced by new, functioning neurons. Why does this not happen automatically in the body? As you have learned, neurogenesis is very limited in adult humans, so once neurons in the brain die, they are not normally replaced to any significant extent. However, scientists are studying the ways in which neurogenesis might be able to be increased in cases of disease or injury to the brain. Also, they are investigating the possibility of using stem cell transplants to replace damaged or dead neurons with new neurons. But this research is in very early stages and is not currently a treatment for AD.

One promising area of research is in the development of methods to allow earlier detection and treatment of AD, given that the changes in the brain may actually start 10 to 20 years before the diagnosis of AD. For example, a radiolabeled chemical called Pittsburgh Compound B (PiB) binds to amyloid plaques in the brain and in the future may be used in conjunction with brain imaging techniques to detect early signs of AD. Scientists are also looking for biomarkers in bodily fluids such as blood and cerebrospinal fluid that might indicate the presence of AD before symptoms appear. Finally, researchers are also investigating possible early and subtle symptoms, such as changes in how people move or a loss of smell, to see whether they can be used to identify people who will go on to develop AD. This research is in the early stages, but the hope is that patients can be identified earlier to provide earlier and possibly more effective treatment and to allow families more time to plan.

Scientists are also still trying to fully understand the causes of AD, which affects more than 5 million Americans. Some genetic mutations have been identified that play a role, but environmental factors also appear to be important. With more research into the causes and mechanisms of AD, hopefully, a cure can be found, and people like Rosa can live a longer and better life.

Chapter Summary

In this chapter, you learned about the human nervous system. Specifically, you learned that:

