Basic Neurobehaviour and Special

Senses System (NBSS)

by Ivan Christian Channel
ivan-icch
ivanchristianch
 ORGANIZATIONAL EXPERIENCE
Institution Name Position Year
EFRAIM STUDENT’S COUNCIL OF SMPK 1 BPK Member of Section 3 : Promotion of Superior 2011 - 2012
PENABUR BANDUNG Personality, National Insight, and State Defense
EFRAIM STUDENT’S COUNCIL OF SMPK 1 BPK Coordinator of Section 1 : Development of Faith and 2012-2013
PENABUR BANDUNG Devotion to God Almighty
EKLESIA STUDENT’S COUNCIL OF SMAK 1 Member of Section 6 : Creativity, Skill, and 2014-2015
BPK PENABUR BANDUNG Entrepreneur
EKLESIA STUDENT’S COUNCIL OF SMAK 1 General Chairman of Eklesia Student’s Council of 2015-2016
BPK PENABUR BANDUNG SMAK 1 BPK PENABUR BANDUNG
GKI KEBONJATI 100 BANDUNG Administer of Teenager Commission 2016-2018

PMK FK Unpad Administer of Pray Department 2018

SCOPE CIMSA FK Unpad Member 2018
SRC FK Unpad Member of Scientific and Academic Study 2018

Rinengga Member of Rinengga 2018

Obscura Member of Obscura 2018
PSM FK Unpad Member of PSM Fk Unpad 2019
PMK FK Unpad Administer of Pray Department 2019
SCOPE CIMSA Fk Unpad Media and Communication Coordinator 2019

IFMSA IFMSA-certified Trainer 2019

CIMSA Indonesia Member of Research and Development Team 2019

 COMMITTEE EXPERIENCE
Committee Name Position Institution Name Year
Arvagata Division of Kinship FK Unpad 2017
Member of Publication and Documentation of
SCOPE
Exchange Fair

SCOPE Project Officer of March 2019 Social Program CIMSA FK UNPAD 2018

Member of Publication and Documentation for

CIMSA
Crush 3.0
BPM KEMA FK Member of Event Division Pemilu Kema FKUNPAD BPM KEMA FK
2017
UNPAD UNPAD
MABIM FK UNPAD BEM KEMA FK
Facilitator 2018
2018 UNPAD
CIMSA Member of Logistic Division of CGN 2019 CIMSA 2019
PMK Oikumene
Vice Leader of PMK Oikumene Christmas PMK FK Unpad 2019
Christmas
Achievement Name
ACHIEVEMENTS Year
The 1st Best Graduate of SDS BPK PENABUR THI 2011
The 1st Best Graduate of SMPK 1 BPK PENABUR BANDUNG 2014

The 1st Best LSP Program Graduate of SMAK 1 BPK PENABUR BANDUNG 2017

April Best Documentation Member of Division of Documentation FK Unpad Fair 2018 2018

1 st Year Program (Arvagata) Highest GPA in 2018 at FK Unpad (3.97)

2nd Year Program (Arvagata) Highest GPA in 2019 at FK Unpad (3.92) 2018, 2019, 2020

3rd Year Program (Arvagata) 2nd Highest GPA in 2020 at FK Unpad (3.93)

Bronze Medal at Seoul International Invention Fair November 2019 with an innovation topic “Free Antimicrobial
2019
Resistance Movement “FAIRMONT” Project

Gold Medal Paper International Competition “Free Antimicrobial Resistance (AMR) “Fairmont” Software Application: A
2020
Capstone in Fighting against AMR with Digital Technology” at Indonesia Inventors Day 2020 by WINTEX

Gold Medal Business Plan International Competition “Ettawa.Co : Best Enterprise Goat’s Milk In The Town” at Indonesia
2020
Inventors Day 2020 by WINTEX

Best Commercialization Award Business Plan International Competition “Ettawa.Co : Best Enterprise Goat’s Milk In The
2020
Town” at Indonesia Inventors Day 2020 by WINTEX
What did you think the first time you
heard about NBSS?
NEURO =

= BEHAVIOUR

SPECIAL
SENSES =
What we learn today
01 Anatomy of Brain and Spinal Cord

02 Ascending and Descending Tract

03 Cranial Nerves

04 Psychiatry Overview
Yuk kita pemanasan otak dulu!!!
Pemeriksaan Fisik apa yang mau dilakukan??
Diagnosis klinis nya apa yaa kira2 ??
Butuh pemeriksaan penunjang apa ya kira2?
Anatomy of
Brain and
Spinal Cord
 NEUROANATOMY OVERVIEW

