1.Kuliah motorik 2006.PPT

7/23/2019 1.Kuliah motorik 2006.PPT

1/38

MOTOR SYSTEM


2/38


3/38


4/38

CENTRAL MOTOR NERVOUS SYSTEMS

Pyramidal motor system Extrapyramidal motorsystem

Excitatory neurotransmitter : glutamate, aspartate Neurotransmitter : Glu, Ach, DA, GABA, 5HTNeuropeptide : P,en!ephalin,"##


5/38

PERIPHERAL MOTOR NS :

a. Cell body / nuclear :

spinal o!or neurons

nuclei o" !#e cranial ner$es

b. %en!ral roo!s& spinal / cranial ner$es '

c. Ple(usa. Perip#eral ner$es


6/38


7/38

"entral and peripheral ner$ous system


8/38

P)RAMI*AL MOTOR S)STEM

Mo!or Cor!e( :

Primary Motor Cortex

( Broadmanns area 4 )

motor homonculus

Premotor cortex

( Broadmanns area 6 )


9/38

PYRAMIDAL MOTOR SYSTEM

Pyramidal tract =corticospinal tract The execution o% precise $oluntary

mo$ementsThe cell &odies lying in layer 5 o%the cere&ral cortex

' (( giants Bet) cells *

Pons + medulla o&longata : pyramis

ed- .&longata : decussatio pyramidum

/ateral corticospinal tract ' 05 1 *Anterior corticospinal tract ' 25 1 * +33 still ipsilateral ' ", Th *


10/38

Pyramidal tract 4 corticospinal tract

/ateral corticospinal tract ' 05 1 *Anterior corticospinal tract ' 25 1 *


11/38

Cor!icobulbar !rac! +

cor!iconuclear !rac!

to the contra / ipsilateral

nuclei of the cranial motor nerves

( ! "# %II# $%# %# %$# ,II )

Broadmanns area &

nuclei of the ! $$$# $"# "$


12/38

Type o" paralysis

Monoparesis ' eaness in sin*le lim+ / extremity

Paraparesis ' eaness in +oth arms or le*s

Te!ra / -uadriparesis' eaness in all four lim+s

*ipleia ' le*s , arms

Heiparesis'

eaness in one side of the +ody

and extremities# limited +y the median

Heipleia al!ernans'

eaness in one or more ipsilateral cranial nerves and

contralateral paralysis of the arm - le*


13/38

!mipl!"ia cr#ciatasolated paralysis '62 muscle groups*

!mipl!"ia alt!rnans:

7ea!ness in one or more ipsilateral cranial ner$esAnd contralateral paralysis o% the arm 8 leg


14/38

Pa!!ern o" Muscular ea0ness

1. 2pper o!or neuron & 2MN ' + supra nuclear

.he cere+ral cortex

Cere+ral peduncles

Brain stem

pinal cord

3. Lo4er o!or neuron & LMN '0 final common pathays

1 motor neurons / nuclei of the cranial nerves

"entral root of the spinal nerves or cranial nerves

Plexus

Peripheral nerves

$% N#cl!ar9 otor neurons nuclei o% the cranial ner$es&%M#scl! dis!as!'% N!#rom#sc#lar()#nction


15/38

ignign ;N;N /N/N NuclearNuclear uscle Disuscle Dis Nexesre>exes ''?*?* '?*'?*

mpaired mpaired

NN '?*'?*

"utaneus"utaneus

@e>exes@e>exes ''?*?* NN NN NN NN

PathologicPathologic

@e>exes@e>exes '?*'?* '?*'?* '?*'?* '?*'?*

uscleuscle

atrophyatrophy'?*'?* 33 33

''disuseddisusedatrophy*atrophy*

'?*'?*

23asciculation

Patt!rn o* M#sc#lar +!a,n!ss

;N: upper motor neuron/N: lo7er motor neuronN< : neuromuscular unction


16/38

Lesion o" !#e cerebral cor!e(

Motor homonculus ' paracentral le*

precentral arm

Contralateral seiures

Contralateral paralysis / paresis

Lesion o" !#e in!ernal capsule

Contralateral hemiparalysis / paresis

( arm 0 le* )

Contralateral hemihypesthesia


17/38

M!s!nc!p-alonM!s!nc!p-alon

4 hemiplegia4 hemiplegia

alternans superioralternans superior4 e&erCs4 e&erCs

syndromesyndrome

"ontralateral"ontralateral lesionlesion

hemiplegiahemiplegiapsilateralpsilateral lesionlesion

N- palsyN- palsy

PonsPons

4 hemiplegia4 hemiplegiaalternans in%erioralternans in%erior

4 illard+Gu&lerCs4 illard+Gu&lerCs

syndromesyndrome

"ontralateral"ontralateral lesionlesion

hemiplegiahemiplegia

psilateralpsilateral lesionlesion

N- , palsyN- , palsy"ontralateral ga)e"ontralateral ga)e

palsypalsy

M!d%o.lon"ataM!d%o.lon"ata "ontralateral"ontralateral lesionlesion

hemiplegiahemiplegia

psilateralpsilateral lesionlesion

N- palsyN- palsy

Lesions o" !#e brain s!e

5emiple*ic alternans


18/38

M!s!nc!p-alonM!s!nc!p-alonL!sionsL!sions

HHemiplegia alternans superioremiplegia alternans superior4 e&erCs syndrome4 e&erCs syndrome

"ontralateral"ontralateral lesionlesion hemiplegiahemiplegiapsilateralpsilateral lesionlesionN- palsyN- palsy


19/38

PonsPonsL!sionsL!sions

!mipl!"ia alt!rnans in*!rio!mipl!"ia alt!rnans in*!riorr= Millard/0#.l!r1s syndrom!= Millard/0#.l!r1s syndrom!

