NEUROSAINS

Setiawan, M Physio
 Sistem Saraf Manusia
Dapat dibagi menjadi:
1. Sistem Saraf Pusat :
Otak
Medulla spinalis/Sumsum tulang belakang
2. Sistem Saraf Tepi :
Saraf kranial (Nervi Cranialis)
Saraf spinal (Nervi Spinalis)
Cara lain:
Saraf Afferent (sensorik)
Saraf Efferent (motorik)
Cara lain:
Saraf Somatik
Saraf Otonom (Simpatis & Parasimpatis)
Gangguan gerak dan fungsi pada kasus
neurologi ini dapat digolongkan sebagai
sesuatu yang unik, karena alat gerak tubuh
itu sendiri, dimana gerakan itu terjadi,
seperti otot, tendon dan tulang tempat
perlekatannya serta sendi, berada dalam
keadaan yang normal.
Kelainan pd sistem saraf yaitu pengontrol
dan lintasan impuls gerak.
Suatu gerakan terjadi dg proses sbb: (1)
ide, (2) perencanaan motorik, (3)
pengambilan keputusan, dan (4) eksekusi
gerakan.
 SUSUNAN
SARAF
Susunan saraf pusat
(SSP)
Otak
Medulla Spinalis

Susunan saraf tepi (SST)

Saraf kranial : 12 ps
Saraf spinal : 31 ps
CORTICAL LOBES
 FUNCTIONS OF THE NERVOUS
SYSTEM
COMPLICATED
COMPLICATED COMPLICATED (ASTRONOMICAL)
STRUCTURES
STRUCTURES && INTERCONNECTIONS &
FUNCTIONS
FUNCTIONS INTERACTIONS
(1 neuron 10,000 neurons)

FUNCTIONS:
INTERNAL
1. MONITORS:CNS (SENSORY) RECEPTORS
(info)
EXTERNAL
2. COORDINATES: APPROPRIATE RESPONSES
(Processes, Integrates)

3. INSTRUCTS: CNS (MOTORIC) EFFECTORS TO RESPOND

 SENSORY/AFFRENT SYSTEM
(CNS RECEPTOR)
(INFO.)

(CNS) RECEPTOR (events/stimuli)

EXTERNAL CONTACT
(somatosensory) (pain, temp., touch, pressure)
RECEPTORS
DISTANT
* COLLECTING (Info) (sound, light, odours)
* PROCESSING
INTERNAL
(viscerosensory)
RECEPTORS
Tension, blood pressure,
pressure, chemical
composition of the blood
(hormones, glucose, CO2,
ions/electrolytes)
 MOTOR/EFFERENT SYSTEM
( CNS EFFECTOR)
(INFO.)

SOMATOMOTORIC SKELETAL MUSCLES

MOTOR/ EFFECTORS
AFFERENT
SYSTEM

VISCEROMOTORIC VISCERA, VASA

Smooth muscles
Myocardium
ExocrineEnzymes
Glandular cells
EndocrineHormones
Three functional classes of neurons: 1. Afferent neuron,
2. Interneuron (in the CNS), and 3. Efferent neuron
 DIVISIONS OF THE NERVOUS
SYSTEM

BRAIN (Encephalon)
(within the cranial cavity)
CENTRAL
(CNS)
NERVOUS SYSTEM
(Neurons : 100 billion SPINAL CORD (Medulla spinalis)
Neuroglia: 10x Neurons) (within the vertebral column)
(anatomical) CRANIAL NERVES (N I - XII)
(from the brain)
PERIPHERAL
(PNS) SPINAL NERVES (31 pairs)
(from the spinal cord)
(functional)

AUTONOMIC (ANS)* (unconscious) SOMATIC (conscious)