“The nervous system is perhaps

the most beautiful, elegant, and
complex system in the body.”
 BASIC MACROSCOPIC
ORGANIZATION OF THE NERVOUS
SYSTEM
Main parts of the nervous system:
1. Central nervous system (CNS)
a. Brain
b. Spinal Cord
2. Peripheral nervous system (PNS)
c. Cranial nerves and ganglia
d. Spinal nerves and dorsal root ganglia
e. Sympathetic and parasympathetic nerves and ganglia
f. Enteric nervous system

Embryologically
The CNS forms from the neural tube.
The fluid-filled cavities within the neural tube develop into
brain ventricles that contain cerebrospinal fluid (CSF)
 EMBRYOLOGY OF THE CENTRAL NERVOUS
SYSTEM
The developing brain has 3 main divisions:
a. Prosencephalon / forebrain
1. Telencephalon  cerebral hemisphere,
cortex, and basal ganglia
2. Diencephalon  thalamus and hypothalamus
b. Mesencephalon / midbrain
c. Rhombencephalon / hindbrain
3. Metencephalon  pons and cerebellum
4. Myelencephalon  medulla (medulla
oblongata)

Brainstem refers to midbrain, pons, and medulla.

 control respiration, blood pressure, and heart
rate.
EMBRYOLOGY OF THE CENTRAL NERVOUS
SYSTEM
 CEREBROSPINAL FLUID (CSF)
Clear watery fluid which fills the space between the arachnoid membrane and
the pia mater.

It is formed by vascular tufts lying within the ventricles called choroid plexus.

CSF circulates from the lateral ventricles  third ventricles  fourth

ventricles  percolate the outside surface of brain and spinal cord between
arachnoid and pia mater  reabsorbed into the venous system

3 membranous protective layers of the CNS:

1. PIA MATER
2. ARACHNOID MATER
3. DURA MATER
 MENINGES
•Jaringan yang memisahkan jaringan saraf pada SSP dari tengkorak dan vertebrae
•Meninges tersusun atas 3 lapisan:
• Dura mater : lapisan luar yang melapisi otak. Terdapat subdural space di bawahnya
• Arachnoid (laba) mater : ruang dibawahnya disebut dengan subarachnoid space
(mengandung CSF dan pembuluh darah)
• Pia mater : lapisan dalam yang secara langsung melapisi otak dan spinal cord
ORIENTATION OF THE CNS IN REPTILES
ORIENTATION OF THE CNS IN HUMAN
 Basic Cellular and Neurochemical
Organizations of the Nervous System
Microscopically, the nervous system is composed of neurons (nerve cells), and
support cells called glial cells/glia.

Neurons are the basic units of signaling in nervous system, and it has:
a. Cell Body  containing nucleus
b. Dendrites  short processes
c. Axons  long processes
d. Synapes  to communicate between neurons
-. Chemical Synapes
-. Electrical Synapes

Types of neurons : unipolar (Invertebrates), bipolar (olfaction or vision nerve),

and multipolar (most of mammalian)
 Basic Cellular and Neurochemical
Organizations of the Nervous System
At chemical synapses, chemical neurotransmitter molecules (stored primarily in
synaptic vesicles) are released from presynaptic terminals and bind to
neurotransmitter receptors on the postsynaptic neuron.

When neuron is excited, action potential occurs (1 millisecond), propagating at 60

m/s, travel from dendritic end of the neuron along its axon to reach the presynaptic
terminals.

Action potentials trigger the release of neurotransmitter molecules, which functions

1. Mediate fast communication through EPSP and IPSP
2. Neuromodulation  regulate synaptic transmission and neuronal growth.
Types : small molecules, amino acids, and large molecules (peptides)
BRAIN
 Gray Matter and White Matter Concepts
White matter  areas of the CNS that made up of myelinated axons
(functions to transmit signals)
Several names for white matter : tract, fascicle, lemniscus, and bundle.
Commissure  white matter that connects right and left side of the brain
In the PNS  white matter (axons) are called peripheral nerves or nerves

Gray matter  areas of the CNS that made up of cell bodies

(function to mediate local synaptic communication)
Cerebral cortex  a unique mantle of gray mater covering cerebral hemispheres
Gray matter is also found as nuclei within cerebrum such as basal ganglia,
thalamus, and cranial nerve.
In the PNS  gray matter (cell bodies) are called ganglia
 Cerebral cortex
Cerebral cortex has numerous infoldings called sulci and ridges called gyri.

