sensation kinds and types of sensory disturbance syndromes of lesion

SensationSensationKinds and types of Kinds and types of

sensory disturbancesensory disturbance Syndromes of lesionSyndromes of lesion

SensationSensation

is an ability of an organism to is an ability of an organism to accept stimuli from external and accept stimuli from external and internal environmentinternal environment

Classification of sensationClassification of sensation

І.І. Classification, which is based on Classification, which is based on the place of originating of stimuli:the place of originating of stimuli:

ExteroceptiveExteroceptive

InteroceptiveInteroceptive ProprioceptiveProprioceptive


ІІ.ІІ. Classification, which is based on biological Classification, which is based on biological principle of originating of sensation:principle of originating of sensation:

Protopatical (vital, nociceptive, thalamic). Protopatical (vital, nociceptive, thalamic). This ancient sensation is typical for the This ancient sensation is typical for the primitive nervous system of our ancestorsprimitive nervous system of our ancestors

Epicritical sensation is connected with cortex Epicritical sensation is connected with cortex and it is based on the differentiation of and it is based on the differentiation of stimuli according to their modality, intensity, stimuli according to their modality, intensity, localization etc localization etc


In clinical practice usually we use In clinical practice usually we use classification, which is based on the kind classification, which is based on the kind of stimuli:of stimuli:

SuperficialSuperficial DeepDeep ComplicatedComplicated

Superficial sensationSuperficial sensation - - light touch light touch pain pain temperaturetemperature TrihoesthesiaTrihoesthesia – is a sensation of touch of – is a sensation of touch of

hairhair HydroesthesiaHydroesthesia – is a sensation of humidity– is a sensation of humidity Sensation of electrical currentSensation of electrical current Feeling of ticklingFeeling of tickling

Superficial painSuperficial pain – is – is a feeling of pain, a feeling of pain, which can be tested which can be tested with a corsage pin or with a corsage pin or pinwheel (acutely or pinwheel (acutely or bluntly, pricks or does bluntly, pricks or does not prick)not prick)

Light touch Light touch (tactile) (tactile) sensationsensation – is – is feeling of touch, feeling of touch, which may be which may be examined by examined by touch of cotton, touch of cotton, end of hammer, end of hammer, paintbrushpaintbrush

Temperature sensationTemperature sensation – is feeling of cold or hot, – is feeling of cold or hot, which may be tested by which may be tested by application of glass tubes application of glass tubes filled with iced (10 C) filled with iced (10 C) and hot (43 C) water to and hot (43 C) water to the skinthe skin

Deep sensationDeep sensation

This includes joint and vibratory sense and This includes joint and vibratory sense and pain from the deep-lying somatic pain from the deep-lying somatic structures, namely, muscle, ligaments, structures, namely, muscle, ligaments, fascia, bone, and so on.fascia, bone, and so on.

Feeling of mass (Feeling of mass (baroesthesia)baroesthesia) – – is the is the ability to distinguish different weightsability to distinguish different weights

Feeling of pressure Feeling of pressure - - is the ability to is the ability to distinguish pressure from touchdistinguish pressure from touch

Joint senseJoint sense (bathyesthesia)(bathyesthesia) - is - is the ability to distinguish position the ability to distinguish position and passive movements in jointsand passive movements in joints

The joint senseThe joint sense The loss of joint sense, which is called The loss of joint sense, which is called

bathyanesthesia,bathyanesthesia, results in disturbance of results in disturbance of muscular coordination and is known as muscular coordination and is known as sensitive ataxiasensitive ataxia..

Sensitive ataxiaSensitive ataxia is divided on: is divided on: static static dynamicdynamic

Static ataxia in legsStatic ataxia in legs can be can be investigated by means of investigated by means of Romberg’s test -Romberg’s test - patient is asked patient is asked to stand directly with the extended to stand directly with the extended forward arms and feet together. In forward arms and feet together. In case of ataxia difficulty of standing case of ataxia difficulty of standing and instability occurs. That is and instability occurs. That is magnified while eyes are closed.magnified while eyes are closed.

