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SPECIAL SENSES AND CLINICAL NEUROLOGY ASPECT

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Anwar Wardy W SpS (K), DFM FKK UMJ

4 CLASSIFICATIONS OF CRANIAL NERVES


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1.

Sensory nerves:

carry somatic sensory information:

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touch, pressure, vibration, temperature, and pain

2.

Special sensory nerves:

carry sensations:

smell, sight, hearing, balance

3.

Motor nerves:

axons of somatic motor neurons

4.

Mixed nerves:

mixture of motor and sensory fibers

THE SENSORY SYSTEM IS DIVIDED INTO 2 SECTIONS:


The somatic sensory system is the system responding to information from the skin, muscles

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and viscera (organs).

The special senses are taste, smell, vision and

hearing.

RECEPTORS
Receptor

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Specialized cell or multicellular structure Collects information about the environment Sends information via afferent pathways to spinal cord and brain. Cerebral cortex then processes information.

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RECEPTORS
Types

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of receptors

Chemoreceptors
Sense changes in chemical concentration. Ex: smell and taste

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Pain receptors (nociceptors)

Sense tissue damage from excess stress on tissue.

Thermoreceptors

Sense temperature change

RECEPTORS
Types

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of receptors (cont)

Mechanoreceptors
Sense changes that deform the receptor Sense change in tensions of muscles and tendons. Sense changes in blood pressure in blood vessels. Sense changes in tissue length (found in lungs). Sense changes in light intensity.

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Proprioceptors

Baroreceptors

Stretch receptors

Photoreceptors

SENSORY IMPULSES
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Stimulasi reseptor menyebabkan perubahan potensial membran yang menghasilkan aksi potensial dalam serabut sensorik.

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Jadi semua reseptor pada dasarnya melakukan hal yang sama; ..mereka menerima informasi tentang lingkungan dan perubahan menjadi informasi elektrokimia sehingga dapat diproses oleh sistem saraf .

SENSATION
Ketika impuls sensorik diproses oleh otak dan menghasilkan sensasi. Otak menginterpretasikan sensasi yang berasal dari daerah impuls proyeksi.

So from the persons perspective, the sensation is occurring in one area of the body, but the processing of the actual feeling of the sensation is occurring in the brain.

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SENSATION
When receptors are continually stimulated they become less responsive to the stimulussensory adaptation. Example: hot and cold

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SPECIAL SENSES
This concludes the review of the somatic sensory system. We will now investigate the special senses

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Smell

Feel

Taste
Hearing

Vision

SeNsE and PerCepTiOn


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Lihat Cium

Dengar

Raba Rasa

SPECIAL SENSES
Smell
Sensed

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via olfactory receptors in olfactory organs


Chemoreceptors Smell and taste work together 75-80% of flavor comes from sense of smell.

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SPECIAL SENSES
Smell (pathway)

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Olfactory receptors stimulated by substance. Nerve impulse travels via fibers running through cribriform plate of ethmoid bone. Fibers synapse with neurons located in olfactory bulbs (crista galli of ethmoid bone). Impulses are analyzed and travel along olfactory tracts to limbic system (smell may be linked to memory).

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SPECIAL SENSES
Taste
Taste buds located on surface of tongue (papillae) (also on roof of mouth, linings of cheeks and walls of pharynx. Chemoreceptors (taste cells) pick up dissolved substances.

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SPECIAL SENSES
Taste
There are 4 primary taste sensations. So all tastes are combinations of these 4 primary tastes.
1. 2. 3. 4.

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Sweet Sour Salty Bitter

SPECIAL SENSES
Taste is carried by cranial nerves and is processed in the parietal lobe.
Sensory impulses on anterior 2/3 of tongue travel via CN VII. Posterior 1/3 of tongue = CN IX Smell Base of tongue = CN X Impulses travel to medulla oblongata thalamusparietal lobe.

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SPECIAL SENSES
Hearing is processed by the ear. The ear is divided into 3 main divisions:

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Externalmiddleinner ear

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Well first look at the external ear

HEARING
External Ear

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Auricle (pinna) (outer portion you see) External auditory meatus (passes into temporal bone) EAM lined with skin that contains ceruminous glands that secrete cerumen (wax).

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TYMPANIC MEMBRANE
Middle ear

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Tympanic membrane marks boundary between external and middle ear.


Has thin layer of skin on outside and mucous membrane on inside. Proximal to tympanic membrane is the tympanic cavity.

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Middle ear
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Contains

3 small bones (auditory

ossicles)
Incus Malleus Stapes

The stapes or stirrup is connected to the inner ear at the oval window. The oval window marks the start of the inner ear.