• The nervous system is the organ system that coordinates all of the body’s voluntary and involuntary actions by transmitting signals to and from different parts of the body. It has two major divisions, the central nervous system (CNS) and the peripheral nervous system (PNS).
• The CNS includes the brain and spinal cord.
• The PNS consists mainly of nerves that connect the CNS with the rest of the body. It has two major divisions: the somatic nervous system and the autonomic nervous system. The somatic system controls activities that are under voluntary control. The autonomic system controls activities that are involuntary.
• The autonomic nervous system is further divided into the sympathetic division, which controls the fight-or-flight response; the parasympathetic division, which controls most routine involuntary responses; and the enteric division, which provides local control for digestive processes.
• Signals sent by the nervous system are electrical signals called nerve impulses. They are transmitted by special, electrically excitable cells called neurons, which are one of two major types of cells in the nervous system.
• Glial cells are the other major type of nervous system cells. There are many types of glial cells, and they have many specific functions. In general, glial cells function to support, protect, and nourish neurons.
• The main parts of a neuron include the cell body, dendrites, and axon. The cell body contains the nucleus. Dendrites receive nerve impulses from other cells, and the axon transmits nerve impulses to other cells at axon terminals. A synapse is a complex membrane junction at the end of an axon terminal that transmits signals to another cell.
• Axons are often wrapped in an electrically-insulating myelin sheath, which is produced by glial cells. Electrical impulses called action potentials occur at gaps in the myelin sheath, called nodes of Ranvier, which speeds the conduction of nerve impulses down the axon.
• Neurogenesis, or the formation of new neurons by cell division, may occur in a mature human brain but only to a limited extent.
• The nervous tissue in the brain and spinal cord consists of gray matter, which contains mainly the cell bodies of neurons; and white matter, which contains mainly myelinated axons of neurons. Nerves of the peripheral nervous system consist of long bundles of myelinated axons that extend throughout the body.
• There are hundreds of types of neurons in the human nervous system, but many can be classified on the basis of the direction in which they carry nerve impulses. Sensory neurons carry nerve impulses away from the body and toward the central nervous system, motor neurons carry them away from the central nervous system and toward the body, and interneurons often carry them between sensory and motor neurons.
• A nerve impulse is an electrical phenomenon that occurs because of a difference in electrical charge across the plasma membrane of a neuron.
• The sodium-potassium pump maintains an electrical gradient across the plasma membrane of a neuron when it is not actively transmitting a nerve impulse. This gradient is called the resting potential of the neuron.
• An action potential is a sudden reversal of the electrical gradient across the plasma membrane of a resting neuron. It begins when the neuron receives a chemical signal from another cell or some other type of stimulus. The action potential travels rapidly down the neuron’s axon as an electric current.
• A nerve impulse is transmitted to another cell at either an electrical or a chemical synapse. At a chemical synapse, neurotransmitter chemicals are released from the presynaptic cell into the synaptic cleft between cells. The chemicals travel across the cleft to the postsynaptic cell and bind to receptors embedded in its membrane.
• There are many different types of neurotransmitters. Their effects on the postsynaptic cell generally depend on the type of receptor they bind to. The effects may be excitatory, inhibitory, or modulatory in more complex ways. Both physical and mental disorders may occur if there are problems with neurotransmitters or their receptors.
• The CNS includes the brain and spinal cord. It is physically protected by bones, meninges, and cerebrospinal fluid. It is chemically protected by the blood-brain barrier.
• The brain is the control center of the nervous system and of the entire organism. The brain uses a relatively large proportion of the body’s energy, primarily in the form of glucose.
• The brain is divided into three major parts, each with different functions: brain stem, cerebellum, and cerebrum. The cerebrum is further divided into left and right hemispheres. Each hemisphere has four lobes: frontal, parietal, temporal, and occipital. Each lobe is associated with specific senses or other functions.
• The cerebrum has a thin outer layer called the cerebral cortex. Its many folds give it a large surface area. This is where most information processing takes place.
• Inner structures of the brain include the hypothalamus, which controls the endocrine system via the pituitary gland; and the thalamus, which has several involuntary functions.
• The spinal cord is a tubular bundle of nervous tissues that extends from the head down the middle of the back to the pelvis. It functions mainly to connect the brain with the PNS. It also controls certain rapid responses called reflexes without input from the brain.
• A spinal cord injury may lead to paralysis (loss of sensation and movement) of the body below the level of the injury because nerve impulses can no longer travel up and down the spinal cord beyond that point.
• The PNS consists of all the nervous tissue that lies outside of the CNS. Its main function is to connect the CNS to the rest of the organism.
• The tissues that make up the PNS are nerves and ganglia. Ganglia act as relay points for messages that are transmitted through nerves. Nerves are classified as sensory, motor, or a mix of the two.
• The PNS is not as well protected physically or chemically as the CNS, so it is more prone to injury and disease. PNS problems include injury from diabetes, shingles, and heavy metal poisoning. Two disorders of the PNS are Guillain-Barre syndrome and Charcot-Marie-Tooth disease.
• The human body has two major types of senses, special senses, and general senses. Special senses have specialized sense organs and include vision (eyes), hearing (ears), balance (ears), taste (tongue), and smell (nasal passages). General senses are all associated with touch and lack special sense organs. Touch receptors are found throughout the body but particularly in the skin.
• All senses depend on sensory receptor cells to detect sensory stimuli and transform them into nerve impulses. Types of sensory receptors include mechanoreceptors (mechanical forces), thermoreceptors (temperature), nociceptors (pain), photoreceptors (light), and chemoreceptors (chemicals).
• Touch includes the ability to sense pressure, vibration, temperature, pain, and other tactile stimuli. The skin includes several different types of touch receptor cells.
• Vision is the ability to sense light and see. The eye is the special sensory organ that collects and focuses light, forms images, and changes them to nerve impulses. Optic nerves send information from the eyes to the brain, which processes the visual information and “tells” us what we are seeing.
• Common vision problems include myopia (nearsightedness), hyperopia (farsightedness), and presbyopia (age-related decline in close vision).
• Hearing is the ability to sense sound waves, and the ear is the organ that senses sound. It changes sound waves to vibrations that trigger nerve impulses, which travel to the brain through the auditory nerve. The brain processes the information and “tells” us what we are hearing.
• The ear is also the organ that is responsible for the sense of balance, which is the ability to sense and maintain an appropriate body position. The ears send impulses on head position to the brain, which sends messages to skeletal muscle via the peripheral nervous system. The muscles respond by contracting to maintain balance.
• Taste and smell are both abilities to sense chemicals. Taste receptors in taste buds on the tongue sense chemicals in food and olfactory receptors in the nasal passages sense chemicals in the air. The sense of smell contributes significantly to the sense of taste.
• Psychoactive drugs are substances that change the function of the brain and result in alterations of mood, thinking, perception, and/or behavior. They include prescription medications such as opioid painkillers, legal substances such as nicotine and alcohol, and illegal drugs such as LSD and heroin.
• Psychoactive drugs are divided into different classes according to their pharmacological effects. They include stimulants, depressants, anxiolytics, euphoriants, hallucinogens, and empathogens. Many psychoactive drugs have multiple effects so they may be placed in more than one class.
• Psychoactive drugs generally produce their effects by affecting brain chemistry. Generally, they act either as agonists, which enhance the activity of particular neurotransmitters; or as antagonists, which decrease the activity of particular neurotransmitters.
• Psychoactive drugs are used for various purposes, including medical, ritual, and recreational purposes.
• Misuse of psychoactive drugs may lead to addiction, which is the compulsive use of a drug despite negative consequences. Sustained use of an addictive drug may produce physical or psychological dependence on the drug. Rehabilitation typically involves psychotherapy and sometimes the temporary use of other psychoactive drugs.