4 major lobes of cerebral hemispheres:

a. Frontal lobe
b. Temporal lobe
c. Parietal lobe
d. Occipital lobe
BRAIN SURFACE ANATOMY
BRAIN SURFACE ANATOMY
BRAIN SURFACE ANATOMY
BRAIN SURFACE ANATOMY
PRIMARY MOTOR AND SENSORY AREAS
CELL LAYERS OF THE CEREBRAL CORTEX
BROADMANN AREA
CEREBELLUM & BASAL GANGLIA
 THALAMUS
“An egg-shaped gray matter structures located deep within the
cerebral white matter just above the brainstem and behind the basal
ganglia”
The thalamus is an important relay center. Nearly all pathways
that project to cerebral cortex will synapse in the thalamus first.

Hypothalamus  an important region for control of autonomic,

neuroendocrine, limbic, and other circuits

Epithalamus  encompasses several small nuclei including pineal

body, habenula, and pretectum
 LIMBIC SYSTEM
Several structures in the brain are referred as the limbic system
because they are located near the medial edge of the cerebral
cortex.

Functions:
Regulation of emotions, memory, appetitive drives, and autonomic
and neuroendocrine control

Lesions in this area may cause:

Deficits in the consolidation of immediate recall into longer-term
memories, behavioural changes, psychiatric disorders, epileptic
seizures, memory distortions such as déjà vu, and olfactory
hallucinations
BLOOD SUPPLY TO THE BRAIN AND SPINAL CORD
BLOOD SUPPLY TO THE BRAIN AND SPINAL CORD
BRAINSTEM
 BRAINSTEM
Is composed of the midbrain, pons, and the medulla.
It is connected to the diencephalon rostrally, the cerebellum
dorsally, and spinal cord caudally.

Most of the cranial nerve arise from the brainstem.

Brainstem contains nuclei that play important roles in the

motor system, nausea and vomiting regulator, pain
modulation, heart rate, blood pressure, and respiration
controller.
 RETICULAR FORMATION
An important region of the brainstem that contains nuclei
forming a network-like appearance histologically which
extends throughout the central portions of the brainstem from
the medulla to the midbrain.

Lower/caudal  motor and autonomic functions

Upper/rostral  regulate level of consciousness
SPINAL
CORD
 SPINAL CORD
A long, fragile tube-like structure that begins at the end of the
brainstem and continues down to the bottom of the spine.
The spinal nerves arise from the segments of the spinal
cord, and each segment gives rise to sensory and motor
nerve roots

Dorsal nerve roots  convey afferent sensory information

Ventral nerve roots  carry efferent motor signals

There are cervical, thoracic, lumbar, and sacral spinal cord

 SPINAL CORD
•Spinal cord consists 8 cervical segments, 12 thoracic segments,
5 lumbar segments, 5 sacral segments, 1 coccygeal segment.
•Dorsal nerve roots : sensori/afferent
•Ventral nerve roots : motoric/efferent
•Cervical enlargement : brachial plexus
•Lumbosacral enlargement : lumbosacral plexus
The bony vertebral canal increases in length faster than the spinal
cord, therefore spinal cord ends at L1 or L2. Below this, the spinal
canal contains cauda equina.

Cervical enlargement is due to brachial plexus

Lumbosacral enlargement is due to lumbosacral plexus
 Ascending
and
Descending
Tracts
 MOTOR SYSTEMS  ventral/anterior
Involves a delicate balance between pathways and recurrent feedback loops

Main Motor Pathways

The most important motor pathway in humans: the corticospinal tract / pyramidal
tract
1. Upper motor neurons  from the cortex to the spinal cord/brainstem
2. Lower motor neurons  located in the anterior horns/central gray matter of the
spinal cord or in the brainstem motor nuclei
MOTOR SYSTEMS
Involves a delicate balance between
pathways and recurrent feedback
loops
SOMATOSENSORY SYSTEMS  dorsal/posterior
Thalamus : a major relay center of all kinds of signals travelling to cerebral cortex

Main Somatosensory Pathways

Two main pathways in the spinal cord for somatic sensation:
Posterior (Dorsal) Column Pathway
Spinothalamic Tract
ANTERIOR SPINOCEREBELLAR TRACT
 STRETCH REFLEX
The monosynaptic stretch reflex is a reflex arc that provides rapid
local feedback for motor control.

