NERVOUS SYSTEM

2012
 NERVOUS SYSTEM
SETRUCTURALLY: CNS AND PNS.
FUNCTIONALLY: SOMATIC AND
AUTONOMIC NS.
*COMPONENTS:
- Two main cell types: neurons and glial cells.
- Vassa: arteries and veins.
*Neuron: 1. Kecil; 2. Sedang; 3. Besar.
1. Unipolar; 2. Bipolar; 3. Multipolar (type
I and type II).
 GLIAL CELLS
1. ASTROCYTE/ASTROCYTUS.

2. MICROGLIA.

3. OLIGODENDROGLIA
CENTRAL NERVOUS SYSTEM
CNS:BRAIN AND SPINAL CORD
NUCLEUS: Collection of nerve cell bodies in
cns; Ganglion: collection of nerve cell bodies
in pns (peripheral nervous system).
Constitute: gray and white matter/substance;
-gray matter: cell bodies.
-white matter: Nerve fibers.
 PRINCIPAL ROLES OF CNS:
INTEGRASI DAN COORDINASI SIGNAL
YANG MASUK DAN KELUAR.

THINKING.

LEARNING.
TRANVERSE SECTION of SPINAL
CORD
GRAY MATTER.
WHITE MATTER.
POSTERIOR AND ANTERIOR
HORN(CORNU).
THREE MEMBRANOUS LAYERS:
MENINGES (DURAMATER,
ARACHNOID, subarachnoid space,
PIAMATER).
 PERIPHERAL NERVOUS
SYSTEM
DIBENTUK OLEH: NERVE FIBERS AND
NERVE CELL BODIES.
PERIPHERAL NERVES DIBENTUK OLEH
KUMPULAN BEBERAPA NERVE FIBERS,
DIBUNGKUS JAR. IKAT DAN BLOOD
VESSELS.
PERIPHERAL NERVE FIBER TERDIRI DARI
AXON, NEUROLEMMA, ENDONEURIUM.
NERVE FIBERS ADA 2: MYELINATED DAN
UNMYELINATED.
 PERIPHERAL NERVES DILIPUTI
OLEH:
1. ENDONEURIUM:MEMBUNGKUS
NEUROLEMMA CELLS AND AXONS.
2. PERINEURIUM: JAR. IKAT MEMBUNGKUS
FASCICLE/FASCICULUS/BUNDLE of
PERIPHERAL NERVE FIBERS.
3. EPINEURIUM: JAR. IKAT YANG TEBAL
membungkus BUNDLE of
FASCICLECOVERING of the NERVE
(TERMASUK: FATTY TISSUES, BLOOD
VESSELS, LYMPHATICS).
 DAMAGE TO CNS
THE INJURED AXONS DO NOT RECOVER IN
MOST CIRCUMTANCES.
THEIR PROXIMAL STUMPS BEGIN TO
REGENERATELESION.
GROWTH IS BLOCKED BY ASTROCYTE.
RESULT: PERMANENT DISABILITY
FOLLOWS DESTRUCTION OF A TRACT IN
THE CNS
 PERIPHERAL NERVE
DEGENERATION:
WHEN PN ARE CRUSHED OR SERVED:
-distaldegenerate
-cell bodies biasanya survive, axon akan
tumbuh ke distal mengikuti jar.ikat/myelin.
Tindakan pembedahan diperlukan bila satu
saraf putus.
Compression of vassa nervorumischemia
dalam waktu cukup lamacause nerve
degeneration.
 PERIPHERAL NERVES:
CRANIAL NERVES: 12 PASANG, KELUAR
DARI CRANIUM, 11 PASANG
BERASAL/ARISE DARI BRAIN. N.XI
ASALNYA/NUCLEINYA DI MEDULLA
SPINALIS CERVICAL 1-6.
SPINAL NERVES: CERVICAL-8; THORACAL-
12; LUMBAL-5; SACRAL-5; COCCYGEUS-1.
BERASAL DARI SPINAL CORD DAN KELUAR
MELALUI FORAMINA INTERVERTEBRALES.
ANS=AUTONOMIC NERVOUS SYSTEM.
 SOMATIC NERVOUS SYSTEM
VOLUNTARY.
SOMATIC PARTS of CNS and PNS.
GENERAL SENSORY and MOTOR all parts of
the BODY (SOMA); EXCEPTS: viscera in body
cavities, smooth muscles, and glands.
Somatic motor fibers: otot skelet, reflex.
Somatic sensory fibers: rasa raba umum pada
kulit: panas, dingin, nyeri, raba, sendi, tulang.
 AUTONOMIC NERVOUS SYSTEM
INVOLUNTARY.
VISCERAL AFFERENT AND EFFERENT.

