Department of Neurology Dr. Hasan Sadikin Hospital Medical Faculty PadjadjaranUniversity Bandung
Sensation and perception of the internal / external environment and the response of the
2. Proprioceptors mediating deeper somatic structurs inform of muscle, joint position Golgi tendon Muscle spindles
Paccinian corpuscles
Golgi Mazzoni corpuscles
According to receptors location : 1. Superficial touch pain temperature two point discrimination 2. Profunda / deep muscle & joint position ( propriception ) deep muscle pain vibration sense 3. Combined stereognosis topognosis
Heads classification 1. Protopathic senses pain severe degree of temperature 2. Epicritic senses
light touch
two point discrimination lesser differences in temperature
Hennys
Nerve fibers :
unmyelinated fibers : C fibers* myelinated fibers : A-alfa fibers, A-beta fibers* (6-16um) A-gamma fibers, A-delta fibers* (2-6um)
Peripheral Nerves
2nd neuron
3rd neuron
DERMATOME
a specific segmental territory of the skin to make certain about location of the lesion
Spinal nerves 8 12 5
Sacral
Coccigeus
5
4
5
-
THE DERMATOMES
The spinal cord is shorter than the spinal collumn & terminates at the LI - LII vertebrae Segment cervical Segment thoracal vertebrae C : () 1
vertebrae Th : () 2
Head Innervations
Autonomous Zones
Types of pain : Nociceptive pain Inflammatory pain Neuropathic pain Functional pain
Diabetes Mellitus
Polyneuropathy
immunology toxic ( e.g alcohol,Co, Pb ) vit B1 deficiency Diabetes Mellitus
Cranial nerves
ventral / dorsal roots dorsal root ganglia peripheral nerves Gloves & stocking negative/positive sensory disturbances
Motor disturbances :
flacid paralysis trunk & upper extremities LCS : cyto-albuminic dissociation
The posterior root ganglia e.g. Herpes zoster ( shingles ) Acute pain & vehicle formation segmental distribution Post herpetic neuralgia The dorsal roots of the spinal nerves e.g. Tabes dorsalis Ataxia ( dorsal roots + post columns )
Areflexia
Tabetic crises Extradural, extramedularry tumor
spinocerebellar tract
corticospinal tract Below the lesion
Transvers lesion of the spinal cord motor, sensory, vegetatif, disturbances below the lesion
Intramedullary lesion of the spinal cord e.g. > Syringomyelia loss of exteroceptive, but retains proprioceptive in the affected parts ( dissociated anesthesia ) Caused by gliosis around
Subacute combined degeneration Degeneration of the posterior & lateral column Loss of proprioceptive
Tetraparalysis
In the advanced cases of pernicious anemia ( vit. B12 deficiency )
Friedreichs ataxia
cerebellar disartri
ataxia loss of proprioceptive
Medulla oblongata
Wallenbergs Syndrome ( lateral medulla syndrome ) Occlusion of the main trunk of the post. inf. cerebellar artery Alternans hemihypesthesia
hyperesthesia
Weakness Ataxia