Static ataxia in armsStatic ataxia in arms can be examined by can be examined by follows: we ask patient to extend forward follows: we ask patient to extend forward arms and to place fingers separately. In arms and to place fingers separately. In case of ataxia consensually spontaneous case of ataxia consensually spontaneous (involuntary forced) movements (involuntary forced) movements (pseudoathetosis) in fingers of arms (pseudoathetosis) in fingers of arms occurs.occurs.

Dynamic ataxiaDynamic ataxia in arms may be examined in arms may be examined by means of finger-to-nose test, and in by means of finger-to-nose test, and in legs - heel-to-knee test.legs - heel-to-knee test.

Vibration sense Vibration sense (pallesthesia)(pallesthesia) ––

is the

ability to distinguish different vibration

Kinesthesia - Kinesthesia - is a sensation of is a sensation of movement of dermal foldmovement of dermal fold

Complicated sensationComplicated sensation Localization senseLocalization sense - is the ability to - is the ability to

point an exact place of the stimulipoint an exact place of the stimuli Discrimination senseDiscrimination sense (two-point (two-point

discrimination)discrimination) - - tests the ability of tests the ability of the patient to differentiate one stimulus the patient to differentiate one stimulus from two. It may be examined by from two. It may be examined by Weber’s circus Weber’s circus

Baragnosis Baragnosis – is the impaired ability to – is the impaired ability to distinguish different weightsdistinguish different weights

Graphism Graphism – is the ability to determine figures – is the ability to determine figures and numbers traced on the skin with the closed and numbers traced on the skin with the closed eyes.eyes. Graphesthesia Graphesthesia – impaired graphism is – impaired graphism is very sensitive indicator of parietal lobe damagevery sensitive indicator of parietal lobe damage . .

Complicated sensation Complicated sensation

Stereognosis (Three-point Stereognosis (Three-point distinction)distinction) is the ability to is the ability to identify familiar object placed in identify familiar object placed in the palm of the patient by the palm of the patient by palpation when the eyes are palpation when the eyes are closedclosed

Anatomy of Superficial sensation tractsAnatomy of Superficial sensation tracts

This tract carry out pain, temperature and part of This tract carry out pain, temperature and part of tactile sense and has three neurons.tactile sense and has three neurons.

The 1The 1 neuron neuron is situated in unipolar cell bodies in is situated in unipolar cell bodies in ganglion spinalis of dorsal root of the spinal cord ganglion spinalis of dorsal root of the spinal cord and homologous ganglia of the Cranial nerves. and homologous ganglia of the Cranial nerves.

The 2The 2 neuron neuron - is situated in dorsal horns of the - is situated in dorsal horns of the spinal cord. The axons create spinal cord. The axons create tractus tractus SpinothalamicusSpinothalamicus. The axons of these neurons . The axons of these neurons cross the midline through the ventral commissura cross the midline through the ventral commissura and go to the opposite lateral funiculus of the and go to the opposite lateral funiculus of the spinal cord in the spinal cord in the lateral spinothalamic tracts.lateral spinothalamic tracts.

The 3 neuronThe 3 neuron – – are nuclei of thalamus. The are nuclei of thalamus. The axons form axons form Thalamocortical tractThalamocortical tract

SensorySensoryHomunculusHomunculus

SensorySensoryHomunculusHomunculus

Anatomy of Deep sensation explorersAnatomy of Deep sensation explorers

The first neuronThe first neuron – is in t – is in the unipolar cell bodies in the he unipolar cell bodies in the dorsal root ganglia of the spinal cord and homologous dorsal root ganglia of the spinal cord and homologous ganglia of the cranial nerves ganglia of the cranial nerves

- Medial - Medial Holl’s tractHoll’s tract fibers pass from Th4 and below (carries fibers pass from Th4 and below (carries out deep sense from lower extremities and bottom of trunk) out deep sense from lower extremities and bottom of trunk)

- Lateral - Lateral Burdach’s pathwayBurdach’s pathway - from Th4 and higher (carries - from Th4 and higher (carries out deep sense from upper extremities and top of a trunk)out deep sense from upper extremities and top of a trunk)