(to skeletal muscles)
SYMPATHETIC PARASYMPATHETIC
(to smooth muscle, cardiac muscle and glands)
(* ANS has its cranial component in the brain)
 Fungsi/Perjalanan Impuls saraf
Sensorik
Sensorik Tepi: Receptor serabut saraf sensorik
perifer ganglion pre spinale PHC
Sensorik Pusat: PHC - tr spinothalamicus
thalamus tr thalamo corticalis cortex sensorik
Motorik
Upper Motor Neuron (UMN)/Motorik Pusat:
Cortex motorik tr piramidal & extra piramidal
(cortico spinalis) AHC.
Lower Motor Neuron (LMN)/Motorik Tepi: AHC
serabut saraf motorik perifer Otot
Koordinasi (Prosesing, Integrating, fungsi luhur)
Fungsi ini hanya dimiliki oleh otak
12 pairs CENTRAL
of cranial NERVOUS 31 pairs of
Brain Spinal cord
nerves SYSTEM spinal nerves
(CNS)*
(input to CNS from periphery) (output from CNS to periphery)

PERIPHERAL
Afferent NERVOUS Efferent
divison SYSTEM (PNS) division

Somatic Autonomic
nervous nervous
Sensory Visceral system system
stimuli stimuli

Motor Sympathetic Parasympathetic

neurons nervous nervous
system system
* FUNCTIONAL
DIVISIONS OF THE Skeletal muscle Smooth muscle
NS Cardiac muscle
Glands
EFFECTOR ORGANS
Sel fungsional :

Neuron ( sel saraf )

Sel penunjang :

Neuroglia
 NEURON (NERVE CELL)

STRUCTURAL AND FUNCTIONAL UNIT OF NERVOUS SYSTEM*

SOMA (cell body)

(collective: gray matter/sustantia grisea)
COMPONENT
DENDRITES
PROCESSES
AXON (collective: white matter/
substantia alba)
*NEURON:
TERMINAL SYNAPSE
Specialized to receive info. (contact with
Transmit electrical impulses (action other neuron/
potentials) Influence other effector cells)
effector tissues (neuron, muscle
(skeletal, smooth, cardiac, glands)
 THE UNIQUENESS OF THE
NERVOUS SYSTEM
NEURONAL INTERCONNECTION COMPLEXITY
INPUT: FROM HUNDREDS 200.000 SYNAPSES

NEURON

OUTPUT: TO THOUSANDS - 10.000 NEURONS

IN THE BRAIN: 100 BILLION OF NEURONS

100 TRILLION SYNAPSES
(ASTRONOMICAL: STARS IN MILKWAY GALAXY)

COUNTING: 1 sec./NEURON

IT NEEDS 300.000 yrs.)

THE BRAIN RECEIVES MILLIONS BITS OF INFORMATION FROM THE SENSORY

ORGANS AND INTEGRATES THEM INTO VARIOUS RESPONSES
Neuron Axon Sinaps
 Cell body/soma
Axon

Collateral

Axon
terminal

NEURON
SYNAPSES (interneuronal contacts)
1. Axosomatic 2. Axodendritic
3. Axoaxonic 4. Dendrodendritic
 TYPES OF
NEURONS

1. UNIPOLAR/
PSEUDOUNIPOLAR (D)
2. BIPOLAR (E, F)
3. MULTIPOLAR (A, B, C)
 PRESYNAPTIC
INHIBITION

CONVERGENCE & DIVERGENCE

HOW NEURONS COMMUNICATE
TO EACH OTHER ?

SYNAPSE
CONSISTS OF:
-Presynaptic
element (part of
axon terminal)
-Synaptic
cleft/space
-Postsynaptic
region (receptor at
the postsynaptic
membrane of the
innervated neuron
or effector
structure)
 COMMUNICATION ACROSS THE SYNAPSE

ELECTRICAL IMPULSE (ACTION POTENTIAL) (in the membrane of

presynaptic neuron)

RELEASE OF NEUROACTIVE SUBSTANCE (neurotransmitter (NT),

neurmodulator, neuromediator) from the presynaptic element)
(NT is stored in synaptic vesicles in the terminal, and then is released into
the synaptic cleft)

