1.Sistem Motorik

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    SIST M MOTORIK

    Penyusun : Willy Wijaya, dr

    Pembimbing: Henny. A.S, dr, SpS(K)

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    Effectors MOTOR SYSTEM

    Skeletal Muscle → SOMATIC MOTOR SYSTEM

    Smooth Muscle → AUTONOMIC MOTOR SYSTEM

    Glands (sympathetic and Parasympathetic)

    Elements of Motor System

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    KORTEX PUSAT MOTORIK

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    Lower Motor Neuron

    cell body: anterior horn

    axon: anterior root,

    spinal nerve

    axon terminal:

    neuromuscular

     junctionEffector:

    skeletal muscle

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    Somatic Motor System

    Upper Motor Neuron

    Lower Motor Neuron

    Skeletal Muscle

    Auxiliary

    Motor Pathways

    motor nerve

    pyramidaltract

    reflexarc

    descendingpathways from

    brain stem

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    Corticospinal Tract

    Origin: Cerebral Cortex

    Brodmann Area 4 (Primary Motor Area, M I)

    Brodmann Area 6 (Premotor Area, PM )

    Brodmann Area 3,1,2 (Primary Somesthetic Area, S I)

    Brodmann Area 5 (Anterior Portion of Sup. Parietal Lobule)

    Corona Radiata

    lnternal Capsule, Posterior Limb

    Crus Cerebri, Middle PortionLongitudinal Pontine Fiber

    Pyramid - pyramidal decussation

    Corticospinal Tract - Lateral and Anterior

    Termination: Spinal Gray (Rexed IV-IX)

    Upper Motor Neuron Pyramidal Tract

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    Upper Motor Neuron Pyramidal Tract

    1. corona radiata

    2. internal capsule,

    posterior limb

    3. crus cerebri

    4. longitudinal

    pontine fiber

    5. pyramid

    6. pyramid decussation

    7. lateral corticospinaltract

    8. anterior corticospinal

    tract

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    Upper Motor Neuron

    Pyramidal Tract

    1. corona radiata

    2. internal capsule

    3. crus cerebri

    4. pontine longitudinal fiber

    5. pyramid

    6. pyramid decussation

    7. lateral corticospinal tract

    8. anterior corticospinal tract

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    CorticospinalTract

    • completion of 

    myelination in2nd year of life

    • time of

    standing and

    walking

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    Upper Motor Neuron Pyramidal Tract

    Corticobulbar Tract

    - Corticofugal fibers projecting to, and terminating in

    the portions of lower brainstem

    - Termination:

    1) motor nuclei (upper motor neuron pathway)

    hypoglossal, ambiguus, facial motor,

    trigeminal motor, abducens, trochlear

    and oculomotor nucleus2) sensory relay nuclei

    nuclei gracilis and cuneatus, trigeminal

    sensory nucleus, solitary tract nucleus

    3) reticular formation (corticoreticular fiber)

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    Corticobulbar Tract (UMN Pathway)

    - Corticofugal fibers projecting to, cranial motor nuclei

    GSE - hypoglossal (XII), abducens (VI),

    trochlear (IV) and oculomotor (III) nucleus

    SVE - ambiguus (IX, X, XI), facial motor (VII),

    trigeminal motor (V) nucleus

    - largely bilateral

    laryngeal, pharyngeal, palatal and upper facial

    muscles of mastication and extraocular muscles

    - unilateral

    lower facial musculature (facial palsy)

    SCM and trapezius (uncrossed) --- spinal accessory

    - Pseudobulbar Palsy --- syndrome of bilateral UMN lesion

    Upper Motor Neuron Pyramidal Tract

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    Upper Motor Neuron vs Lower Motor Neuron Syndrome

    LMN syndrome UMN Syndrome

    Type of Paralysis Flaccid Paralysis Spastic Paresis

    Atrophy Severe Atrophy No (Disuse) Atrophy

    Deep Tendon Reflex Absent DTR Increase

    Pathological Reflex Absent Positive Babinski Sign

    Superficial Reflex Present Absent

    Fasciculation and Could be Absent

    Fibrillation Present

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    Upper Motor Neuron Syndrome

    Spasticity

    - Increased resistance to passive movement in

    antigravity muscle (flexor in arm, extensor in leg)

    Clasp Knife Phenomenon

    - Sign of Upper Motor Neuron Syndrome,

    especially internal capsule lesion

    cf. Rigidity

    - increased muscle tone, no increased DTR

    Cogwheel Phenomenon

    - symptom of basal ganglia or cerebellar lesion

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    LESI SESUAI TINGKATAN

    a. Lesi kortikal : parese kontralateral, jarang plegi.

    b. Lesi kapsula interna : hemiplegi spastik kontralateral.

    Terlibat kortikonuklearis→ paralisis fasialis

    kontralateral.

    c. Lesi pedunkel : hemiplegi spastik kontralateral +

    paralisis n.okulomotoris isilateral.

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    d. Lesi pons : hemiplegi kontralateral, mungkin

    bilateral. Nervus kranial mungkin tidakterkena.

    e. Lesi piramidalis : hemiparesis flasid

    kontralateral, jaras ekstrapiramidalis utuh.

    f. Lesi servikal : traktus piramidalis lateral

    terlibat→ hemiplegi spastik ipsilateral.

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    g. Lesi torakalis : monoplegi spastik

    ipsilateral tungkai, bila bilateral →

    paraplegi.

    h. Lesi radix anterior : kelumpuhan flasid

    ipsilateral.

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    SINDROMA CORNU ANTERIOR

    • Paling sering terkena pada poliomielitis akut

    dan atrofi muskular spinalis progresif kronik.

    • Mengakibatkan paralisis flasid disertai atrofi

    otot.

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