principles of anatomical structures and function of nervous system. unconditioned reflexes. active...

Principles of anatomical structures and Principles of anatomical structures and function of nervous system. Unconditioned function of nervous system. Unconditioned

reflexes. Active movements system reflexes. Active movements system (symptomatic and topical diagnostics of (symptomatic and topical diagnostics of

movement disturbances)movement disturbances)

ProfProf. . SS.І. .І. ShkrobotShkrobot

Neurology as scienceNeurology as science

Neuropathology (from Greek neuro – nerve, pathos – disease, logos – science) – is a part of clinical

medicine, which is involved in nervous diseases and its role in pathology of other organs and

systems of human body

Functions of nervous systemFunctions of nervous system

The main function of nervous systemThe main function of nervous system is is unification and regulation of unification and regulation of

different physiological processes. different physiological processes. That means that nervous system That means that nervous system

unites, integrates and unites, integrates and subordinates all the parts of subordinates all the parts of human body and provides its human body and provides its connection with environment.connection with environment.

Functions of nervous systemFunctions of nervous system

The base of nervous system activity is The base of nervous system activity is reflex principlereflex principle

Reflex – is a reaction of our organism to Reflex – is a reaction of our organism to various outside and inside effects. It is various outside and inside effects. It is provided by nervous system.provided by nervous system.

Reflex consists of:Reflex consists of:

afferent part (which accepts information)afferent part (which accepts information)

central part (that keeps information)central part (that keeps information)

efferent part (that creates response).efferent part (that creates response).

As a result we have a circle – like structure As a result we have a circle – like structure - receptor (primary information centre) – - receptor (primary information centre) – programme centre – executive apparatus. programme centre – executive apparatus.

Reflex archeReflex arche

Reflexes are divided into:Reflexes are divided into:

simple and complexsimple and complex

inborn and trainedinborn and trained

conditioned and unconditioned conditioned and unconditioned

Unconditioned reflexes:Unconditioned reflexes:

They are inborn onesThey are inborn ones

They are phylogenetically old, that means they They are phylogenetically old, that means they were formed in course of phylogenesiswere formed in course of phylogenesis

They are based on certain anatomic structures They are based on certain anatomic structures (segments of spinal cord or brain stem)(segments of spinal cord or brain stem)

They exist even without brain cortex influenceThey exist even without brain cortex influence

They are inheritedThey are inherited

They can be regulated by brain cortexThey can be regulated by brain cortex

They are basis for the conditioned reflexesThey are basis for the conditioned reflexes

Conditioned reflexes:Conditioned reflexes:

They are the result of the individual experience They are the result of the individual experience and are formed during ontogenesisand are formed during ontogenesisThey are unstable, that means they need They are unstable, that means they need constant supportconstant supportThey aren’t based on certain anatomic They aren’t based on certain anatomic structuresstructuresThey are fixed in brain cortexThey are fixed in brain cortex

There are such conditioned reflexes as speaking, There are such conditioned reflexes as speaking, writing, reading, calculation, practicewriting, reading, calculation, practice

Unconditioned reflexes are divided Unconditioned reflexes are divided into:into:

Superficial and deepSuperficial and deep

Simple and complexSimple and complex

Unconditioned reflexes are divided Unconditioned reflexes are divided into:into:

Proprioceptive (stretch, periosteal, joint)Proprioceptive (stretch, periosteal, joint)

Exteroceptive (dermal, from mucoExteroceptive (dermal, from mucouuse se membrane)membrane)

Interoceptive (from mucouse membrane of Interoceptive (from mucouse membrane of internal organs – for example urination in internal organs – for example urination in case of internal sphincter irritation)case of internal sphincter irritation)

In clinical practice we evaluate the following reflexes:Reflex The group of

reflexMuscles Nerves Segments

Subeyesbrow Deep, periostal reflex

M. orbicularis oculi

N. trigeminus ( V ) – N.facialis (VII)

Medulla oblongata and pons

Corneal (lid) Superficial, from mucose membrane

M. orbicularis oculi

N. trigeminus ( V ) – N.facialis (VII)


Jaw Jerk (mandibular, chin, masseter) reflex (Bechterev’s)

