Principles of anatomical structures and
function of nervous system. Unconditioned
reflexes. Active movements system
(symptomatic and topical diagnostics of
movement disturbances)
Prof. S.І. Shkrobot
Neurology 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 system
The main function of nervous system is
unification and regulation of
different physiological processes.
That means that nervous system
unites, integrates and
subordinates all the parts of
human body and provides its
connection with environment.
Functions of nervous system
The base of nervous system activity is
reflex principle
Reflex – is a reaction of our organism to
various outside and inside effects. It is
provided by nervous system.
Reflex consists of:
afferent part (which accepts information)
central part (that keeps information)
efferent part (that creates response).
As a result we have a circle – like structure receptor (primary information centre) –
programme centre – executive apparatus.
Reflex arche
Reflexes are divided into:
simple and complex
inborn and trained
conditioned and unconditioned
Unconditioned reflexes:
They are inborn ones
They are phylogenetically old, that means they
were formed in course of phylogenesis
They are based on certain anatomic structures
(segments of spinal cord or brain stem)
They exist even without brain cortex influence
They are inherited
They can be regulated by brain cortex
They are basis for the conditioned reflexes
Conditioned reflexes:
They are the result of the individual experience
and are formed during ontogenesis
They are unstable, that means they need
constant support
They aren’t based on certain anatomic
structures
They are fixed in brain cortex
There are such conditioned reflexes as speaking,
writing, reading, calculation, practice
Unconditioned reflexes are divided
into:
Superficial and deep
Simple and complex
Unconditioned reflexes are divided
into:
Proprioceptive (stretch, periosteal, joint)
Exteroceptive (dermal, from mucouse
membrane)
Interoceptive (from mucouse membrane of
internal organs – for example urination in
case of internal sphincter irritation)
In clinical practice we evaluate the following reflexes:
Reflex
The group
reflex
Subeyesbrow
Deep,
reflex
Corneal (lid)
Nerves
Segments
periostal M.
orbicularis N. trigeminus ( V ) Medulla
oculi
– N.facialis (VII)
oblongata
pons
Superficial,
mucose
membrane
Jaw
Jerk Deep,
(mandibular, chin, reflex
masseter) reflex
(Bechterev’s)
of Muscles
from M.
orbicularis N. trigeminus ( V ) Medulla
oculi
– N.facialis (VII)
oblongata
pons
periostal M.masseter
N. trigeminus ( V ) Medulla
–
N.mandibularis oblongata
(sensory and motor pons
)
Pharyngeal
Superficial,
mucose
membrane
from Mm.
constrictores
pharyngis and
others
N.glossoMedulla
pharyngeus,
oblongata
n.vagus
(sensory
and motor), 9th and
10th pair of CCN
Palatal (palatine)
Superficial,
mucose
membrane
from Mm. levatores N.glossoMedulla
velli palatini
pharyngeus,
oblongata
n.vagus
(sensory
and motor)
and
and
and
Biceps
Deep,
reflex
stretch M.biceps brachii N.musculocutaneus
C5-C6
Triceps
Deep,
reflex
stretch M.triceps
brachii
C7-C8
Radial (carporadial, Deep, periostal Mm.pronatores
brachioradial)
reflex
flexores,
digitorum,
brachioradialis,
biceps
N.radialis
N.medianus, N. C5-C8
radialis,
N.
musculocutaneus
Scapulo- humeral Deep, periostal Mm.
teres N.
(scapuloperiosteal) reflex
major,
subscapularis
reflex (Bechterev’s)
subscapularis
C5-C6
Upper
superficial Superficial,
abdominal
dermal
Mm.
N.intercostales
transversus,
obliquus, rectus
abdominis
D7-D8
Middle
superficial Superficial,
abdominal
dermal
Mm.