SYNAPTIC CLEFT (SPACE) (NT diffuse rapidly across the synaptic cleft)

BIND TO RECEPTOR SITES on the postsynaptic membrane

NEURON POSTSYNAPTIC MAY BE EXCITED

(lead to the generation of action potential)
NEUROGLIA (GLIAL CELL)
1.Oligodendrocyte
2. Astrocyte
3. Microglia
4. Ependymal cell
NERVOUS NEURONS --------- RECEIVE/PROCESS/SEND
SYSTEM
INFORMATION
GLIA --------- * CONTROL ENVIRONMENT
WITHIN THE CNS (MICRO-
ENVIRONMENT)
Shuttle nutritive molecules
(blood neuron)
Remove waste products of neurons
Maintain electrochemicals surroundings of neurons
Guiding developing neurons (migration)
Phagocytosis
Structural support for neurons

STRUCTURE CELL BODY (soma/perikaryon)

DENDRITES Info
OF NEURON PROCESSES
AXON TERMINALS
Fig. 2-1 (Info)
TERMINAL ARBORS

TERMINAL BOUTONS

SYNAPSES

EFFECTOR / TARGET CELLS

 CELL BODY
Contains:
Mitochondria (Power Plant)
Ribosomes
rER : stacks Nissl bodies
Golgi complex (Packing cell products)

UNIPOLAR/PSEUDOUNIPOLAR
(sensory ganglia)
Peripheral/dendrite
Branch ----
TYPES OF NEURON BIPOLAR Central/axon
(see Tab. 2-1) (olfactory, auditory, vestibular)

MULTIPOLAR
(many area of CNS)
Neuronal pole
 CLASSIFICATION
& GROUPS OF NEURONS
CNS

GROUP OF CELL BODIES

NUCLEUS A cluster of functionally related nerve cell bodies
(pl. nuclei)
COLUMN (in cerebral cortex, spinal cord)
LAYER/STRATUM/LAMINA (in spinal cord)

BUNDLE OF AXONS
TRACT A bundle of axons of a specific
FASCICULUS populations of functionally related fibers
(pl. fasciculi)
LEMNISCUS FUNICULUS (pl. funiculi)/
(pl. lemnisci) SYSTEM
PNS

CELL BODIES
GANGLION A collection of cell bodies
(pl. ganglia)
SENSORY (dorsal root, cranial nerves)
MOTORIC (visceromotoric, autonomic)

AXONS
NERVES A bundle of axons
RAMUS
(pl. rami)
ROOT/RADIX
 GLIA (NEUROGLIA/GLIAL
CELL)
FUNCTIONS:
STRUCTURE SUPPORT
MAINTAIN APPROPRIATE MICROENVIRONMENT FOR NEURONAL
FUNCTIONS
PHAGOCYTOSIS

Central glia Peripheral glia

TYPES OF GLIA
CNS
PNS

ASTROCYTE OLIGODENDROCYTE MICROGLIA EPENDYMA

Protoplasmic Fibrous (Gray & white (Lining of cerebral
(Gray matter) (White matter) matter) ventricles)

SCHWANN CELLS
SATELLITE CELLS
G
L FUNGSI: - Penyanggastruktur saraf ASTROCYTES
I - Berespon thd lesi/cedera OLIGODENDROCYTES
A MICROGLIA

I. ASTROCYTES:
- Membentuk pola untuk migrasi neuron (pada
masa tumbuh kembang)
- Membentuk kelompok-kelompok neuron tertentu
- Sekresi faktor pertumbuhan (growth factor)
- Sekresi cytokines
- Mengisi ruang dengan mengurai debris (astrocyte
berproliferasi dan atau hypertrophy)
- Mengontrol lingkungan (komposisi ion/pH)
- Metabolisme (berpartisipasi dalam metabolisme
neurotransmitter)
II. OLIGODENDROCYTES
(terdapat di substansia abu-abu dan
substansia putih)
Myelination:the provision of an
electrochemically insulating sheath
around some axons in the white matter)
(Myelin sheath)
Meningkatkan kecepatan hantar dari action potential
(AP) sepanjang axon (Saltatory conduction)
Pada bagian tertentu terdapat interupsi yang disebut
NODE OF RANVIER (antara 2 selubung myelin atau
disebut internodal segments atau internodes)
MICROGLIA (1% dari populasi sel di CNS)

