You are on page 1of 43


Henny Anggraini Sadeli

Department of Neurology Dr. Hasan Sadikin Hospital Medical Faculty PadjadjaranUniversity Bandung

Sensation and perception of the internal / external environment and the response of the

organism achieved through the integrated

operation of the sensory system

RECEPTORS The end organs of afferent nerve fibers Receptors Classification :

Receptors function (Sherringtons) Receptors location
Heads classification

According to receptors functions (Sherringtons)

1. Exteroceptors : mediating superficial sensation
1.1. Mechanoreceptors ( touch, pressure )

Meissners corpuscles touch

Merkels corpuscles Hair cells corpuscles pressure touch

Paccinian corpuscles vibration, tickle

1.2. Thermoceptors ( cold, heat ) Krauses end bulbs cold Ruffinis cylinder warm / heat 1.3. Nociceptors ( pain ) Free nerve endings

2. Proprioceptors mediating deeper somatic structurs inform of muscle, joint position Golgi tendon Muscle spindles

Paccinian corpuscles
Golgi Mazzoni corpuscles

3.Interoceptors within visceral tissue & blood vessels

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


The Sensory Pathways

Three sensory neuron.

Nerve fibers :
unmyelinated fibers : C fibers* myelinated fibers : A-alfa fibers, A-beta fibers* (6-16um) A-gamma fibers, A-delta fibers* (2-6um)

1st neuron ganglia N.V )

Peripheral Nerves

spinal root ganglia ( cranial nerve

2nd neuron

Spinal Cord tophografic

3rd neuron

Thalamic Cerebral Cortex somatothopic

Anterior and posterior spinocerebellar tracts

a specific segmental territory of the skin to make certain about location of the lesion

Vertebras Cervical Thoracal Lumbal 7 12 5

Spinal nerves 8 12 5





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

Segment Th 12 LS vertebrae Th IX XII,


Head Innervations

Autonomous Zones


Negative symtoms : sensory loss e.g hypesthesia hypalgesia
Positive symtoms : pain e.g stabbing pain , burning pain paraesthesia , dysesthesia hyperesthesia , allodynia


Types of pain : Nociceptive pain Inflammatory pain Neuropathic pain Functional pain


1.Peripheral nerves lesion

Mononeuropathy, mononeuropathy multiplex e.g traumatic compression inflammation infection of M. Hansen

Diabetes Mellitus

immunology toxic ( e.g alcohol,Co, Pb ) vit B1 deficiency Diabetes Mellitus

Gullain Barre Syndrome :

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 )

Tabetic crises Extradural, extramedularry tumor

HNP Between L IV V or L V S I Radicular pain.

pain increases with cough, snezzing, straining

Positif Laseque test / Nafziger test Sometimes motor paralysis

Syndrome of Root Damage (Radiculopathy)

Syndromes of Epiconus, Conus and Cauda Equina

2. Spinal cord lesion

. Brown Sequard syndrome

Caused by hemisection of the spinal cord ( tumor, traumatic, compression fracture ) Dorsal funiculus spinal thalamic tract

spinocerebellar tract
corticospinal tract Below the lesion

Ipsilateral loss proprioceptive & ataxia

Contralateral loss of exteroceptive Ipsilateral motor paralysis

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

The central canal of the spinal cord

Subacute combined degeneration Degeneration of the posterior & lateral column Loss of proprioceptive

In the advanced cases of pernicious anemia ( vit. B12 deficiency )

Friedreichs ataxia

A familial & hereditary disease

Degeneration of the cerebellum, dorsal & ventral spinocerebellar tracts, lateral corticospinal tracts

Gliosis of the posterior column


cerebellar disartri
ataxia loss of proprioceptive

3. Brain stem lesion

Medulla oblongata
Wallenbergs Syndrome ( lateral medulla syndrome ) Occlusion of the main trunk of the post. inf. cerebellar artery Alternans hemihypesthesia

( spinothalamic tracts & N.V )

Ipsilat weakness of the vocal cords & pharinx ( N.IX, X ) Nistagmus, vertigo, vomitus ( N.VIII vestibularis ) Ipsilat ataxia ( spinocerebellar tract ) Contralat hemiparalysis Loss of sense of taste ( solitarius tract )
Pons Mesencephalon

4. Thalamic lesion Thalamic pain : central pain paresthesia allodynia

Weakness Ataxia