N.intercostales
transversus,
obliquus, rectus
abdominis
D9-D10
Lower superficial Superficial,
abdominal
dermal
Mm.
transversus,
obliquus,
rectus
abdominis
N.intercostale
s
D11-D12
Cremasteric
M.cremaster
N.genitofemoralis
L1-L2
Knee jerk, or Deep, stretch M.quadriceps
patellar
reflex reflex
femoris
(quadriceps
stretch reflex)
N.femoralis
L3-L4
Achilles
jerk)
N.tibialis
(n.ischiadicus
S1-S2
Superficial,
dermal
(ankle Deep, stretch M.triceps
reflex
surae
Plantar (sole)
Superficial,
dermal
Mm. flexores N.ischiadicus
digitorum
pedis
and
others
L5-S1
Anal
Superficial,
dermal
M.sphinter ani Nn.
externus
anococcygei
S4-S5
Motor system
Provides conduction of nervous impulse
from brain cortex to muscles.
The way of this impulse is known as
motorway or tractus corticomuscularis.
It consists of two neurons:
central
peripheral
Upper and lower extremities, neck, trunk
and perineum muscles’ innervation
The first (central) neuron is called
tractus corticospinalis.
The second (peripheral) neuron is called
tractus spinomuscularis.
The first (central) neuron
The first (central) neuron
tractus corticomuscularis
tractus corticomuscularis
Spinal nerve gives 4 branches:
ramus anterior ( together they form plexus
– cervical, brachial, lumbar and sacral)
ramus posterior (it is spinal nerve, which
innervates posterior trunk muscles)
ramus meningeus
ramus comunicante albi
Conclusions:
The muscles of upper and lower
extremities have unilateral cortical
innervation from contralateral hemisphere
The muscles of neck, trunk and pelvic
organs have bilateral innervation from both
hemispheres. In case of unilateral
pathologic focus these structures do not
suffer
Face, tongue and pharynx
muscles innervation
This way is called tractus corticomuscularis.
The first central neuron is called tractus
corticonuclearis.
The second peripheral one is called tractus
nucleomuscularis.
Face, tongue and pharynx
muscles innervation
We can make the following conclusions:
1. The face muscles have bilateral cortex
innervation except the mimic muscles and
tongue muscles that have unilateral
innervation from the opposite hemisphere.
2. The muscles of upper and lower
extremities, lower mimic muscles and tongue
muscles have unilateral cortical innervation.
3. All the other muscles (the muscles of
neck, trunk, perineum, m. oculomotorial, m.
masseter, pharyngeal and palatal muscles)
have bilateral cortical innervation.
Paralysis
Paralysis (plegia) - means the absence of
active movements. It occurs in case of
complete lesion of motor way (tractus
corticomuscularis) .
Paresis occurs in case of incomplete
lesion of motor way. That means disorders
of active movements
Clinically can be – hemi-, tetra-, mono-, triand paraparesis.
Paralysis is divided into:
Central (spastic)
Peripheral (flaccid)
Central or spastic paralysis is caused by the
lesion of central neuron and its fibers (tr.
corticospinalis or tr. corticonuclearis).
Peripheral or flaccid paralysis is caused by
the lesion of peripheral neuron (tractus
spinomuscularis or tractus
nucleomuscularis).
Features of central (spastic)
paralysis are:
1. It is a diffuse paralysis
2. There is spastic hypertonus of muscles
3. Hyperreflexion of stretch and periostal reflexes
4. There are pathologic reflexes. They are
considered to be reliable signs of central
paralysis
5. Protective reflexes (the reflexes of spinal
automatism)
6. Pathologic synkinesis is involuntary movements
in paralysed extremity
Paresis
Paresis
Spastic hypertonus features:
Tonus is increased in the group of flexors
in upper extremities and in the group of
extensors in lower extremities
“clasp – knife“ symptom
in course of evaluation tonus decreases
Flexing pathological reflexes
Bechterev’s sign
Jukovski sign
Rossolimo
(Venderovych) reflex
Rossolimo
(Venderovych) reflex
Jukovski sign
Extension pathological reflexes
Extension pathological reflexes
Pathologic reflexes on upper
extremities:
Bechterev’s sign. This is simply a musclestretch reflex of bending of fingers obtained by
tapping the back of hand with a reflex hammer.