The second neuron -The second neuron - is in Holl’s and Burdach’s nuclei of is in Holl’s and Burdach’s nuclei of medulla oblongata. The axons of the second neuron create medulla oblongata. The axons of the second neuron create BBulbothalamic tractulbothalamic tract. The fibers of this path are crossed on . The fibers of this path are crossed on olives level of medulla oblongata, on the Pons of brain stem olives level of medulla oblongata, on the Pons of brain stem they join of they join of SSpinothalamic tract lateralpinothalamic tract lateral and create a and create a medial closed loopmedial closed loop (lemniscus medialis)(lemniscus medialis) The axons of The axons of the 2-d neurons carry all sorts of sensation from opposite the 2-d neurons carry all sorts of sensation from opposite side of the body side of the body

The third neuronThe third neuron - is in thalamus, from which cells - is in thalamus, from which cells thalamocortical tract startsthalamocortical tract starts

Sensory innervation of the faceSensory innervation of the face The first neuronThe first neuron of face, nasal sinuses, oral cavities and of face, nasal sinuses, oral cavities and

nose sensory conductors are situated in nose sensory conductors are situated in Trigeminal Trigeminal (Gasser’s ganglion).(Gasser’s ganglion). Those for larynx mucouse membrane, Those for larynx mucouse membrane, pharynx, radix of tongue - in ganglions of Vague and pharynx, radix of tongue - in ganglions of Vague and Glossopharyngeal nerves Glossopharyngeal nerves (ganglion superior and inferior(ganglion superior and inferior). ). Those for 2/3 front of tongue - in a geniculate ganglion Those for 2/3 front of tongue - in a geniculate ganglion (ganglion geniculi)(ganglion geniculi) of facial nerve of facial nerve

The second neuronsThe second neurons are situated in the sensitive nuclei of are situated in the sensitive nuclei of the adequate cranial nerves in brain stem. The axons of the adequate cranial nerves in brain stem. The axons of the second neuron make decussate and after that join the second neuron make decussate and after that join medial closed loopmedial closed loop, in which structure pass to ventral-, in which structure pass to ventral-lateral nuclei of a thalamuslateral nuclei of a thalamus

The third neuronThe third neuron is in thalamus. The axons form is in thalamus. The axons form thalamocortical tractthalamocortical tract, pass through internal capsule, a , pass through internal capsule, a radiate crown and are ended in lower parts of postcentral radiate crown and are ended in lower parts of postcentral gyrus gyrus

Trigeminothalamic Trigeminothalamic TractTract

A. trigeminal ganglionA. trigeminal ganglionB. trigeminal sensory B. trigeminal sensory nucleusnucleusC. thalamus (VPM)C. thalamus (VPM)D. cerebral cortex (S I)D. cerebral cortex (S I)

1. 1. spinal tract of spinal tract of trigeminal nervetrigeminal nerve2. 2. ventral ventral trigeminothalamic tracttrigeminothalamic tract3. 3. dorsal dorsal trigeminothalamic tracttrigeminothalamic tract4. 4. corona radiatacorona radiataV.V. trigeminal nerve trigeminal nerve

Objective sorts of sensory disordersObjective sorts of sensory disorders AnesthesiaAnesthesia - - complete loss of any sorts of complete loss of any sorts of

sensation. For example:sensation. For example: AnalgesiaAnalgesia - - loss of pain sense.loss of pain sense. ThermoanesthesiaThermoanesthesia - - loss of a temperature senseloss of a temperature sense BathyanesthesiaBathyanesthesia - - loss of deep joint senseloss of deep joint sense AstereognosiaAstereognosia - - loss of stereognostic senseloss of stereognostic sense Topanesthesia Topanesthesia - - loss of localization senseloss of localization sense Pallanesthesia Pallanesthesia – – loss of vibratory senseloss of vibratory sense HypoesthesiaHypoesthesia - - lowering of sensationlowering of sensation.. HyperesthesiaHyperesthesia – – increasing of sensationincreasing of sensation

Objective sorts of sensory disordersObjective sorts of sensory disorders Dysesthesia Dysesthesia - - distortion of sensitivity, when distortion of sensitivity, when

instead of one stimulus the patient feels instead of one stimulus the patient feels absolutely other. For example, warm touch absolutely other. For example, warm touch one feels as coldone feels as cold

