Neurology as scienceNeurology 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 systemFunctions of nervous system

The main function of nervous systemThe main function of nervous system is is unification and regulation of unification and regulation of

different physiological processes. different physiological processes. That means that nervous system That means that nervous system

unites, integrates and unites, integrates and subordinates all the parts of subordinates all the parts of human body and provides its human body and provides its connection with environment.connection with environment.

Functions of nervous systemFunctions of nervous system

The base of nervous system activity is The base of nervous system activity is reflex principlereflex principle

Reflex – is a reaction of our organism to Reflex – is a reaction of our organism to various outside and inside effects. It is various outside and inside effects. It is provided by nervous system.provided by nervous system.

Reflex consists of:Reflex consists of:

afferent part (which accepts information)afferent part (which accepts information)

central part (that keeps information)central part (that keeps information)

efferent part (that creates response).efferent part (that creates response).

As a result we have a circle – like structure As a result we have a circle – like structure - receptor (primary information centre) – - receptor (primary information centre) – programme centre – executive apparatus. programme centre – executive apparatus.

Reflexes are divided into:Reflexes are divided into:

simple and complexsimple and complex

inborn and trainedinborn and trained

conditioned and unconditioned conditioned and unconditioned

Unconditioned reflexes:Unconditioned reflexes:

They are inborn onesThey are inborn ones

They are phylogenetically old, that means they They are phylogenetically old, that means they were formed in course of phylogenesiswere formed in course of phylogenesis

They are based on certain anatomic structures They are based on certain anatomic structures (segments of spinal cord or brain stem)(segments of spinal cord or brain stem)

They exist even without brain cortex influenceThey exist even without brain cortex influence

They are inheritedThey are inherited

They can be regulated by brain cortexThey can be regulated by brain cortex

They are basis for the conditioned reflexesThey are basis for the conditioned reflexes

Conditioned reflexes:Conditioned reflexes:

They are the result of the individual experience They are the result of the individual experience and are formed during ontogenesisand are formed during ontogenesisThey are unstable, that means they need They are unstable, that means they need constant supportconstant supportThey aren’t based on certain anatomic They aren’t based on certain anatomic structuresstructuresThey are fixed in brain cortexThey are fixed in brain cortex

There are such conditioned reflexes as speaking, There are such conditioned reflexes as speaking, writing, reading, calculation, practicewriting, reading, calculation, practice

Unconditioned reflexes are divided Unconditioned reflexes are divided into:into:

Superficial and deepSuperficial and deep

Simple and complexSimple and complex

Proprioceptive (stretch, periosteal, joint)Proprioceptive (stretch, periosteal, joint)

Exteroceptive (dermal, from mucose Exteroceptive (dermal, from mucose membrane)membrane)

Interoceptive (from mucose membrane of Interoceptive (from mucose membrane of internal organs – for example urination in internal organs – for example urination in case of internal sphincter irritation)case of internal sphincter irritation)

Motor systemMotor system

Provides conduction of nervous impulse Provides conduction of nervous impulse from brain cortex to muscles. from brain cortex to muscles.

The way of this impulse is known as The way of this impulse is known as motorwaymotorway or or tractus corticomuscularistractus corticomuscularis. .

It consists of two neurons: It consists of two neurons:

centralcentral

peripheralperipheral

Paralysis is divided into:Paralysis is divided into:

Central (spastic)Central (spastic)Peripheral (flaccid)Peripheral (flaccid)

CentralCentral or spastic paralysis is caused by the or spastic paralysis is caused by the lesion of central neuron and its fibers (tr. lesion of central neuron and its fibers (tr. corticospinalis or tr. corticonuclearis).corticospinalis or tr. corticonuclearis).

PeripheralPeripheral or flaccid paralysis is caused by or flaccid paralysis is caused by the lesion of peripheral neuron (tractus the lesion of peripheral neuron (tractus spinomuscularis or tractus spinomuscularis or tractus nucleomuscularis).nucleomuscularis).