Muscle spindles (detecting the amount and rate of stretch in

muslces)  distal processes of sensory neurons  dorsal root 
spinal gray matter  form multiple synapses  direct synapses
onto LMNs in the anterior horn  ventral root  back to the muscle
 contraction

Examples : deep tendon reflex

COMPLETE CORD
TRANSECTION
SYNDROME
ANTERIOR CORD
SYNDROME
CENTRAL CORD
SYNDROME
BROWN-SEQUARD
SYNDROME
Cranial Nerves
CRANIAL NERVES
A. Olfactory nerve I- sensory nerve for smell, it runs below the
frontal lobe, purely sensory, cerebrum
B. Optic nerve II- a brain tract exiting through the optic chiasma, it
sends signals of images to the brain, purely sensory, cerebrum
C. Oculomotor nerve III- caudal to optic chiasma it innervates internal eye muscles
to move the eye (superior, inferior, lateral, medial rectus) and eyelids. It adjust the
pupil and lens. Motor nerve, visceral motor, and proprioceptive, midbrain
D. Trochlear nerves IV- (pulley) it inervates the superior
oblique muscles of the eye. Motor nerve, midbrain
E. Trigeminal nerves V – (three fold)- it has three branches that carry
sensory information from the face (superficial and internal) and motor
information for chewing muscles. Mixed, pons
F. Abducens nerves VI-  innervates a muscle that abducts the
eye ( lateral rectus), motor nerve, pons
 G. Facial nerves VII- innervates muscles of facial expression,
activates facial glands, conveys sensory from taste buds. Mixed
and visceral motor, pons
Yuk kita pemanasan otak lagee!!!
 Anamnesis
RPS
Identitas : Ms. Z, wanita, usia 25 tahun

Keluhan Utama : Mulut mencong ke kiri serta mata kanan tidak bisa menutup sejak 2 hari
SMRS.

Keluhan pertama dirasakan secara tiba-tiba ketika pasien sedang berkaca dan merasa bibir
bagian kanan lebih turun dan tidak mengangkat ketika tersenyum. Keluhan lain, yaitu pasien
tidak dapat mengangkat alis sebelah kanan. Keluhan tidak disertai dengan bicara rero dan
kelemahan anggota gerak sisi. Pasien dalam keadaan hamil. Pasien merasa mata kanan nya
menjadi tidak nyaman karena tidak bisa ditutup secara sempurna dan merasa sulit tidur di
malam hari. Pasien menyangkal adanya riwayat demam, nyeri di telinga, penurunan
pendengaran, keluhan pada mata, kencing manis dan riwayat keluarga yang memiliki keluhan
serupa. Riwayat operasi di daerah telinga/wajah juga disangkal.
 Pemeriksaan Fisik
Umum
Tanda-Tanda Vital
Keadaan Umum
❖ Tekanan darah : 120/80 mmHg
❖ Keadaan: sakit ringan
❖ Denyut nadi : 80x/menit
❖ Kesadaran : compos mentis
❖ Respirasi : 22x/menit
❖ Suhu : 37,3˚C
 Pemeriksaan Fisik
Status Interna
Status Interna
❖ Kepala: ❖ Abdomen :
➔ Konjungtiva anemis (-) ➔ Datar, lembut
➔ Sklera ikterik (-) ➔ Bising usus normal
❖ Leher: ➔ Nyeri tekan (-)
➔ Pembesaran kelenjar getah bening (-) Tekanan vena ➔ Hepar dan lien tidak teraba
jugular tidak meningkat ❖ Ekstremitas :
❖ ➔ Akral hangat, capillary refill time < 2 detik
Thoraks:
➔ Bentuk dan gerak simetris ➔ Edema (-) / (-)
➔ Jantung: bunyi jantung S1-S2 murni regular, ➔ Turgor baik
murmur (-)
➔ Paru: Vesicular breathing sound kanan = kiri,
Ronchi (-) / (-) Wheezing (-) / (-)
 Pemeriksaan Fisik
Status Neurologis
Status Neurologis
❖ Pemeriksaan umum
➔ Kepala : normocephal
➔ Column vertebra : tidak ada deformitas