Berasal dari sel-sel darah

(monocytic-macrophage)
Bermigrasi ke CNS

Proses fagositosis (saat teraktivasi)

Microglia teraktivasi bila CNS mengalami lesi/cedera
Bermigrasi ke tempat kerusakan
Proliferasi
Fagositosis debris sel
Memproduksi cytokines (interleukins)
Terdapat Antigen-presenting cells Berperan
dalam proses autoimmune disease
 PET scanner at the Keck
The geodesic sensor Laboratory for Functional
net containing 256 Brain Imaging and Behavior
electrodes picks up
electrical impulses
from numerous parts
of the brain.
Teknik EEG
PET Scan
fMRI
 MENTAL PRACTICE

For many patients with stroke,

the lesion is sufficiently vast
that actual performance of
motor tasks is very difficult,
sometimes impossible,
precluding early participation
in an active rehabilitation
program. This figure illustrates
that a similar network of
cerebral structures (e.g.,
premotor cortex) is activated
when normal control subjects
execute physically or imagine
a sequence of up-down foot
movements. This sort of
evidence thus suggests that
mental practice with motor
imagery can be used as a
therapeutic approach to keep
active the neural circuits
involved in locomotion, for
example, hence facilitating the
rehabilitation of patients who
These PET/MR
images show
increased neural
activity in the superior
temporal gyrus in
congenitally deaf
subjects when they
viewed signs or sign-
like movements.
These data therefore
suggest that auditory
cortical regions may
contribute to the
processing of visual
information in the
deaf.
 Otak
Berat otak 1200 1400 gram (2 % Berat
Badan)
Terbagi atas
Otak besar (cerebrum)
Otak kecil (cerebellum)
Batang otak (brain stem, truncus cerebri)

Otak besar terbagi menjadi 4 lobus

Frontalis
Parietalis
Temporalis
Occipitalis
THE HUMAN
BRAIN MIND (memory, thought/
intellect, emotion)
CONSCIOUSNESS
COGNITION
(Produces)
PERCEPTION
PERSONALITY
BEHAVIOR

The largest organ of the body

Composed of soft tissue (jelly) Needs strict protection
In adult: 1,300 g
Mushroom-shaped
 BRAIN

BRAIN STEM DIENCEPHALON CEREBRUM CEREBELLUM

MEDULLA CEREBRAL BASAL

PONS THALAMUS CORTEX GANGLIA
OBLONGATA
HYPOTHALAMUS
MESENCEPHALON
 BRAIN
1. BRAIN STEM
- The oldest and smallest region of the brain
- Controls many of the sustaining processes (breathing,
circulation, and digestion) (VEGETATIVE FUNCTIONS)
- (With the loss of higher brain functions, can still functions
essential for survival)
2. DIENCEPHALON
HYPOTHALAMUS: Controls many homeostasis functions
important in maintaining stability of the internal environment
THALAMUS: Performs some primitive sensory processing,
and plays a role in coordinating movements
3. CEREBRUM
- More convoluted gyri (ridges) & sulci (grooves/folds)
- Most highly developed in humans
- 80% of total brain weight
- The outer layer: CEREBRAL CORTEX (highly convoluted)
 3. CEREBRUM (cont.)
- Plays key role in the most sophisticated neural functions:
- Voluntary initiation of movement
- Final sensory perception
- Conscious thought
- Language
- Personality traits
- Other factors we associate with the mind or intellect
(THE HIGHEST MOST COMPLEX INTEGRATING AREA OF THE BRAIN)
4. CEREBELLUM
- Maintaining proper position of the body in space
- Conscious coordination of motor activity (movement)
cerebrum (otak besar) merupakan bagian
otak manusia yang terbesar, paling
berkembang dan memiliki fungsi luhur
yang paling utama.
Otak besar terdiri dari substansia abu-
abu (grey mater) setebal + 2 cm (cortex
cerebri) yang berfungsi sebagai pusat
intelektual, pusat bicara, emosi, integrasi
sensorik dan motorik, kontrol gerak dan
lain-lain.
Sedangkan bagian dalam otak
merupakan substansia putih (white
matter) berisi network serabut-
serabut saraf yang memungkinkan
antar bagian otak saling
berkomunikasi dan jaringan penyangga
saraf yang berfungsi memberi bentuk
otak.
Cerebellum (otak kecil) merupakan bagian otak
terbesar kedua, yang bertanggung jawab dalam
mengaturkeseimbangan, koordinasi dan berbagai
kontrol motorik