VISCERAL AFF: RASA2 VISCERA: VISCERAL

PAINS REGULATE VISCERAL FUNCTION.

VISCERAL EFF: SMOOTH MUSCLES IN

ORGAN VISCERA AND BLOOD
VESSELS,CARDIAC MUSCLE, GLANDS.
 VISCERAL AFFERENT
SENSATION:
PENTING SEKALI DALAM ANS.
BAIK SECARA ANATOMI DAN FUNGSI NYA
INTEGRASI DAN REFLEX VISCERA.
REFLEX VISCERA: REGULATE BLOOD
PRESSURE DAN KIMIAWI, RESPIRASI,
VASCULAR RESISTANCE. Rasa lapar dan
mual.
Sebagian besar visceral pain (dari Cor,
peritoneum) dibawa ke central: visceral afferent
fibers melalui Symphatetic fibers.
 Visceral motor innervation:
Efferent nerve fibers dan ganglia dari ANS
melalui 2 system:

1. System symphaticus (thoracolumbal),

bersifat katabolik: flight or fight.

2. System parasymphaticus (craniosacral),

bersifat anabolik: menghemat energy.
 SETRUCTURE AND
COMPONENTS SPINAL NERVE:
N. SPINALIS BERCABANG 2: RAMUS
ANTERIOR ET POSTERIOR (ramus= root).
Umum: somatic sensory fibers and motor fibers.
Thoracal 1-Lumbal 2/3: symphaticus.
Sacral 2,3,4: parasymphaticus.
Anatomical unit NS: neuron/neuron cells.
Functional unit NS: lengkungan reflex/reflex arc:
a. receptor; b. afferent/sensorik; c. efferent/
motor/motorik; d. effector (muscles & glands).
 GANGLIA
Symphaticus: paravertebral ganglia.
Kecuali: prevertebral gangliaviscera
abdomen; medulla adrenal tanpa
ganglia/synaps.

* Parasymphaticus: intrinsic/enteric ganglia.

Letak ganglion nya: pada atau dekat dinding
organ viscera/effector organ.
 SCALP
S =SKIN.
C= CONNECTIVE TISSUE/jar. Ikat.
A= Aponeurosis/ epicranial aponeurosis.
L =Loose connective tissue/ jar. Ikat
kendor/sponge-like layer.
P= Pericranium= jar. Ikat padat, mem bentuk
external periosteum dari neurocranium.
 CRANIAL MENINGES
PROTECT AND COVERINGS THE BRAIN.
TERDIRI DARI:
1. DURAMATER: Paling superficial, paling
tebal, jar. Ikat fibrous.
2. Arachnoid mater /arachnoid: intermediate
layer, tipis. Profundusnya: subarachnoid
space/spatium yang dilewati liquor CS/CSF.
3. Pia mater: paling profundus, vascular layer.
*1 Disebut pachymeninx; 2 dan 3: leptomeninx.
 SCALP INJURIES and
INFECTIONS
Lapisan jar.ikat kendordanger area dari Scalp.
Infeksi+pus+blood gampang kesini.
Infeksi mudah menyebar ke cranial cavity melalui
emissary veins (vv.emissaria).

*Infeksi tak bisa kearah neck/collum dan temporal,

namun bisa ke eyelids/kelopak matablack eyes.

* Ecchymosis/purple patches=extravasasi darah

kedalam jar. Subcutan dan skin dari kelopak mata dan
sekitarnya.
 DURAMATER
2 LAPISAN: External periosteal layer dan
internal meningeal layer.
Internal meningeal layer membentuk:
1. Cerebral falx.
2. Cerebellar tentorium.
3. Cerebellar falx.
4. Sellar diaphragm.

*Dural Venous Sinuses/Sinus duramateris.