"ontralateral"ontralateral lesionlesion hemiplegiahemiplegiapsilateralpsilateral lesionlesion N- , palsyN- , palsy

"ontralateral ga)e palsy"ontralateral ga)e palsy


20/38

M!d%o.lon"ataM!d%o.lon"ataL!sionsL!sions

"ontralateral"ontralaterallesionlesionhemiplegiahemiplegia

psilateralpsilateral lesionlesionN- palsyN- palsy


21/38

Lesions o" !#e spinal cord

$psilateral l!m!n paralysis in the se*ment of the lesion

$psilateral u!m!n paralysis +elo the level of the lesion

$psilateral loss of proprioceptive +elo the level of the

lesion

Contralateral loss of extreroceptive ( pain

temperature ) +elo the level of the lesion


22/38

Spinal Cord Somatotopic Or"ani2ation


23/38


24/38


25/38

P!rip-!ral N!r3!s l!sions


26/38

E4TRA PYRAMIDAL SYSTEM

n>uences spinal motor acti$ity

"onsists o% : cere&ral cortex

&asal ganglia mid &rain


27/38

E,TRA P)RAMI*AL S)STEM

5asal anlia

7lo+us pallidus 0 pallidum 0 paleotriatum

Putamen 0 neostriatum 0 striatum

9 glo&us pallidus F putamen 4 lenti%orm lenticular nucleus

Caudate nucleus 0 striate +ody

u+stantia ni*ra

u+thalamic nucleus ( corpus 8uysi )

9ed nucleus



28/38



29/38

Lesion o" E(!rapyraidal Sys!e

.he main si*n '

:isorders of muscle tone ( dystonia )

$nvoluntary movement disorders ( hyper/hypo/a;inesia )

a+sent durin* sleep

Syndroes o" e(!rapyraidal lesions:

=! 5yperinesia ; hypotonia


30/38

1. Hypo0inesia 6 #yper!onia syndroe

a! Parinsons disease 0 paralysis a*itans0 shain* palsy

+! Parinson syndrome 0 parinsonism

Par0inson7s *isease

:e*eneratif process hereditary

8oss of melanin containin* neurons of su+stantia ni*ra

- of dopaminer*ic neurons that connect ith the striatum

Bilateral

>nilateral


31/38

8 cardinal sin o" Par,inson1s Dis!as!

a. 5rady / a0inesia

tartin* a movement +ecomes very difficult#

the mo+ility decreases!

.he entire +ody anteflexed position#

no sin* durin* alin*

5ypo / amimia a mas face

peech monotonous# dysarthic

Postural reflex decreases pro / latero / retropultion

$ di l i * P ,i 1 Di


32/38

b. Riidi!y

Co*heel phenomenon

c. Treor

Passive tremor ' 4 & movements / sec

Pill rollin* 0 money countin* movement

9estin* tremor

$ cardinal si"n o* Par,inson1s Dis!as


33/38

Par0inson syndroe + par0insonis

euronal loss in the su+stantia ni*ra caused +y '

Postencephalitic parinsonism

Cere+ral arteriosclerosis

.rauma

.umors

$ntoxication +y Co# M*# etc!

phenotiaines# reserpin


34/38

3. Hyper0ine!ic 6 #ypo!onic syndroe

8esion in neostriatum

?ccasionally *lo+! pallidus# thalamus#cere+ral cortex

C-or!a


35/38

C-or!ashort, %ast, er!y mo$ementsdistal proximal portion o% the extremities

C-or!a minor = Syd!n-am1s c-or!a

= St Vit#s danc!? in children? acute, sel>imiting? lin!ed to rheumatic %e$er ' 4 chorea in%ectiosa*

C#orea ra$idaru

; acute chorea

; early pre*nancy

Hun!in!on7s c#orea + c#orea a9or

dominant# hereditary# de*enerative disease

middle a*e

cortical neuron de*enerate dementia


36/38

Heiballis + ballis!ic syndroe

lesion of the su+thalamic nucleus ( 8uysi ) and itsconnection

the muscle of shoulder - pelvis out reachin* -

hurlin* movements

Spasodic !or!icollis !orsion dys!onia

+iochemical a+normallity of the putamen# thalamus(centro median nucleus - in other extrapyramidal

nuclei)


37/38

At-!tosis

"ontinuous, arrhytmic, slo7, 7ormli!emo$ementsDistal portion o% the extremitiesPosture 8 mo$ement are &i)arre"aused &y perinatal damage to the striatum


38/38

Documents

1.Kuliah motorik 2006.PPT