In addition to the nervous system, there is another system of the body that is important for coordinating and regulating many different functions – the endocrine system. You will learn about the endocrine system in the next chapter.

Chapter Summary Review

• Which part of the brain is neuron A located in — the cerebellum, cerebrum, or brain stem? Explain how you know.
• The cell body of neuron A is located in a lobe of the brain that is involved in abstract thought, problem-solving and planning. Which lobe is this?
• Part of neuron A travels all the way down to the spinal cord to meet neuron B. Which part of neuron A travels to the spinal cord?
• Neuron A forms a chemical synapse with neuron B in the spinal cord. How is the signal from neuron A transmitted to neuron B?
• Is neuron A in the central nervous system (CNS) or peripheral nervous system (PNS)?
• The axon of neuron B travels in a nerve to a skeletal muscle cell. Is the nerve part of the CNS or PNS? Is this an afferent nerve or an efferent nerve?
• What part of the PNS is involved in this pathway — the autonomic nervous system or the somatic nervous system? Explain your answer.
• What are the differences between a neurotransmitter receptor and a sensory receptor?
• The axon terminal
• The nodes of Ranvier
• The dendrites
• The cell body
• True or False. Glial cells produce action potentials.
• True or False. The spinal cord consists of white matter only.
• True or False. Axons may be more than a meter long in adult humans.
• If a person has a stroke and as a result has trouble using language correctly, which hemisphere of their brain was most likely damaged? Explain your answer.
• head region
• trunk and leg regions
• Define what an electrical gradient is, in the context of a cell.
• What is responsible for maintaining the electrical gradient that results in the resting potential?
• Compare and contrast the resting potential and the action potential.
• Where along a myelinated axon does the action potential occur? Why does it happen here?
• What does it mean that the action potential is “all-or-none?”
• The neurotransmitter itself
• The specific receptor for the neurotransmitter on the postsynaptic cell
• The number of synaptic vesicles in the axon terminal
• Whether it is in a sensory neuron or a motor neuron
• Compare and contrast Schwann cells and oligodendrocytes.
• True or False. The cerebellum makes up most of the brain and is divided into four lobes.
• True or False. The hypothalamus is part of the brain.
• Mechanoreceptors
• Nociceptors
• Photoreceptors
• Chemoreceptors
• For the senses of smell and hearing, name their respective sensory receptor cells, what type of receptor cells they are, and what stimuli they detect.
• True or False. Sensory information such as smell, taste, and sound, are carried to the CNS by cranial nerves.
• True or False. The parasympathetic nervous system is a division of the central nervous system.

Attributions

• Characteristics of AD by National Institute on Aging, National Institutes of Health; public domain via Wikimedia Commons
• Alzheimer’s Disease, Spreads through the Brain by National Institute on Aging, National Institutes of Health; public domain via Flickr.com
• Text adapted from Human Biology by CK-12 licensed CC BY-NC 3.0

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Chapter 1:  Nervous System

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Functional classification of neurons, anatomical divisions of the nervous system.

• FUNCTIONAL DIVISIONS OF THE NERVOUS SYSTEM
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The neuron , or nerve cell, is the basic functional unit of the nervous system. A neuron includes its cell body and processes (axons and dendrites). Long neuronal processes are frequently referred to as fibers . Neurons are generally classified as either afferent or efferent:

Afferent , or sensory, neurons receive input from peripheral structures and transmit it to the spinal cord and/or brain.

Efferent , or motor, neurons transmit impulses from the brain and/or spinal cord to effectors (skeletal muscle, cardiac muscle, smooth muscle, glands) throughout the body.