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THE MIDDLE EAR


Other structures of the middle ear include: Tensor tympani muscle Stapedius muscle Eustachian tube (auditory tube)

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EUSTACHIAN
(auditory) tube
Connect

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Eustachian (auditory) tube


middle ear to throat. Equalizes air pressure on both sides of eardrum.

INNER EAR

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Cochlea

Functions in hearing
Equilibrium, balance Between cochlea and semicircular canals

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Semicircular canals (3)

Vestibule

VESTIBULE
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The vestibule contains the utricle and saccule which are both important structures in sensing equilibrium. The cochlea senses hearing.

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COCHLEA
Looks like a snails shell wound around a bony core (modiolus). Upper and lower compartments

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Upper = scala vestibuli Lower = scala tympani extends to round window.

AUDITORY
PATHWAY
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Transverse temporal gyrus Acoustic radiation Medial geniculate body Lateral lemniscus

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Cochlear nuclei Trapezoid body


Cochlear nerve Spinal organ Bipolar neuron of cochlear ganglion

HEARING
Sound is transmitted through the air as waves. The sound waves then enter the external auditory meatus and travel to typmpanic membrane (eardrum). The tympanic membrane moves in response to the sound waves.

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HEARING
In the middle ear, sound travels from tympanic membrane to malleus (connected to membrane) then to the incus and stapes. The stapes is connected to oval window. The stapes acts as piston to move fluid in inner ear.

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HEARING
The ossicles also act as lever to amplify sound (from tympanic membrane to oval window). Small muscles attach to ossicles called the tensor tympani and stapedius. These muscles are important in what is called the tympanic reflex.

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HEARING
The tympanic Reflex is a protective mechanism:

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Muscles contract with loud sound and restrict movement of ossicles (and amplification of sound to inner ear). Also muffles lower frequency sounds during speech (for better understanding) Tensor tympani muscle maintains some tension on tympanic membrane for efficient transmission of sound.

PERILYMPH
Inside the inner ear are chambers filled with fluid. The scala vestibuli and scala tympani are filled with a fluid called perilymph. The cochlear duct is filled with a fluid of a different density called endolymph.

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THE ORGAN OF CORTI


The organ of corti contains 2 membranes called the tectorial and basilar membranes. There are special sensory cells called hair cells between them.

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THE SOUND WAVES


The sound waves are transferred to the fluid filled chambers (scala) by the movement at the oval window caused by the movement of the ossicles.

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The vibrations in the fluid cause the tectorial membrane to move in relation to the basilar membrane. The movement is picked up by the hair cells that relay an impulse to the nervous system via cranial nerve 8 (vestibulocochlear nerve).

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Some impulses cross to contralateral side of cortex. So damage to one side of temporal region does not cause complete hearing loss.

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FUNCTIONS OF THE EAR


Now that we have seen how sound is processed, lets look at the other functions of the ear Static equilibrium

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Dynamic equilibrium

BALANCE AND EQUILIBRIUM

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Static equilibrium is sensed in small organs located in vestibule called the utricle and saccule. Each contains an area called a macula.

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Inside the utricle and saccule is a macula.

BALANCE AND EQUILIBRIUM


Static equilibrium is sensed:

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When head is upright hairs of macula in utricle project vertically and hairs in saccule project horizontally. Hairs contact calcium carbonate crystals (otoliths). Hairs bend in response to gravity changing position of otoliths. This causes impulses to be sent to central nervous system via vestibulocochlear nerve. Brain responds by sending motor impulses to skeletal muscles to correct and maintain balance.

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BENIGN POSITIONAL VERTIGO.


Sometimes the otoliths can get out of position. This can cause a condition called benign positional vertigo. The otoliths can be repositioned by a relatively easy maneuver. The next slide contains a link to see this maneuver.

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DYNAMIC EQUILIBRIUM
Dynamic equilibrium is sensed by the semicircular canals. There are 3 semicircular canals because we live in 3dimensional space.

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FLUID MOVES
When a person moves, fluid inside the semicircular canals moves the cupula. The movement of the cupula bends the hair cells. The hair cells then send impulses to the vestibular portion of cranial nerve 8.

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THE OPTIC NERVES (II)

Figure 1420

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OPTIC NERVES (II)


Primary

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function:

special sensory (vision)


retina of eye optic canals of sphenoid diencephalon via optic chiasm

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Origin: Pathway: Destination:

OPTIC NERVE STRUCTURES

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Optic chiasm:

where sensory fibers converge and cross to opposite side of brain

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Optic tracts:
reorganized axons leading to lateral geniculate nuclei

EYENEURO CASE
Conjunctiva

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Mucous membrane lining inner surface of eyelids and folds back to cover surface of eyeball.