Deep, periostal reflex

M.masseter N. trigeminus ( V ) – N.mandibularis (sensory and motor )


Pharyngeal Superficial, from mucose membrane

Mm. constrictores pharyngis and others

N.glosso- pharyngeus, n.vagus (sensory and motor), 9th and 10th pair of CCN

Medulla oblongata

Palatal (palatine) Superficial, from mucose membrane

Mm. levatores velli palatini

N.glosso- pharyngeus, n.vagus (sensory and motor)

Medulla oblongata

Biceps Deep, stretch reflex

M.biceps brachii N.musculo- cutaneus

C5-C6

Triceps Deep, stretch reflex

M.triceps brachii

N.radialis C7-C8

Radial (carporadial, brachioradial)


Mm.pronatores flexores, digitorum, brachioradialis, biceps

N.medianus, N. radialis, N. musculo-cutaneus

C5-C8

Scapulo- humeral (scapuloperiosteal) reflex (Bechterev’s)


Mm. teres major, subscapularis

N. subscapularis

C5-C6

Upper superficial abdominal

Superficial, dermal

Mm. transversus, obliquus, rectus abdominis

N.intercostales D7-D8

Middle superficial abdominal

Superficial, dermal


N.intercostales D9-D10

Lower superficial abdominal

Superficial, dermal


N.intercostales

D11-D12

Cremasteric Superficial, dermal

M.cremaster N.genito- femoralis

L1-L2

Knee jerk, or patellar reflex (quadriceps stretch reflex)

Deep, stretch reflex

M.quadriceps femoris

N.femoralis L3-L4

Achilles (ankle jerk)

Deep, stretch reflex

M.triceps surae

N.tibialis (n.ischiadicus

S1-S2

Plantar (sole) Superficial, dermal

Mm. flexores digitorum pedis and others

N.ischiadicus L5-S1

Anal Superficial, dermal

M.sphinter ani externus

Nn. anococcygei

S4-S5

Motor systemMotor system

Provides conduction of nervous impulse Provides conduction of nervous impulse from brain cortex to muscles. from brain cortex to muscles.

The way of this impulse is known as The way of this impulse is known as motorwaymotorway or or tractus corticomuscularistractus corticomuscularis. .

It consists of two neurons: It consists of two neurons:

centralcentral

peripheralperipheral

Upper and lower extremities, neck, trunk Upper and lower extremities, neck, trunk and perineum musclesand perineum muscles’’ innervation innervation

The The first (central) neuronfirst (central) neuron is called is called tractus corticospinalistractus corticospinalis..

The The second (peripheral) neuronsecond (peripheral) neuron is called is called tractus spinomuscularis.tractus spinomuscularis.

The The first (central) neuronfirst (central) neuron

tractus corticomuscularistractus corticomuscularis

Spinal nerve gives 4 branches:Spinal nerve gives 4 branches:

ramus anterior ( together they form plexus ramus anterior ( together they form plexus – cervical, brachial, lumbar and sacral)– cervical, brachial, lumbar and sacral)

ramus posterior (it is spinal nerve, which ramus posterior (it is spinal nerve, which innervates posterior trunk muscles)innervates posterior trunk muscles)

ramus meningeusramus meningeus

ramus comunicante albiramus comunicante albi

Conclusions:Conclusions:

The muscles of upper and lower The muscles of upper and lower extremities have unilateral cortical extremities have unilateral cortical innervation from contralateral hemisphere innervation from contralateral hemisphere

The muscles of neck, trunk and pelvic The muscles of neck, trunk and pelvic organs have bilateral innervation from both organs have bilateral innervation from both hemispheres. In case of unilateral hemispheres. In case of unilateral pathologic focus these structures do not pathologic focus these structures do not suffersuffer

Face, tongue and pharynx Face, tongue and pharynx muscles innervationmuscles innervation

This way is called This way is called tractus corticomuscularistractus corticomuscularis..