The nervous system has two anatomical divisions:

The central nervous system (CNS) includes the brain and spinal cord.

The peripheral nervous system (PNS) consists of spinal nerves, their roots, and branches; cranial nerves (CN) and their branches; and components of the autonomic nervous system (ANS).

Collections of nerve cell bodies in the CNS form nuclei , whereas those in the PNS form ganglia . Ganglia and nuclei contain either motor or sensory neurons. Bundles of axons in the CNS are called tracts . Similar neuronal processes collected in the PNS form nerves . Nerves are categorized based on their CNS origin:

Spinal nerves are attached to the spinal cord. They transmit both motor and sensory impulses and are, thus, considered mixed nerves .

Most CN are attached to the brain. Some CN are either motor or sensory only, while others are mixed.

Spinal Nerves

The spinal cord is composed of segments, as indicated by the 31 pairs of spinal nerves. Each segment has numerous dorsal (posterior) and ventral (anterior) rootlets that arise from the respective surfaces of the spinal cord ( Fig. 1.1 ). Dorsal rootlets contain neuronal processes that conduct afferent impulses to the spinal cord, whereas the ventral rootlets conduct efferent impulses from the spinal cord. Respective rootlets from each segment unite to form dorsal and ventral roots :

The dorsal root contains the central processes of sensory neuronal cell bodies that are located in the dorsal root ganglion (DRG) . The DRG is also called a spinal ganglion. The peripheral processes of these neurons are located in the spinal nerve, its rami, and their branches. These processes end at or form receptors.

The ventral root contains motor fibers. Their neuronal cell bodies are found in the gray matter of the spinal cord: ventral horn if the axons innervate skeletal muscle; lateral horn if the axons supply smooth muscle, cardiac muscle, or glands.

Somatic components of a spinal nerve.

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Peripheral Nervous System Patient Case Studies

Nine interactive computer-based cases providing beginner health professionals with drill-and-practice exercises that assess introductory nervous system content acquisition and knowledge. Another version of it is published by MedEdPORTAL (MEP ID# 3159).

Media:  Interactive Patient Cases

Last Update:  12/14/2007

Authors:  Reilly, F., E. Allen, A. Reed, and J. Altemus.

Certification:  HEAL, 2009, ID = 429

Technology:  Browser (Internet Explorer 6.0 or higher, Firefox 2.0 or higher, Safari 3.0 or higher) and Adobe Flash 6.0 or higher.

Copyright:  WVU and Frank Reilly

Contact:   [email protected]

Links:   HSC  |  External

Central Nervous System: Case Study

Welcome to the 21st Century electronic classroom for Advanced Human and Physiology class. You can find additional resources on my science web site Mitchell's Cosmic Adventure. Com. While case studies cannot provide specific guidance for the management of successive patients, they are a record of clinical interactions. You will need to locate the Google Document file on my website. Here will need to read the case study: Spinal Cord Injury, the patient is Thomas (Tommy) Potter. It is under the Nervous System TAB and then select Central Nervous System - Patient Medical History! Read more This test has a T. E. M. (Test Exam Mode) setting that doesn't reveal the answer during the test period. A report and certificate will be printed for each attempt. Each attempt will randomly generate a new set of 20 questions and answers. This is a method to cover all the material and increase your testing ability. Good Luck on this case study and your studies in Human Anatomy & Physiology!

What activity was Thomas (Tommy) Potter, a 20-year old college student performing to send him to emergency Trauma Center for treatment?

Riding a bicycle

Rock climbing

Jogging on campus

Playing tennis

Painting the ceiling of his campus apartment

Rate this question:

After you gathered initial information from this patient concerning his activities on campus.  Please check all to which apply to Mr. Potter.  

Which one of the following explanations best describes the changes in Thomas's vital signs?

Lying on his back during transport

The level and extent of injury

Anxiety related to the injury

Lack of Mobility during transport

Tommy Potter is a 20-year old college student, who was rock climbing and fell _____ meters to the ground. Please round to one tenth of a decimal.

How tall is tommy potter in ______centimeters  please round to one tenth of a centimeter., what was thomas potter's skin condition in the emergency room  please check all which applies to this patient..

Paramedics applied a cervical collar at the scene of the accident, placed him on a backboard and immobilized his head. Mr. Potter asked a paramedic why he could feel just a little sensation in some parts of his arms and legs. The paramedic's response would be based on the understanding that:   (HINT: this is a multiple answer question.)