❖ Tanda rangsang meningen dan iritasi radikal spinal

➔ Kaku kuduk (-)
➔ Brudzinsky I/II/III/IV (-/-/-/-)
➔ Test Laseque (-/-)
➔ Test Kernig (-/-)
 Pemeriksaan Fisik
Status Neurologis
❖ Saraf Otak
➔ Saraf ke-I : Penciuman baik ➔ Saraf ke-V:
➔ Saraf ke-II: - Motorik : baik / baik
- Tajam penglihatan : Baik - Sensorik : baik / baik
- Lapang pandang : Baik - Refleks kornea : (+) / (+)
➔ Saraf ke-III/IV/VI:
- Ptosis (-) / (-) ➔ Saraf ke-VII:
- Pupil bulat isokor diameter 3 cm ODS - Motorik:
- Refleks cahaya (D/I) (+) / (+)
- Posisi mata di tengah Parese : kanan perifer
- Gerakan bola mata baik ke segala arah Gerakan involunter : -
- Nistagmus (-) - Sensorik:
Rasa kecap (2/3 bagian depan lidah): bagian
kanan tidak bisa merasakan manis, asam, asin
- House-Brackmann : grade 5
 Pemeriksaan Fisik
Status Neurologis

➔ Saraf ke-VIII: ➔ Saraf ke-XI:

- Pendengaan : baik / baik - Angkat bahu : baik / baik
- Keseimbangan : baik - Menengok kanan kiri : baik / baik

➔ Saraf ke-IX/X: ➔ Saraf ke-XII:

- Suara atau bicara : baik - Gerakan lidah : tidak ada deviasi
- Menelan : baik - Atrofi : (-)
- - Tremor/fasikulasi : (-)
Kontraksi palatum : simetris
- Refleks faring : (+) / (+)
- Refleks kecap 1/3 belakang : baik
 Pemeriksaan Fisik
Status Neurologis
Status Neurologis
❖ Sistem Sensorik :
❖ Sistem Motorik : ➔ Anggota Badan Atas
➔ Anggota badan atas: - Eksteroseptif : Baik / Baik
- Kekuatan otot 5/5, normotonus, atrofi (-), - Proprioseptif : Baik / Baik
fasikulasi (-)
➔ Anggota Badan Bawah
➔ Anggota badan bawah: - Eksteroseptif : Baik / Baik
- Kekuatan otot 5/5, normotonus, atrofi (-), - Proprioseptif : Baik / Baik
fasikulasi (-)
➔ Gerakan involunter : (-)
 Pemeriksaan Fisik
Status Neurologis
Status Neurologis
❖ Refleks Patologis :
❖ Refleks Fisiologis
➢ Biceps : +2/+2 Babinski: -/- Chaddock : -/-
➢ Triceps : +2/+2 Hoffman Tromner : -/- Oppenheim : -/-
➢ Brachioradialis : +2/+2
➢ Patella : +2/+2 Gordon : -/- Schaefer : -/-
➢ Achilles : +2/+2 Mendel Bechterew : -/- Rossolimo : -/-
➢ Abdomen:
➔ Epigastrium : Tidak diperiksa ❖ Refleks Primitif :
➔ Paragastrium : Tidak diperiksa
➔ Hipogastrium : Tidak diperiksa Glabela : - Mencucu : -
Memegang : - Palmomental : -
KIRA2 DIAGNOSIS NYA APA YAAA?????
 Diagnosis Kerja

❖ Parase Nervus VII dekstra perifer et causa Bell’s Palsy

❖ Bell’s palsy adalah suatu kelumpuhan saraf fasialis perifer yang

bersifat unilateral, penyebabnya tidak diketahui (idiopatik), akut
dan tidak disertai oleh gangguan pendengaran, kelainan
neurologi lainnya atau kelainan lokal.
❖
H. Vestibulocochlear nerves VIII- sensory nerve for hearing
and equilibrium, purely sensor, medulla oblongata
 I.  Glossopharyngeal nerves IX.  innervates the tongue and pharynx,
controls a muscle used for swallowing, activates salivary gland, conducts
taste, and  other facial sensory. Mixed and visceral motor, medulla oblongata
 J. Vagus Nerves X- (wanders) controls muscles of swallowing extends beyond the face
and neck into the thorax and abdomen to innervate internal organs for motor and sensory
impulses, some sensory near ear area. Mixed and visceral motor, medulla oblongata.
K. Accessory nerves XI- accessory for the vagus nerve- it joins it, and
controls muscles that moves the head and some of the same as the
vagus.  Motor and visceral motor, medulla oblongata.
 L. Hypoglossal nerves XII- (below the tongue) runs below the
tongue and innervates the tongue muscles, motor nerves, medulla
oblongata.
Psychiatry
Overview
 What is psychiatry?
Psychiatry is the branch of medicine focused on the diagnosis,
treatment and prevention of mental, emotional and behavioral
disorders.

A psychiatrist is a medical doctor (an M.D. or D.O.) who specializes

in mental health, including substance use disorders. Psychiatrists
are qualified to assess both the mental and physical aspects of
psychological problems.
THANK YOU FOR YOUR ATTENTION