The The firstfirst central neuron is called central neuron is called tractus tractus corticonucleariscorticonuclearis..

The The secondsecond peripheral one is called peripheral one is called tractus tractus nucleomuscularis.nucleomuscularis.

Face, tongue and pharynx Face, tongue and pharynx muscles innervationmuscles innervation

We can make the following conclusions:We can make the following conclusions:

1. The 1. The face muscles have bilateral cortex face muscles have bilateral cortex innervationinnervation except the mimic muscles and except the mimic muscles and tongue muscles that have unilateral tongue muscles that have unilateral innervation from the opposite hemisphere.innervation from the opposite hemisphere.2. The muscles of 2. The muscles of upper and lower upper and lower extremities, lower mimic muscles and tongue extremities, lower mimic muscles and tongue muscles have unilateral cortical innervationmuscles have unilateral cortical innervation..3. All the other muscles 3. All the other muscles (the muscles of (the muscles of neck, trunk, perineum, m. oculomotorial, m. neck, trunk, perineum, m. oculomotorial, m. masseter, pharyngeal and palatal muscles) masseter, pharyngeal and palatal muscles) have bilateral cortical innervation.have bilateral cortical innervation.

ParalysisParalysisParalysis Paralysis (plegia)(plegia) - means the absence of - means the absence of active movements. It occurs in case of active movements. It occurs in case of complete lesion of complete lesion of motor waymotor way (tractus (tractus corticomuscularis) . corticomuscularis) .

ParesisParesis occurs in case of incomplete occurs in case of incomplete lesion of motor way. That means disorders lesion of motor way. That means disorders of active movementsof active movements

Clinically can be – hemi-, tetra-, mono-, tri- Clinically can be – hemi-, tetra-, mono-, tri- and paraparesis.and paraparesis.

Paralysis is divided into:Paralysis is divided into:

Central (spastic)Central (spastic)Peripheral (flaccid)Peripheral (flaccid)

CentralCentral or spastic paralysis is caused by the or spastic paralysis is caused by the lesion of central neuron and its fibers (tr. lesion of central neuron and its fibers (tr. corticospinalis or tr. corticonuclearis).corticospinalis or tr. corticonuclearis).

PeripheralPeripheral or flaccid paralysis is caused by or flaccid paralysis is caused by the lesion of peripheral neuron (tractus the lesion of peripheral neuron (tractus spinomuscularis or tractus spinomuscularis or tractus nucleomuscularis).nucleomuscularis).

Features of central (spastic) Features of central (spastic) paralysis are:paralysis are:

1. It is a diffuse paralysis1. It is a diffuse paralysis2. There is spastic hypertonus of muscles 2. There is spastic hypertonus of muscles 3. Hyperreflexion of stretch and periostal reflexes3. Hyperreflexion of stretch and periostal reflexes4. There are pathologic reflexes. They are 4. There are pathologic reflexes. They are

considered to be reliable signs of central considered to be reliable signs of central paralysisparalysis

5. Protective reflexes (the reflexes of spinal 5. Protective reflexes (the reflexes of spinal automatism)automatism)

6. Pathologic synkinesis6. Pathologic synkinesis is involuntary movements is involuntary movements in paralysed extremity in paralysed extremity

ParesisParesis

Spastic hypertonus features:Spastic hypertonus features:

Tonus is increased in the group of flexors Tonus is increased in the group of flexors in upper extremities and in the group of in upper extremities and in the group of extensors in lower extremitiesextensors in lower extremities

““clasp – knife“ symptomclasp – knife“ symptom

in course of evaluation tonus decreasesin course of evaluation tonus decreases

Flexing pathological reflexesFlexing pathological reflexes

Bechterev’s signBechterev’s sign

Jukovski sign Jukovski sign

Rossolimo Rossolimo

(Venderovych) reflex(Venderovych) reflex

Rossolimo Rossolimo (Venderovych) reflex(Venderovych) reflex

Jukovski signJukovski sign

Extension pathological reflexesExtension pathological reflexes

Pathologic reflexes on upper Pathologic reflexes on upper extremities:extremities:

Bechterev’s sign.Bechterev’s sign. This is simply a muscle- This is simply a muscle-stretch reflex of bending of fingers obtained by stretch reflex of bending of fingers obtained by tapping the back of hand with a reflex hammer. tapping the back of hand with a reflex hammer. Jukovski sign. Jukovski sign. This is caused by hammer This is caused by hammer impact on a palm under fingers; response is impact on a palm under fingers; response is reflex flexing of II-V fingers.reflex flexing of II-V fingers.Rossolimo (Venderovych) reflexRossolimo (Venderovych) reflex: This is : This is simply a muscle-stretch reflex obtained by simply a muscle-stretch reflex obtained by tapping the palmar surfaces of the fingers with a tapping the palmar surfaces of the fingers with a reflex hammer; the response is reflex flexing of reflex hammer; the response is reflex flexing of II-V fingers.II-V fingers.

Pathologic reflexes on upper Pathologic reflexes on upper extremities:extremities:

Tremner reflex. Tremner reflex. This is simply a muscle-stretch This is simply a muscle-stretch reflex obtained by tapping the palmar surfaces of reflex obtained by tapping the palmar surfaces of the nail-phalax of II – V fingers. The response is the nail-phalax of II – V fingers. The response is fingers flexing.fingers flexing.Jakobson – Laske reflex.Jakobson – Laske reflex. This is caused by This is caused by hammer impact on processus styloideus; the hammer impact on processus styloideus; the response is reflex flexing of II-V fingers.response is reflex flexing of II-V fingers.Klipel –Klipel – Veil reflex.Veil reflex. This is caused by passive This is caused by passive bending of II – V fingers. The response is thumb bending of II – V fingers. The response is thumb flexingflexing

Protective reflexes Protective reflexes ((the reflexes of spinal automatismthe reflexes of spinal automatism ) )

They also are one of signs of lesion of motor way. They also are one of signs of lesion of motor way. They are especially clearly expressed at cross They are especially clearly expressed at cross lesion of a spinal cord (dissociation of underlaying lesion of a spinal cord (dissociation of underlaying segments of the last from a brain). segments of the last from a brain). The result is squeezing of foot, and also an The result is squeezing of foot, and also an injection or sharp plantar flexion of toes injection or sharp plantar flexion of toes (V.M.Bechterev). (V.M.Bechterev). The response reflex flexion of paralyzed The response reflex flexion of paralyzed extremities, flexion in femoral, knee and talocrural extremities, flexion in femoral, knee and talocrural joints (shortly reaction); opposite extremities thus joints (shortly reaction); opposite extremities thus straightens, being unbent in joints (long reaction).straightens, being unbent in joints (long reaction). Serial putting irritations on one and the other leg, Serial putting irritations on one and the other leg, can result in imitation of automatisms of walking.can result in imitation of automatisms of walking.

Pathologic synkinesisPathologic synkinesis

- are involuntary movements in - are involuntary movements in paralysed extremity . They are observed paralysed extremity . They are observed while moving by healthy extremity. while moving by healthy extremity.

Synkinesis are divided into:Synkinesis are divided into:

GlobalGlobal

CoordinatoryCoordinatory

ImitatingImitating

Central paralysisCentral paralysis

Features of peripheral paralysisFeatures of peripheral paralysis

1. Areflexion or hyporeflexion1. Areflexion or hyporeflexion

2. Atonia or hypotonia2. Atonia or hypotonia

3. Muscular atrophy3. Muscular atrophy

4. Fasciculation of muscles4. Fasciculation of muscles

5. It is limited paralysis 5. It is limited paralysis

6. There is reaction of degeneration.6. There is reaction of degeneration.

Types of gate:Types of gate:

Symptoms of motor way lesionSymptoms of motor way lesion

11. . The lesion of anterior central gyrusThe lesion of anterior central gyrus monoplegia (or monoparesis) on the opposite monoplegia (or monoparesis) on the opposite side. If the focus is situated in upper part of side. If the focus is situated in upper part of anterior central gyrus, paralysis of lower anterior central gyrus, paralysis of lower extremity occurs.extremity occurs.If it is in middle part of anterior central gyrus, we If it is in middle part of anterior central gyrus, we can observe paralysis of upper extremity.can observe paralysis of upper extremity. If it is in lower one, face suffers. If it is in lower one, face suffers. In case of anterior central gyrus irritation Motor In case of anterior central gyrus irritation Motor Jackson takes place. Motor Jackson is a set of Jackson takes place. Motor Jackson is a set of local seizures that can cause generalized local seizures that can cause generalized seizures.seizures.


2. 2. The lesion of radiate crownThe lesion of radiate crown central hemiplegia on the opposite side central hemiplegia on the opposite side (that means that arm, leg, lower mimic (that means that arm, leg, lower mimic muscles and tongue muscles are muscles and tongue muscles are involved). Paralysis can dominates in involved). Paralysis can dominates in lower extremity,in upper extremity or in lower extremity,in upper extremity or in face muscles face muscles Besides hemianesthesia can join Besides hemianesthesia can join hemiplegia.hemiplegia.


3. 3. The lesion of internal capsule part of The lesion of internal capsule part of motor waymotor way hemiplegia on the opposite side, central hemiplegia on the opposite side, central paresis of tongue muscles and lower paresis of tongue muscles and lower mimic musclesmimic musclesHemihypesthesia often joins all the other Hemihypesthesia often joins all the other symptoms. Vernike – Mann posture is symptoms. Vernike – Mann posture is typical for this lesion. typical for this lesion. HemianopsiaHemianopsia


4. 4. The lesion of brain stemThe lesion of brain stemalternating syndrome- central paralysis on the alternating syndrome- central paralysis on the opposite side and peripheral paralysis of face opposite side and peripheral paralysis of face muscles on the side of lesion. The last are muscles on the side of lesion. The last are divided into peduncle, pontine and bulbar ones.divided into peduncle, pontine and bulbar ones.

5. 5. The lesion of pyramidal decussation part of The lesion of pyramidal decussation part of motor waymotor way central paralysis of upper extremity on the side central paralysis of upper extremity on the side of lesion and paralysis of lower extremity on the of lesion and paralysis of lower extremity on the opposite side. Sometimes tetraplegia or triplegia opposite side. Sometimes tetraplegia or triplegia is observed.is observed.


6. 6. The lesion of motor way in lateral funiculus of spinal The lesion of motor way in lateral funiculus of spinal cordcordcentral paralysis below the level C1-C4, C5-Th1, central paralysis below the level C1-C4, C5-Th1, Th1- Th12, L1-S2Th1- Th12, L1-S2

7. 7. The lesion of anterior horns or motor nucleus of CNsThe lesion of anterior horns or motor nucleus of CNsperipheral paralysis of certain muscles with peripheral paralysis of certain muscles with fasciculation of muscles. Also there are early atrophy fasciculation of muscles. Also there are early atrophy and degenerative reaction.and degenerative reaction.

8. 8. Anterior roots lesionAnterior roots lesion peripheral paralysis. In most of cases it is observed peripheral paralysis. In most of cases it is observed only when several roots are damaged.only when several roots are damaged.


9. 9. The lesion of nerve plexusThe lesion of nerve plexus

peripheral paralysis , pain, sensory and peripheral paralysis , pain, sensory and autonomic disturbancesautonomic disturbances

10. 10. The lesion of peripheral nerveThe lesion of peripheral nerve

peripheral paralysis of the muscle , peripheral paralysis of the muscle , innervated by this nerve, pain, sensory innervated by this nerve, pain, sensory and autonomic disturbances.and autonomic disturbances.

principles of anatomical structures and function of nervous system. unconditioned reflexes. active...

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