Brain stem (batang otak) merupakan jalur

terakhir dari otak yang menghubungkannya
dengan medulla spinalis. Batang otak ini
bertanggung jawab pada berbagai fungsi otonom
seperti kontrol pernapasan, denyut jantung,
tekanan darah, bangun, rangsangan dan
perhatian.
Principal parts of the brain (medial aspect)
 FUNCTIONS OF THE MAJOR COMPONENTS
OF THE BRAIN

CEREBRAL CORTEX
1. Sensory perception
2. Voluntary control of movement
3. Language
4. Personality traits
5. Sophisticated mental events (thinking, memory, decision
making, creativity, and self-consciousness)

BASAL NUCLEI
1. Inhibition of muscle tone
2. Coordination of slow, sustained movements
3. Suppression of useless patterns of movement
 THALAMUS
1. Relay station for all synaptic input
2. Crude awareness of sensation
3. Some degree of consciousness
4. Role in motor control

HYPOTHALAMUS
1. Regulation of many homeostatic functions (temperature control,
thirst, urine output, and food intake)
2. Important link between nervous and endocrine systems
3. Extensive involvement with emotion and basic behavioral patterns
 CEREBELLUM
1. Maintenance of balance
2. Enhancement of muscle tone
3. Coordination and planning of skilled voluntary muscle activity

BRAIN STEM
1. Origin of majority of peripheral and cranial nerves
2. Cardiovascular, respiratory, and digestive control centers
3. Regulation of muscle reflexes involved with equilibrium and
posture
4. Reception and integration of all synaptic input from spinal cord,
arousal
and activation of cerebral cortex
5. Sleep center
FUNCTIONAL AREAS OF THE CERBRAL CORTEX
SENSORY HOMUNCULUS
MOTOR HOMUNCULUS
 BASAL NUCLEI

LENTICULAR CAUDATE AMYGDALA

NUCLEUS NUCLEUS
(function: limbic system)

PUTAMEN GLOBUS PALLIDUS

BASAL NUCLEI
BASAL NUCLEI
 LIMBIC SYSTEM

Primitive parts of the brain that involve in: * SELF-PRESERVATION

* SPECIES-PRESERVATION
THE MAIN COMPONENTS
I. CORTICAL (LIMBIC LOBE):
1. Parolfactory area 2. Paraterminal area
3. Cingulate gyrus 4. Isthmus
5. Hippocampal formation: - Hippocampus - Hippocampal gyrus -
Parahippocampal gyrus - Dentate gyrus

II. SUBCORTICAL (NUCLEI)

1. Amygdala 2. Septal nuclei 3. Thalamus 4. Preoptic nucleus
5. Mammillary body
LIMBIC SYSTEM
LIMBIC SYSTEM
 PROTECTION & COVERINGS
OF CNS
(protection against injury)