A concussion is causing these transient signs

The autonomic nervous center in the cerebellum was injured

C5 and C6 injury would be consistent with these sensations

Brain pathways are too complex to respond to his question

Damage to this patent's cervical region is in question

Damage to the spinal cord will affect the function of the nervous from the point of injury upward.

Due to the nature of tommys injuries, all of the following central nervous system functions will be affected except :.

Control of posture

Conduction route to the brain

Reflex activity for the spine

Conduction route from the brain

Control of posture is a cerebellar activity, not a spinal cord function.

Dr. john babinski was checking tommy's vital signs and noticed a drop in his blood pressure. what is causing this condition at the time of the emergency.

patient has suffered damage to his spinal cord

Patient has no sensory detection in his arms

Patient has no motor movement in his arms

Patient has no sensory detection in his legs

Patient has no motor movement in his legs

___ ___ is a combination of areflexia/hyporeflexia and autonomic dysfunction that accompanies spinal cord injury .

What is spinal shock phase 1?

0 - 1 day: areflexia/Hyporeflexia

1 - 3 days: Initial reflex return

1 - 4 weeks: Hyperreflexia (initial)

1 - 12 weeks: Hyperreflexia, Spasticity

What is spinal shock phase 2?

What is spinal shock phase 3?

What is spinal shock phase 4?

What phrases of spinal shock shows strong reflexes usually produced with minimal stimulation. Motor neurons begin sprouting and attempting to re-establish synapses?

Phase 1 - 0 - 1 day: areflexia/Hyporeflexia

Phase 2 - 1 - 3 days: Initial reflex return

Phase 3 - 1 - 4 weeks: Hyperreflexia (initial)

Phase 4 - 1 - 12 weeks: Hyperreflexia, Spasticity

What does S.C.I. stand for as it relates to spinal shock?

Standard Control Instructions

Spinal Cord Injury

Spinal Cord Instructions

Spinal Control Instructions

Spinal Cord Innervation

What is the cause of Thomas Potter's respiratory rate at 24 (very shallow breathing)?

Injury to C3

Injury to C4

Injury to C5

Injury to T1

Injury to C4 and C5

Which cervical vertebrae was damaged in the patient's rock climbing injury? Taking all of the physical examination findings suggest that there was incomplete, diffuse, bilateral damage to the spinal cord at about the ___ segment.

Due to damage of the c5 vertebrae and the respiration rate of this patient. what condition is causing his blood ph to 7.25.

Thomas is hypoventilating resulting in respiratory acidosis.

Thomas is hyperventilating resulting in respiratory acidosis.

Thomas is hyporeflexia resulting in respiratory acidosis.

Thomas is not breathing on his own resulting in respiratory acidosis.

At what blood pH would Thomas have died?

The micturition reflex may return as Mr Potter's spinal shock resolves, since this reflex arc involves non-damaged segments of the spinal cord (S2 to S4).

What is the halo traction brace called?

Halo Orthosis

Cervical Halo Brace

Thoracic Halo Brace

Lumbar Halo Orthosis

Cervical Orthosis

Tommy Potter will wear his halo orthosis due to severe damage to the C5 vertebrae for ___ weeks. (Hint: please enter a number from 5 to 24 .)

How many rock climbing members are part of Thomas's team including himself?

___ / ___ is the medical term used when a person has a spinal cord injury above the first thoracic vertebra. Paralysis affects the cervical spinal nerves (C1-C8) resulting in paralysis in varying degrees in all four limbs.

Tetraplegia

Quadriplegia

Cauda Equina Syndrome

___ / ___ is the medical term used when the level of spinal cord injury occurs below the first thoracic spinal nerve root (T1-S5). The degree at which the person is paralysed can vary from the impairment of leg movement, to complete paralysis of the legs and abdomen up to the nipple line. Paraplegics have full use of their arms and hands.

___ / ___  is the mass of nerves which fan out of the spinal cord at just below the first and second Lumbar region of the spinal cord, an area known as the conus medullaris. The spinal cord ends at L1 and L2 at which point a bundle of nerves travel downwards within the lumbar and sacral vertebrae.

When Cauda Equina Syndrome,  Injury to these nerves will cause partial or complete loss of movement and sensation of ___, ___, ___, and ___.

Urinary Bladder

Sexual Organs

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