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Lacrimal

apparatus

Consists of lacrimal gland and series of ducts. Tears move from lacrimal gland across eye superior and inferior canaliculilacrimal sac nasolacrimal ductnasal cavity. Tears contain lysozyme (enzyme with antibacterial properties) to inhibit infections.

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VISUAL PATHWAY
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Optic nerve Optic chiasma Optic tract

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Lateral geniculate body

Optic radiation

Visual area

EYE MUSCLES
There are 6 different eye muscles that move the eye:
Eye

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muscles

Superior rectus Inferior rectus Medial rectus Lateral rectus Superior oblique Inferior oblique

EYE MUSCLES
Damage to any eye muscles causes double vision. Eyes will normally track together to follow a moving object. This movement is called conjugate eye movement. If eye muscles or the cranial nerves controlling the eye muscle movements are damaged the eyes cannot track properly. This leads to double vision (diploplia).

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PUPIL
The pupillary reflex occurs when light enters the eye and pupil constricts. The reflex is carried by 2 cranial nerves: Afferent pathway follows cranial nerve 2 (optic) frontal lobes Efferent pathwaycranial nerve 3 (PS) light reaction

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PUPILLARY REFLEXES
Sphincter pupil Ciliary muscle
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Ciliary ganglia Occculomotor n.

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Accessory oculomotor nuclei

Pretectal area

PUPILLARY REFLEX
So, if a light is shown into one eye and the pupil on the same side constricts what cranial nerves are we testing?
CN

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II and III on same side (unilatareal) This is called the direct reflex.

PUPILLARY REFLEX
Or, if a light is shown into one eye and the pupil constricts on the other side, what cranial nerves are we testing? CN II on the same side of constriction and CN III on the opposite side. This is called the consensual reflex.

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PUPILLARY REFLEX
How does the pupil constrict? There is a small sphincter muscle around the pupil.

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PUPILS
If the sympathetic nervous system is involved in producing the fight or flight response, would the pupil constrict or dilate when the SNS is active? Dilateto let more light in (mydriasis) Opposite response for PNS stimulation.

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2 TYPES OF RECEPTORS
The light coming into the eye is sensed by receptors in the retina. There are 2 types of receptors:

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Rods

Cones

VISUAL RECEPTORS
Rods

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Hundreds of times more sensitive to light than cones Provide vision in poor light. Produce colorless (black and white) vision. Nerve fibers converge so impulses produce more general outlines. Concentration of rods increases in areas away from fovea centralis.

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That means that your peripheral vision is better in the dark than your direct vision.

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VISUAL RECEPTORS
Cones
Provide

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sharp images Nerve fibers do not converge as much so impulses produce more detailed images. Concentration of cones greatest in fovea centralis. Concentration of cones decreases in areas away from fovea centralis.

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VISUAL PIGMENTS
Rods contain rhodopsin (visual purple)
Light causes rhodopsin to change shape and release opsin which acts as an enzyme in further reactions. Net result is hyperpolarization directly proportional to intensity of light stimulus. Rhodopsin replenished in dim light. In dim light, a rhodopsin-replenished eye is said to be dark-adapted (can see in dark).

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VISUAL PIGMENTS
Cones contain iodopsins
A group

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of pigments sensitive to light waves of different frequencies. If all are stimulated = white light If none are stimulated = black

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VISUAL NERVE PATHWAYS


Optic

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nerve Optic chiasma


Medial fibers cross over Lateral fibers do not cross over So medial of right eye and lateral of left eye = left optic tract. Fibers continue through thalamus via optic radiations to visual cortex of occipital lobes.

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VISUAL FIELD
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This means that the visual field in one eye is actually processed on both sides of the brain; Monoculer field defect ant. Optic chiasm. Bitemporal field defectoptic chiasm. Homonymous field defectBehind OC Congruous homonymous fdBehind the lateral geniculate bodies.

SISTEM SOMATO SENSORIK


Eksteroseptif

: superfisial, raba, nyeri, suhu Propioseptif : gerak, sikap, otot dan sendi, getar, tekan dalam Viseral : lapar, enek Sensasi khusus: melihat, mendengar

Lesi di thalamus

Lesi traktus spino thalamikus

GANGGUAN SENSIBILITAS PADA


POLINEUROPATI

Bentuk sarung tangan dan kaos kaki

POLA DERMATOM SISTEM SOMATO SENSORIK


Rostal = mulut Kaudal = anus Perhatikan :

Bahu C5 Tangan C6 C8 Puting susu T4 Pusar T10

DISTRIBUSI DERMATOM CAUDAL + KAKI

DISTRIBUSI DERMATOM
= Daerah kulit : dipersyarafi akar posterior dan ganglionnya.

Muka

Belakang

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