PROTECTION
1. BONES: - CRANIAL BONES (CRANIUM) (for the brain)
- VERTEBRAL COLUMN (for the spinal cord)
2. MENINGES: - CRANIAL MENINGES (surround the brain)
- SPINAL MENINGES (surround the spinal cord)
3. CEREBROSPINAL FLUID (CSF)
- Circulates through the subarachnoid space
- Formed by filtration and secretion from CHOROID
PLEXUSES (network of capillaries); located in the
ventricles of the brain
BLOOD-CSF BARRIER: - permits certain substances to enter
the CSF but prohibits the others Protects the brain
and spinal cord from harmful substances
- formed by various components of the choroid plexus
 Selaput Otak-Spinal (Meninx)
Selaput otak-spinal terdiri dari 3 lapis,
yaitu:
Duramater
Arachnoid
Piamater

Dengan adanya selaput ini, maka

terbentuk ruangan-ruangan
Subdural
Sub arachnoid (tempat mengalirnya cairan
otak spinal)
Intra cerebral
 CSF
FORMATION CIRCULATION - ABSORPTION

Lateral ventricles

Arterial blood Interventricular foramen

CSF

HEART 3rd ventricle

CSF
CSF
CHOROID
Venous blood PLEXUS
Cerebral aqueduct

CSF
Arachnoid viLli 4th ventricle
(of dural venous sinuses)

Subarachnoid space Lateral & median appertures

CSF IS PRODUCED BY CHOROID PLEXUSES AND ABSORBED

BY ARACHNOID VILLI (in the sagittal sinus)
 Sistem Ventrikel (LCS)

Merupakan penghasil cairan spinal otak

(LCS/CSF):
Fungsi
Protein, metabolisme
Pelindung otak, med spinalis

Bersirkulasi dan akhirnya masuk dalam

aliran vena
1. Anterior horn of lateral
ventricle
2. Body of lateral ventricle
3. Posterior horn of lateral
ventricle
4. Inferior horn of lateral
ventricle
5. Third ventricle
6. Fourth ventricle
1. Anterior horn of lateral
ventricle
2. Body of lateral ventricle
3. Posterior horn of lateral
ventricle
4. Inferior horn of lateral
ventricle
5. Third ventricle
6. Fourth ventricle
7. Interventricular foramen
8. Cerebral aqueduct
 CLINICAL APPLICATION

INTERFERENCE OF
DRAINAGE CSF OBSTRUCTION
(tumor, congenital blockage)
(from ventricles to
arachnoid space)

INTRACRANIAL (inside the

LARGE AMOUNT OF brain) PRESSURE
CSF ACCUMULATE IN (if the fontanels have not yet
THE VENTRICLES closed The head bulges

INTERNAL HYDROCEPHALUS
(hydro: water; enkephalos: brain)
If an obsruction interferes with drainage somewhere in the
subarachnoid space and CSF accumulates inside the space
EXTERNAL HYDROCEPHALUS
 CEREBROVASCULAR SYSTEM

Otak memiliki berat 2% dr seluruh BB, tp

mengkonsumsi 100 cc darah/menit atau 15%-
20% dr curah jantung dan 25% dari oksigen
yang diinspirasi.
Otak sangat rentan thd ischemik & hipoxia. Ggn
vaskuler otak dlm detik sdh menimbulkan gejala
ggn neurologis, dlm menit sdh bersifat
irreversible.
Ada 4 arteri utama yang mensuplai darah ke
otak yaitu sepasang arteri vertebralis dan
sepasang arteri karotis interna yang membentuk
anyaman circulus willisi di dasar otak.
 Vaskularisasi Otak

1. Sistem Karotis sinistra dan dextra

- Masuk cavum cranii
Carotis Interna Carotis Cerebri Media
2. Sistem Vertebra basilaris sinistra dan dextra
Sistem vaskularisasi yang terganggu menentukan topis
lesi pada stroke
CIRCLE OF WILLIS
 AUTONOMIC
NS

SYMPATHETIC
NS

PARASYMPATHETIC
NS