Features of central (spastic) Features of central (spastic) paralysis are:paralysis are:

1. It is a diffuse paralysis1. It is a diffuse paralysis2. There is spastic hypertonus of muscles 2. There is spastic hypertonus of muscles 3. Hyperreflexion of stretch and periostal reflexes3. Hyperreflexion of stretch and periostal reflexes4. There are pathologic reflexes. They are 4. There are pathologic reflexes. They are

considered to be reliable signs of central considered to be reliable signs of central paralysisparalysis

5. Protective reflexes (the reflexes of spinal 5. Protective reflexes (the reflexes of spinal automatism)automatism)

6. Pathologic synkinesis 6. Pathologic synkinesis is involuntary is involuntary movements in paralysed extremity movements in paralysed extremity

Spastic hypertonus features:Spastic hypertonus features:

Tonus is increased in the group of flexors Tonus is increased in the group of flexors in upper extremities and in the group of in upper extremities and in the group of extensors in lower extremitiesextensors in lower extremities

““clasp – knife“ symptomclasp – knife“ symptom

in course of evaluation tonus decreasesin course of evaluation tonus decreases

Flexing pathological reflexesFlexing pathological reflexes

Bechterev’s signBechterev’s sign

Jukovski sign Jukovski sign

Rossolimo Rossolimo

(Venderovych) reflex(Venderovych) reflex

Extension pathological reflexesExtension pathological reflexes

Extension pathological reflexesExtension pathological reflexes

Synkinesis are divided into:Synkinesis are divided into:

GlobalGlobal

CoordinatoryCoordinatory

ImitatingImitating

Pathologic reflexes on upper Pathologic reflexes on upper extremities:extremities:

Bechterev’s sign.Bechterev’s sign. This is simply a muscle-stretch reflex of bending This is simply a muscle-stretch reflex of bending of fingers obtained by tapping the back of hand with a reflex of fingers obtained by tapping the back of hand with a reflex hammer. hammer. Jukovski sign. Jukovski sign. This is caused by hammer impact on a palm under This is caused by hammer impact on a palm under fingers; response is reflex flexing of II-V fingers.fingers; response is reflex flexing of II-V fingers.Rossolimo (Venderovych) reflexRossolimo (Venderovych) reflex: This is simply a muscle-stretch : This is simply a muscle-stretch reflex obtained by tapping the palmar surfaces of the fingers with a reflex obtained by tapping the palmar surfaces of the fingers with a reflex hammer; the response is reflex flexing of II-V fingers.reflex hammer; the response is reflex flexing of II-V fingers.Tremner reflex. Tremner reflex. This is simply a muscle-stretch reflex obtained by This is simply a muscle-stretch reflex obtained by tapping the palmar surfaces of the nail-phalax of II – V fingers. The tapping the palmar surfaces of the nail-phalax of II – V fingers. The response is fingers flexing.response is fingers flexing.Jakobson – Laske reflex.Jakobson – Laske reflex. This is caused by hammer impact on This is caused by hammer impact on processus styloideus; the response is reflex flexing of II-V fingers.processus styloideus; the response is reflex flexing of II-V fingers.Klipel –Klipel – Veil reflex.Veil reflex. This is caused by passive bending of II – V This is caused by passive bending of II – V fingers. The response is thumb flexing. fingers. The response is thumb flexing.

Central paralysisCentral paralysis

Features of peripheral paralysisFeatures of peripheral paralysis

1. Areflexion or hyporeflexion1. Areflexion or hyporeflexion

2. Atonia or hypotonia2. Atonia or hypotonia

3. Muscular atrophy3. Muscular atrophy

4. Fasciculation of muscles4. Fasciculation of muscles

5. It is limited paralysis 5. It is limited paralysis

6. There is reaction of degeneration.6. There is reaction of degeneration.

Types of gate:Types of gate:

Symptoms of motor way lesionSymptoms of motor way lesion

11. . The lesion of anterior central gyrus The lesion of anterior central gyrus monoplegia (or monoparesis) on the opposite side. If the focus is monoplegia (or monoparesis) on the opposite side. If the focus is situated in upper part of anterior central gyrus, paralysis of lower situated in upper part of anterior central gyrus, paralysis of lower extremity occurs.extremity occurs.If it is in middle part of anterior central gyrus, we can observe If it is in middle part of anterior central gyrus, we can observe paralysis of upper extremity.paralysis of upper extremity. If it is in lower one, face suffers. If it is in lower one, face suffers. In case of anterior central gyrus irritation Motor Jackson takes place. In case of anterior central gyrus irritation Motor Jackson takes place. Motor Jackson is a set of local seizures that can cause generalized Motor Jackson is a set of local seizures that can cause generalized seizures.seizures.

2. 2. The lesion of radiate crown The lesion of radiate crown central hemiplegia on the opposite side (that means that arm, leg, central hemiplegia on the opposite side (that means that arm, leg, lower mimic muscles and tongue muscles are involved). Paralysis lower mimic muscles and tongue muscles are involved). Paralysis can dominates in lower extremity,in upper extremity or in face can dominates in lower extremity,in upper extremity or in face muscles muscles Besides hemianesthesia can join hemiplegia.Besides hemianesthesia can join hemiplegia.

Symptoms of motor way lesionSymptoms of motor way lesion

The lesion of internal capsule part of motor wayThe lesion of internal capsule part of motor way hemiplegia on the opposite side, central paresis of tongue hemiplegia on the opposite side, central paresis of tongue muscles and lower mimic musclesmuscles and lower mimic musclesHemihypesthesia often joins all the other symptoms. Vernike Hemihypesthesia often joins all the other symptoms. Vernike – Mann posture is typical for this lesion. – Mann posture is typical for this lesion. HemianopsiaHemianopsia

4. 4. The lesion of brain stemThe lesion of brain stemalternating syndrome- central paralysis on the opposite side alternating syndrome- central paralysis on the opposite side and peripheral paralysis of face muscles on the side of lesion. and peripheral paralysis of face muscles on the side of lesion. The last are divided into peduncle, pontine and bulbar ones.The last are divided into peduncle, pontine and bulbar ones.

5. 5. The lesion of pyramidal decussation part of motor wayThe lesion of pyramidal decussation part of motor way central paralysis of upper extremity on the side of lesion and central paralysis of upper extremity on the side of lesion and paralysis of lower extremity on the opposite side. Sometimes paralysis of lower extremity on the opposite side. Sometimes tetraplegia or triplegia is observed.tetraplegia or triplegia is observed.

Symptoms of motor way lesionSymptoms of motor way lesion

6. 6. The lesion of motor way in lateral funiculus of spinal cordThe lesion of motor way in lateral funiculus of spinal cordcentral paralysis below the level C1-C4, C5-Th1, Th1- Th12, L1-S2central paralysis below the level C1-C4, C5-Th1, Th1- Th12, L1-S2

7. 7. The lesion of anterior horns or motor nucleus of CNsThe lesion of anterior horns or motor nucleus of CNsperipheral paralysis of certain muscles with fasciculation of muscles. peripheral paralysis of certain muscles with fasciculation of muscles. Also there are early atrophy and degenerative reaction.Also there are early atrophy and degenerative reaction.

8. 8. Anterior roots lesionAnterior roots lesion peripheral paralysis. In most of cases it is observed only when peripheral paralysis. In most of cases it is observed only when several roots are damaged.several roots are damaged.

9. 9. The lesion of nerve plexusThe lesion of nerve plexus peripheral paralysis , pain, sensory and autonomic disturbancesperipheral paralysis , pain, sensory and autonomic disturbances

10. 10. The lesion of peripheral nerveThe lesion of peripheral nerveperipheral paralysis of the muscle , innervated by this nerve, pain, peripheral paralysis of the muscle , innervated by this nerve, pain, sensory and autonomic disturbances.sensory and autonomic disturbances.