SENSORY SYSTEM

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 pressure
Hair cells corpuscles 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. Profonda / 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)

1
st
neuron Peripheral Nerves
spinal root ganglia ( cranial nerve
ganglia N.V )

2
nd
neuron Spinal Cord
tophografic


3
rd
neuron Thalamic
Cerebral Cortex
somatothopic





Anterior and posterior spinocerebellar tracts
DERMATOME
a specific segmental territory of the skin
to make certain about location of the lesion
Vertebras Spinal nerves
Cervical 7 8
Thoracal 12 12
Lumbal 5 5
Sacral 5 5
Coccigeus 4 -
THE DERMATOMES
The spinal cord is shorter than the spinal
collumn
& terminates at the L
I
- L
II
vertebrae
Segment cervical vertebrae C : () 1
Segment thoracal vertebrae Th : () 2
Segment Th 12 LS vertebrae Th IX XII,
L I
Head Innervations
Autonomous Zones
DISORDERS OF THE SENSORY SYSTEM

Negative symtoms : sensory loss
e.g hypesthesia
hypalgesia

Positive symtoms : pain
e.g stabbing pain , burning pain
paraesthesia , dysesthesia
hyperesthesia , allodynia
DISORDERS OF THE SENSORY SYSTEM

Types of (pathological) pain :

Nociceptive pain, inflamation pain
Neuropathic pain
Idiopathic pain, psychogenic pain
DISORDERS OF THE SENSORY SYSTEM
1.Peripheral nerves lesion
Mononeuropathy, mononeuropathy multiplex
e.g traumatic
compression
inflammation infection of M. Hansen
Diabetes Mellitus


Polyneuropathy
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 )
Areflexia
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
Tetraparalysis
In the advanced cases of pernicious anemia
( vit. B
12
deficiency )
Friedreichs ataxia
A familial & hereditary disease
Degeneration of the cerebellum, dorsal & ventral
spinocerebellar tracts, lateral corticospinal tracts
Gliosis of the posterior column
Nystagmus
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
hyperesthesia
Weakness
Ataxia