Jukovski sign. This is caused by hammer
impact on a palm under fingers; response is
reflex flexing of II-V fingers.
Rossolimo (Venderovych) reflex: This is
simply a muscle-stretch reflex obtained by
tapping the palmar surfaces of the fingers with a
reflex hammer; the response is reflex flexing of
II-V fingers.
Pathologic reflexes on upper
extremities:
Tremner reflex. This is simply a muscle-stretch
reflex obtained by tapping the palmar surfaces
of the nail-phalax of II – V fingers. The response
is fingers flexing.
Jakobson – Laske reflex. This is caused by
hammer impact on processus styloideus; the
response is reflex flexing of II-V fingers.
Klipel – Veil reflex. This is caused by passive
bending of II – V fingers. The response is thumb
flexing
Protective reflexes
(the reflexes of spinal automatism )
They also are one of signs of lesion of motor way.
They are especially clearly expressed at cross
lesion of a spinal cord (dissociation of underlaying
segments of the last from a brain).
The result is squeezing of foot, and also an
injection or sharp plantar flexion of toes
(V.M.Bechterev).
The response reflex flexion of paralyzed
extremities, flexion in femoral, knee and talocrural
joints (shortly reaction); opposite extremities thus
straightens, being unbent in joints (long reaction).
Serial putting irritations on one and the other leg,
can result in imitation of automatisms of walking.
Pathologic synkinesis
- are involuntary movements in
paralysed extremity . They are observed
while moving by healthy extremity.
Synkinesis are divided into:
Global
Coordinatory
Imitating
Central paralysis
Features of peripheral paralysis
1. Areflexion or hyporeflexion
2. Atonia or hypotonia
3. Muscular atrophy
4. Fasciculation of muscles
5. It is limited paralysis
6. There is reaction of degeneration.
Types of gate:
Symptoms of motor way lesion
1.
The lesion of anterior central gyrus
monoplegia (or monoparesis) on the opposite
side. If the focus is situated in upper part of
anterior central gyrus, paralysis of lower
extremity occurs.
If it is in middle part of anterior central gyrus, we
can observe paralysis of upper extremity.
If it is in lower one, face suffers.
In case of anterior central gyrus irritation Motor
Jackson takes place. Motor Jackson is a set of
local seizures that can cause generalized
seizures.
Symptoms of motor way lesion
2. The lesion of radiate crown
central hemiplegia on the opposite side
(that means that arm, leg, lower mimic
muscles and tongue muscles are
involved). Paralysis can dominates in
lower extremity,in upper extremity or in
face muscles
Besides hemianesthesia can join
hemiplegia.
Symptoms of motor way lesion
3. The
lesion of internal capsule part of
motor way
hemiplegia on the opposite side, central
paresis of tongue muscles and lower
mimic muscles
Hemihypesthesia often joins all the other
symptoms. Vernike – Mann posture is
typical for this lesion.
Hemianopsia
Symptoms of motor way lesion
4. The lesion of brain stem
alternating syndrome- central paralysis on the
opposite side and peripheral paralysis of face
muscles on the side of lesion. The last are
divided into peduncle, pontine and bulbar ones.
5. The lesion of pyramidal decussation part of
motor way
central paralysis of upper extremity on the side
of lesion and paralysis of lower extremity on the
opposite side. Sometimes tetraplegia or triplegia
is observed.
Symptoms of motor way lesion
6. The lesion of motor way in lateral funiculus of
spinal cord
central paralysis below the level C1-C4, C5-Th1,
Th1- Th12, L1-S2
7. The lesion of anterior horns or motor nucleus of
CNs
peripheral paralysis of certain muscles with
fasciculation of muscles. Also there are early
atrophy and degenerative reaction.
8. Anterior roots lesion
peripheral paralysis. In most of cases it is
observed only when several roots are damaged.
Symptoms of motor way lesion
9. The lesion of nerve plexus
peripheral paralysis , pain, sensory and
autonomic disturbances
10. The lesion of peripheral nerve
peripheral paralysis of the muscle ,
innervated by this nerve, pain, sensory
and autonomic disturbances.