HyperpathiaHyperpathia - - results from rise of a results from rise of a threshold of energization, when there are threshold of energization, when there are strong, unpleasant, badly localized strong, unpleasant, badly localized sensations of stimuli. Thus the mild stimuli sensations of stimuli. Thus the mild stimuli are not received absolutely. In basis of are not received absolutely. In basis of hyperpathia the disturbance of the analytical hyperpathia the disturbance of the analytical function of cortex laysfunction of cortex lays

SynesthesiaSynesthesia - - sensation of stimuli not only sensation of stimuli not only in a place of its plotting, but also in the other in a place of its plotting, but also in the other placeplace

Objective sorts of sensory disordersObjective sorts of sensory disorders PolyesthesiaPolyesthesia - - means sensation of one means sensation of one

stimulus as several onesstimulus as several ones AlloheyriaAlloheyria - - sensation of stimuli in sensation of stimuli in

symmetrical sites on an opposite body partsymmetrical sites on an opposite body part AlloesthesiaAlloesthesia - - sensation of stimuli in the sensation of stimuli in the

other placeother place Dissociation of senseDissociation of sense - - phenomenon of phenomenon of

fallout of some kind of sensitivity while fallout of some kind of sensitivity while saving others in the area of segment saving others in the area of segment innervationinnervation

Subjective sorts of sensory Subjective sorts of sensory disturbances:disturbances:

ParesthesiaParesthesia is a creeping sensation, is a creeping sensation, cold, burning sensation, fever, cold, burning sensation, fever, numbness, itch, the pricking etc. numbness, itch, the pricking etc. Frequently paresthesia is the first sign of Frequently paresthesia is the first sign of nervous system lesionnervous system lesion

PainPain The pain sensations can arise at The pain sensations can arise at stimuli by the pathological process of stimuli by the pathological process of sensitive analyzers at any level (from sensitive analyzers at any level (from receptors up to cortex) receptors up to cortex)

Sorts of painSorts of pain11. . Local painLocal pain - - is pain, for example, at is pain, for example, at

palpation of the nervous trunk. That is pain, palpation of the nervous trunk. That is pain, which coincides with the place of lesionwhich coincides with the place of lesion

2.2. Projectional pain Projectional pain - - is a pain in zone of is a pain in zone of innervation not only in place of stimuli, but innervation not only in place of stimuli, but also distally on a course of nerves or roots. also distally on a course of nerves or roots. To projection belongs the stump neuralgia - To projection belongs the stump neuralgia - pain in absent segments of an extremity pain in absent segments of an extremity after its ablationafter its ablation

Sorts of painSorts of pain3.3. Irradiating pains Irradiating pains - - are pains, which are are pains, which are

distributed from one nerve branch to another, not distributed from one nerve branch to another, not struck. For example, at neuralgia of the first struck. For example, at neuralgia of the first branch of trigeminal nerve the pain is distributed branch of trigeminal nerve the pain is distributed to zone of innervation of the second or the third to zone of innervation of the second or the third branches, in upper or lower jaw, in ears etcbranches, in upper or lower jaw, in ears etc

4. Displayed pains4. Displayed pains - - are pains in zones Zacharyin-are pains in zones Zacharyin-Hed’s at diseases of inner organs, when Hed’s at diseases of inner organs, when irradiation arises to certain zone on skin through irradiation arises to certain zone on skin through cells of dorsal horns of spinal cord. For example, cells of dorsal horns of spinal cord. For example, pain on ulnar territory of the left forearm and pain on ulnar territory of the left forearm and paintbrush at angina pectorispaintbrush at angina pectoris

Sorts of painSorts of pain

55.. CausalgiaCausalgia (Greek causes - burning (Greek causes - burning sensation, algos - pain). It is intensive sensation, algos - pain). It is intensive thermalgia originating, for example, at thermalgia originating, for example, at traumas. It is pain without stimulationtraumas. It is pain without stimulation

6.6. Reactive pains Reactive pains - - are pains that originate are pains that originate at expansion of nerves. The pains can at expansion of nerves. The pains can arise at palpation of pain points and at arise at palpation of pain points and at band spread of nervous trunksband spread of nervous trunks

Straight leg raising test

Types of sensory disturbancesTypes of sensory disturbances Peripheral typePeripheral type Mononeuritic (or neural) Polyneuritic Plexal Segmental (sectional) typeSegmental (sectional) type Segmental - radicularSegmental - radicular Segmental - dissociatedSegmental - dissociatedConductive typeConductive type SpinalSpinal CerebralCerebral

