NERVOUS SYSTEM

Alya Tursina, dr. SpS

FK UNISBA_NBSS_2015 21/09/2021 1
21/09/2021 2
The central nervous
system (CNS) is
composed of the brain
and spinal cord. These
neurons cannot
regenerate if damaged.

21/09/2021
•The peripheral
nervous system (PNS)
is made up of
peripheral nerves that
connect the CNS to
the rest of the body.
31 pairs of spinal
nerves
•12 pairs of cranial
nerves

21/09/2021 4
 PNS can be subdivided into 2
divisions:
 (1) Autonomic
 Cranial & spinal nerves
connecting CNS to heart,
stomach, intestines, glands
 Controls unconscious
activities

21/09/2021 5
21/09/2021 6
 Autonomic division of the nervous system can be
subdivided into 2 divisions:
 (1) Parasympathetic
 Decreases heart rate, bronchiole dilation, blood glucose,
blood to skeletal muscle
 Increases digestion, pupil size, urinary output
 “rest and digest”
 (2) Sympathetic
 Decreases digestion, pupil size, urinary output
 Increases heart rate, bronchiole dilation, blood glucose,
blood to skeletal muscle
 “fight or flight”

21/09/2021 7
CEREBRUM
Alya Tursina, dr. SpS

FK UNISBA_NBSS_2015 21/09/2021 8
FK UNISBA_NBSS_2015 21/09/2021 9
 Hindbrain
carries out
the most
basic
functions.
 Midbrain
coordinates
signals.
 Forebrain
processes
signals,
stores
memories,
creates
thought.

21/09/2021 10
 Gyri : fold,which greatly increase the surface area of the cortex

 Deepest groove between folds : fissure

 Shallow groove between folds : sulci

 The cerebrum is divided into left and right hemisphere by a longitudinal

fissure

.
21/09/2021 12
21/09/2021 13
21/09/2021 14
21/09/2021 15
21/09/2021 16
 Internal Structure of the Cerebral Hemispheres
• The cerebral
hemispheres are
covered with a layer of
gray matter, the
cerebral cortex.

• Located in the interior

of the cerebral
hemispheres are the
lateral ventricles,
masses of gray matter,
the basal nuclei, and
nerve fibers. The
nerve fibers are
embedded in
neuroglia and
constitute the white
matter
 The Cerebral Cortex

Frontal (Forehead to top) → Motor Cortex

Parietal (Top to rear) → Sensory Cortex
Occipital (Back) → Visual Cortex
Temporal (Above ears) → Auditory Cortex
Frontal •The primary motor area (cortex).
lobe
•Motor association area (motor control).
•Brocha's area - motor speech (production)
•Cognitive thought and memory.
•Personality
•Primary olfactory cortex.

Temporal •Primary auditory area (hearing).

lobe
•Auditory association area (hearing).
•Wernicke area (speech comprehension).
•Special senses (hearing, smelling).
•Learning and memory (retrieval).
•Emotions
Parietal lobe • Primary sensory area (cortex).
• Sensory association area (general senses).
• Body orientation.
• Primary gustatory cortex (taste).

Occipital lobe • Primary visual area (cortex).

• Visual association area (vision) - visual
interpretation.

Insula • senses (taste, hearing).

• Visceral sensation.
Region of the cerebral cortex :

1. Sensory areas
Receive & interpret sensory impulses

2. Motor areas
Initiate movements

3. Association areas
Deal with more complex integrative function as memory,
emotions, reasoning,will, judgment, personality traits,
& intelligence
•The white matter is composed of myelinated
nerve fibers of different diameters supported
by neuroglia.

•The nerve fibers may be classified into three

groups according to their connections:
(1) commissural fibers
(2) association fibers
(3) projection fibers.
1. Commisure fibers

• Commissure fibers essentially connect

corresponding regions of the two hemispheres.

• They are as follows:

- the corpus callosum → *splenium
*genu
*rostrum
- the anterior commissure
- the posterior commissure
- the fornix
- the habenular commissure.
2. Association fibers

Interconnect cortical regions within the same

hemisphere

(a) Short association fibers

The short association fibers lie immediately
beneath the cortex and connect adjacent gyri;
these fibers run transversely to the long axis of
- the sulci
.
(b)Long association fibers
Link one lobe with another
The superior longitudinal fasciculus

The arcuate fasciculus

The inferior longitudinal fasciculus

-The uncinate fasciculus

The cingulum

The fronto-occipital fasciculus

3. Projection fibers

Contain axons that Lower parts of the

conduct nerve CNS (thalamus,
impulses from the brainstem, spinal
cerebrum cord)

Lower parts of the

CNS (thalamus,
Cerebrum
brainstem, spinal
cord)
BASAL GANGLIA

FK UNISBA_NBSS_2015 21/09/2021 27
•The term basal nuclei / basal ganglia / striatum is applied
to a collection of masses of gray matter situated within
each cerebral hemisphere.