 SINUS DURAMATERIS/DURAL
VENOUS SINUSES:
Dialiri liquor CS/CSF melalui villi arachnoidales
Vena2 besar dari brain menuangkan darahnya
ke sinus ini.
Sinus duramateriske v. jugularis interna.
Superior sagittal sinus, confluence sinus,
inferior sagittal sinus, straight sinus, sigmoid
sinus, transverse sinus (right and left), superior
petrosal sinus, inferior petrosal sinus, dll.
Arteri dan saraf:a.meningica media dan N.V
(trigeminus)
 DURAL ORIGIN OF HEADACHES
Duramater sensitif terhadap pain.
Khususnya yang berhubungan dengan:
-Dural venous sinuses/sinus duramateris.
-Meningeal arteries/a. meningicae.
Leptomeninx (Pia dan Arachnoid mater):
- Antara 2 lapisan ini ada
spatium/spacesubarachnoid space
dilewati/dialiri liquor cs (cerebrospinal)=csf
dan diisi/ada arachnoid trabeculae.
 BRAIN/ENCEPHALON:
Terdiri dari: CEREBRUM, CEREBELLUM dan
BRAINSTEM (batang otak).
Brainstemmidbrain/mesencephalon, pons
dan medulla oblongata.
CEREBRUM: 2 HEMISPHERES LOBUS
FRONTALIS,TEMPORALIS, PARIETALIS,
OCCIPITALIS.
Cekungan: sulcus, fissurae. Antara 2 sulcus
ada tonjolan: gyrus.
 VENTRICULAR SYSTEM of
BRAIN
LATERAL VENTRICLE: ADA 2.
Interventricular foramina.
3rd VENTRICLE/VENTRICULUS TERTIUS.
Cerebral aqueduct/aqueductus cerebralis
4th VENTRICLE/VENTRICULUS QUARTUS.
keluar menuju subarachnoid space melalui
a. Lateral apertures (2)=Foramen Lushka.
b. Median aperture (1)=Foramen Magendie.
 VASCULATURE of BRAIN
INTERNAL CAROTID ARTERIES.
VERTEBRAL ARTERIES.

CEREBRAL ARTERIAL CIRCLE (Willis):

-anastomosis berbentuk lingkaran.
-inferior of brain.
-menjaga kontinyuitas circulasi brain.
-Dibentuk oleh 9 arteri (seluruhnya).
 STROKES
THE MOST COMMON CAUSES:
SPONTANEOUS CEREBROVASCULAR
ACCIDENTS SEPERTI:
1. Cerebral embolism.
2. Cerebral thrombosis.
3. Cerebral hemorrhage.
4. Subarachnoid hemorrhage (Rowland 2000).
*Hemorrhage stroke: pecahnya arteri, saccular
aneurysm.
 Transient Ischemic Attacks (TIAs)
Neurological symptoms yang dihasilkan oleh
karena ischemia/deficient blood supply of the
brain.

The symptoms of a TIAs bisa ambiguous:

-Staggering/sempoyongan.
-Dizziness/pusing/pening.
-Light-headedness.
 OVERVIEW of CRANIAL NERVES:
Cranial nerves=spinal nerves:
-Mempunyai sensoris atau motoris atau
kombinasi keduanya.
-Cranial nerves, menginnervasi:
a. Muscles/Otot-otot.
b. Glands/glandulae/kelenjar.
c. Menerima impulses dari receptor2.
* Cranial nerves ada 12 pasang diberi nomor I-
XII mulai dari rostral ke caudal.
 MOTOR/EFFERENT FIBERS:
1. Motor fibers innervating striated muscle:
a. Somatic motor/general somatic efferent:
Innervate the striated muscles in orbita,
lidah, leherN. III,IV,VI ; XII; XI.
b. Branchial motor/special somatic efferent:
Innervate muscles of: pengunyah; muka/
mimik; palatum; pharynx, larynx and
upper part of esophagus.
 MOTOR FIBERS to SMOOTH
MUSCLES and GLANDS:
General visceral motor=parasymphaticus.
Innervate/Menginnervasi:
1. Smooth muscles/otot polos.
2. Glands/kelenjar.
*Berasal/nuclei di Brainstem, mengeluarkan
serat2 preganglionik/preganglionic fibers.
*Bersynaps di ganglion parasymphaticus di
dinding atau dekat dinding organserat2 post
ganglionik. Terdapat pada: N. III; VII; IX; X.
 SENSORY(AFFERENT) FIBERS:
3. General visceral afferent: menerima impuls2
viscera: carotid body, carotid sinus, pharynx,
larynx, trachea, bronchi, lungs, heart and GI
tract.
4. General sensory/general somatic afferent:
dari skin dan mucous membranes N. V
(terutama); dan N. VII, IX, X.
5. Special sensory fibers:
a. Special visceral aff:taste (VII,IX,X);smell (I).
b. Special somatic aff: N. II dan N.VIII.
 N.I.=N.Olfactorius=Olfactory nerve:

-Special visceral afferent.

-Pembau/penghidu
-Receptor: sel2 olfactus pada mucosa nasi su
perior.
-Gangguan yang bisa terjadi: anosmia-loss of
smell oleh karena: allergi, infeksi, trauma.
-Rhinorrhea-CSF (cerebrospinal fluid) keluar
melalui hidung/nasus/rhinos-oleh karena
trauma/fracture.
 N.II =N.Opticus= Optic nerve:
-Special somatic afferent.
-Receptor: sel kerucut dan batang (Cones
and
rods) pada retina (lapisan paling
profundus
dari dinding bola mata).
-Dilanjutkan oleh: Nervous opticus, chiasma
opticum, tractus opticus, radiatio optica,
cortex 17, 18 dan 19 (lobus occipitalis
brain).
 N. III; IV dan VI:

-General somatic efferent/somatomotorik umum.