•They are : - the corpus striatum→ - Caudate nucleus

- Lentiform nucleus
* Putamen
* Globus pallidus

-the amygdaloid nucleus

-the claustrum.

•Function : The basal nuclei play an important role in the

control of posture and voluntary movement.
DIENCEPHALON

FK UNISBA_NBSS_2015 21/09/2021 31
• Diencephalon is the part of brain between the brainstem and
the cerebrum,surround the third ventricle
• Its main component are:
-Thalamus
-Subthalamus
-Epithalamus
-Hypothalamus
The thalamus is
covered on its
superior surface by
a thin layer of white
matter, called the
stratum zonale
and on its lateral
surface by another
layer, the external
medullary lamina

The gray matter of

the thalamus is
divided by a vertical
sheet of white
matter, the internal
medullary lamina,
into medial and
lateral halves
CEREBELLUM

FK UNISBA_NBSS_2015 21/09/2021 36
 Gerakan tubuh yang tepat dan halus selalu membutuhkan
koordinasi dari berbagai organ.
 Suatu gerakan volunter akan melibatkan cerebellum, sistem
penglihatan, sistem motorik, sistem sensorik.
 Cerebellum melakukan pengaturan kerja otot, sehingga
terjadi kontraksi otot yang tepat pada saat yang tepat.

21/09/2021 37
Secara filogenetik, serebelum dibagi atas 3 bagian besar :
 Archiserebelum (lobus flokulonodular)
Secara filogenetis merupakan bagian tertua
 Paleoserebelum (Spinocerebelum)
 Neocerebelum (Lobus posterior)

21/09/2021 38
21/09/2021 39
21/09/2021 40
21/09/2021 41
MENINGEN-VENTRIKEL
& CSS
Oleh : dr.Alya Tursina
Pembimbing : dr.Henny A.Sadeli,
FK UNISBA_NBSS_2015 SpS-K
21/09/2021 42
 Selaput otak yang terdiri
atas jaringan ikat berupa
membran

 Menyelubungi seluruh
permukaan otak, batang
otak dan medula spinalis

FK UNISBA_NBSS_2015 21/09/2021 43
 Skull

3.Dura mater

2. Arachnoid
 Terdiri dari 3 lapisan : mater
Subarachnoid
space
 A. LEPTOMENINX
1.Pia mater
1. Pia mater
Brain
2. Arakhnoid mater
 B. PACHYMENINX
3. Dura mater

FK UNISBA_NBSS_2015 21/09/2021 44
SCALP-PAD 45
FK UNISBA_NBSS_2015 21/09/2021
 Terdapat dua lapisan :

A. Lapisan luar dura mater →

daerah kepala bersatu dengan
periosteum tulang tengkorak,
melekat pada inferior sinus otak
dan sutura

B. Lapisan dalam duramater

FK UNISBA_NBSS_2015 21/09/2021 46
 Selaput tidak mengikuti
lekukan otak
 Banyak trabekula halus →
pia mater
 Ruang Subarachnoid :
→diantara lapisan arachnoid dan
piamater
 → berisi cairan serebrospinal dan
pembuluh darah
 Cisterna : r. subarakhnoid
yang melebar

FK UNISBA_NBSS_2015 21/09/2021 47
Villi Arakhnoid / Arakhnoid granulations :
pemanjangan lapisan arachnoid yang menembus
duramater masuk ke sinus sagitalis superior.
Fungsi : transfer CSS dari R. Subarakhnoid
ke dalam sistem venous

FK UNISBA_NBSS_2015 21/09/2021 48
 Selaput tipis melekat →
 Permukaan otak : mengikuti
lekukan dan fissura otak
 Permukaan batang otak
 Permukaan medulla spinalis
sampai ujung caudal medulla
spinalis setingg V.L2

© Copyright 2000-2005, BecomeHealthyNow.com, Inc.

FK UNISBA_NBSS_2015 21/09/2021 49
 Susunan ventrikel otak :
 1. Ventrikulus Lateralis Kiri dan Kanan
 2. Ventrikulus III (tertius)
 3. Ventrikulus IV (quartes)
FK UNISBA_NBSS_2015 21/09/2021 50
FK UNISBA_NBSS_2015 21/09/2021 51
 Luasnya tidak sama pd  Setiap ventrikel lateral
semua bagian, pada berhubungan dengan
pars sentralis berisi Ventrikel ke-3 melalui
plexus choroideus Foramen Intervenrikular
 Terdiri dari Monro
 Cornu Anterior
 Corpus (body)
 Cornu Posterior
 Cornu Inferior

FK UNISBA_NBSS_2015 21/09/2021 52
FK UNISBA_NBSS_2015 21/09/2021 53
 BATAS-BATAS :
 Lateral :
Diencephalon,
(thalamus, hipothalamus,
subthalamus)
 Rostral :
Lamina terminalis,
comissura anterior, fornix
 Dasar :
Hypothalamus
Chiasma opticum
FK UNISBA_NBSS_2015 21/09/2021 54
 Dasar Ventrikel III dekat
chiasma opticum terdapat
suatu penonjolan :
 Recessus opticus
 Recessus infundibular
 Recessus suprapineal
 Ventrikel III mempunya i:
 2 Foramen
interventrikulare Monroi
yang menghubungkan
dengan V.Lateralis
 1 lubang yang
menghubungkan dengan
aquaductus serebri sylvii

FK UNISBA_NBSS_2015 21/09/2021 55
 Merupakan Rhombencephalon
yang berbentuk belah ketupat
 Batas-batas :
 Ventral : Pons+Medulla Oblongata
 Dorsal : Cerebellum
 Kranial : Aquaductus Cerebri Sylvii
 Ventral : Pons+Medulla Oblongata
 Kaudal : Canalis Sentralis
 Atap Ventrikel IV :
 Kranial : Velum Medullare Anterior
 Kaudal : Velum Medullare Posterior
 Ditengah-tengah : Cerebellum Roof of the 4th Ventricle
FK UNISBA_NBSS_2015 21/09/2021 56
  Pada atap recessus lateralis
terdapat FORAMEN
LUSCHKA yang
menghubungkan Ventrikel
IV dengan spatium
subarachnoidale
 Pada ujung kaudal di garis
tengah terdapat FORAMEN
MAGENDIE
FK UNISBA_NBSS_2015 21/09/2021 57
FK UNISBA_NBSS_2015 21/09/2021 58
FK UNISBA_NBSS_2015 21/09/2021 59
 Rata-rata 0,35 ml/menit ~ 500ml/hari

 Total Volume sewaktu CSS harus dipertahankan 75-150

ml → CSS diganti setiap 4-5 kali per hari

 Siklus CSS :
 Pembentukan CSS
 Sirkulasi CSS
 Absorpsi CSS

FK UNISBA_NBSS_2015 21/09/2021 60
 80% dari Pleksus khoroideus
dinding ventrikel :
 Dasar dari masing-masing
ventrikel lateral (paling
penting dan paling banyak
 Atap dari ventrikel III dan
IV (sedikit)
 Pembuluh darah meningen,
otak dan medulla spinalis
(jml sedikit)
 Lapisan ependyma dan glia
penyokong

FK UNISBA_NBSS_2015 21/09/2021 61
 Menjaga keseimbangan neuron dan glia terhadap
pengaruh luar
 Pelindung mekanik terhadap benturan
 Sistem lymphe dalam pengeluaran sisa
metabolisme otak
 pH CSS dipengaruhi oleh ventilasi pulmonal dan
peredaran darah serebral

FK UNISBA_NBSS_2015 21/09/2021 62
 Sirkulasi dari ventrikel lateral →
 Foramen Monro → Ventrikel III
 Aquaductus sylvii → Ventrikel IV
 2 Foramen Luschka dilateral dan
1 Foramen Magendie di tengah
→ Perimeduler dan perispinal R.
Subarachnoid →
 Keluar menuju Basal dan
Sisterna Ambiens → permukaan
superior dan lateral hemisfer
serebri → Villi arachnoid →
 Bermuara ke Sinus Venosus

FK UNISBA_NBSS_2015 21/09/2021 63
Warna Tak berwarna, jernih Na 142-150 meq/L
Tekanan 70-200mmH2O K 2,2 – 3,3 meq/L
Sel 0,5 limfosit/mononuklear Cl 120-130 meq/L
CO2 25 meq/L
Glukosa 45-80 mg% Mg 2,7 meq/L
Protein 5-15 mg% ventrikel HCO3 23 meq/L
10-25 mg% cycterna
15-45 mg% lumbal

Gamma 5-22% dari total protein

globulin
Osmolalitas 295 m.osmol/L
pH 7,31

FK UNISBA_NBSS_2015 21/09/2021 64
STASE NEUROFISIOLOGI-ANATOMI