-Melayani otot2 bola mata:
a. N.IVm. Obliquous superior.
b. N. VIm. rectus lateralis.
c. N. IIIYang lainnya:
-m. Rectus medialis, sup. dan inf.
-m. obliquous inferior.
*Kecuali: N.III +parasymphaticus/viscero motorik:
melayani/innervasi:
a. Ciliary body/m. ciliaris.
b. m. Sphincter pupillae.
 N. V = Nervous Trigeminus:
Mempunyai 3 bagian:
1. N. Ophthalmicus.
2. N. Maxillaris.
3. N. Mandibularis.
*Special somatic efferent=branchiomotorik
Otot2 pengunyah/Musculi masticatorii:
m.masseter; temporalis; pterygoideus lat
et medialis.
*General somatic afferent: semua rasa2 umum
dari kulit wajah, mucoa mulut, nasi, paranasalis,
cornea.
 FACIAL NERVE/ CN VII
Branchial motor/special somatic efferent
Melayani otot mimik/facialis/otot muka.
Visceral motor/parasymphaticusgld:
lacrimalis, nasalis, pharyngealis, palatinus,
sublingualis, submandibularis.
General somatic afferentmeatus acusticus
externus.
Special sensory/special visceral afferent: taste
bud/pengecap pada corpus linguae, palatum
molle/soft palate.
 VESTIBULOCOCHLEAR
NERVE/N.VIII/N.OCTAVUS:
Special sensory/special somatic afferent
terbagi 2 yaitu:
1. N. Vestibularis-keseimbangan
receptornya di semicircular ducts/canalis
semicircularis.
2. N. Cochlearis-pendengaranreceptornya
organon of Corti yang terletak didalam
cochlea.
 GLOSSOPHARYNGEAL
NERVE/N.IX:
Branchial motor/special somatic efferent
m.stylopharyngeus.
*Visceral motor/parasymphaticus: parotid
gland/glandula parotis.
*Visceral sensory/general visceral
afferentbaroreceptor pada carotid sinus;
chemoreceotor pada carotid body. Juga dari mucosa
oropharynx, tonsil, radix linguae/base of the
tonguemual-muntah.
*Special visceral afferent: rasa kecap/taste bud radix
linguae(1/3 posterior lidah) rasa pahit.
 VAGUS NERVE / N.X:
General visceral sensory/afferent: sensory from
pharynx, larynx, organ viscera (thoracal &
abdominal).
Taste bud : root of the tongue and epiglottis.
Branchial motor/Special somatic efferentotot-
otot pharynx, larynx, palatoglossus.
Proprioceptive otot-otot diatas.
Parasymphaticus/visceral efferent otot-otot
polos dan kelenjar/glands organ viscera (thorax
dan abdomen).
 ACCESSORY NERVE / N. XI:
Pure somatomotor=Somatomotorik murni.
N. accessorius.
Effector: m. Sternocleidomastoideus dan
m. Trapezius.
Nuclei: Nuclei centrales cornu ventrales
C 1-6 Medulla spinalis (MS).
 HYPOGLOSSAL NERVE / N. XII:
N. hypoglossalis/n. hypoglossus.

Nucleus hypoglossalis di MO (medulla

oblongata).

Effector: Otot-otot intrinsik dan extrinsik lidah

kecuali: m. palatoglossus (n. X/vagus).
 KELUARNYA NERVI CRANIALES
DARI CRANIUM:
N.I-olfactorius-for.cribriformis os frontalis.
N.II-opticus-Canalis opticus/for.opticum.
N.III-oculomotorius-fissura orbitalis sup.
N.IV-trochlearis-fissura orbitalis superior.
N.V.1.-Ophthalmicus-fissura orbitalis sup.
N.V.2.-Maxillaris-foramen rotundum.
N.V.3.-Mandibularis-foramen ovale.
N.VI-Abducens-fissura orbitalis superior.
 NERVI CRANIALES KELUAR
DARI CAVUM CRANII:
N.VII-facialis-foramen stylomastoideus.
N.VIII-Octavus/Vestibulocochlearis-meatus acusticus
internus/internal acoustic meatusinner ear (telinga
dalam).
N.IX-Glossopharyngeus-foramen jugulare.
N.X-Vagus-foramen jugulare/jugular foramen.
N.XI-Accessorius-dari MS C 1-6 keluar dilateral MS
naik ke superior-foramen magnum-cavum cranii-
foramen jugulare.
N.XII-hypoglossalis/hypoglossus-hypoglossal canal.
 TERIMAKASIH
THANK YOU
MATUR SUKSMA
ARIGATO