The peripheral typeThe peripheral type

Mononeuritic (or neuralMononeuritic (or neural) ) patternpattern - is - is observed at lesion of one peripheral nerve observed at lesion of one peripheral nerve and consists of disturbance of all sorts of and consists of disturbance of all sorts of sensation in innervative zone of this nerve. sensation in innervative zone of this nerve.

there is a pain in the field of nervethere is a pain in the field of nerve sometimes hyperpathia, hyperalgesia, sometimes hyperpathia, hyperalgesia,

causalgia, causalgia, tension signs of nervetension signs of nerve pain at palpationpain at palpation


Polyneuritic patternPolyneuritic pattern - is observed at - is observed at multiple, frequently symmetric lesion of all multiple, frequently symmetric lesion of all peripheral nerves peripheral nerves

Appears by sensory disturbance in distal Appears by sensory disturbance in distal parts of extremities as "socks" on legs and parts of extremities as "socks" on legs and "gloves" on arms"gloves" on arms

The “stocking-glove” pattern of sensory loss The “stocking-glove” pattern of sensory loss is typical for peripheral neuropathy is typical for peripheral neuropathy


Plexal patternPlexal pattern - occurs at lesion of - occurs at lesion of peripheral plexus and appears by sensation peripheral plexus and appears by sensation disturbance in innervative zone of a plexus disturbance in innervative zone of a plexus and painsand pains

The segmental (sectional) typeThe segmental (sectional) type

disturbance of sensation is observed at disturbance of sensation is observed at lesion of sensitive fibbers at segment level lesion of sensitive fibbers at segment level of spinal cordof spinal cord

Segmental - radicular patternSegmental - radicular pattern

Segmental – dissociated patternSegmental – dissociated pattern

Sectional body buildingSectional body building

Lesion of Lesion of dorsal rootdorsal root::

- painpain- loss of all sorts of loss of all sorts of

sensation in its zone sensation in its zone innervation according to innervation according to the segmental type the segmental type (transversal strip on a (transversal strip on a trunk and longitudinal trunk and longitudinal strip on extremities) strip on extremities)

- areflexionareflexion

Lesion of Lesion of spinal nervespinal nerve:: - painpain- loss of all sorts of loss of all sorts of

sensation in its zone sensation in its zone innervation according to innervation according to the segmental type the segmental type (transversal strip on a (transversal strip on a trunk and longitudinal trunk and longitudinal strip on extremities) strip on extremities)

- peripheral paresis of peripheral paresis of segmental musculessegmental muscules

The segmental (sectional) typeThe segmental (sectional) type Segmental - dissociated patternSegmental - dissociated pattern is is

observed at lesion of dorsal horns of spinal observed at lesion of dorsal horns of spinal cord and front grey soldering. cord and front grey soldering.

loss or lowering pain and thermoanesthesia loss or lowering pain and thermoanesthesia and saving tactile and joint sense in given and saving tactile and joint sense in given segment. segment.

The sensitive disturbance are observed in The sensitive disturbance are observed in certain dermatomes as certain dermatomes as "jacket" or "half "jacket" or "half jacketjacket" at lesion of dorsal horns of spinal " at lesion of dorsal horns of spinal cord in thoracic segments, or cord in thoracic segments, or "trousers""trousers" - at - at lesion of dorsal horns of spinal cord in lesion of dorsal horns of spinal cord in lumbar segmentslumbar segments

Conductive type

The lesion of sensory explorers in:The lesion of sensory explorers in: Spinothalamic tractSpinothalamic tract Holl’s and Burdach’s pathwaysHoll’s and Burdach’s pathways Bulbothalamic tractBulbothalamic tract Medial closed loopMedial closed loop Thalamocortical tractThalamocortical tract

Conductive Conductive typetype

SpinalSpinal

CerebralCerebral

Spinal patternSpinal pattern DescendingDescending AscendingAscending, ,

depending on extra- depending on extra- or intramedular or intramedular lesionlesion

MonotypeMonotype HemitypeHemitype

Conductive typeCerebral subtype

Brain stem Brain stem The thalamicThe thalamic Capsular Capsular CorticalCortical

Multiple peripheral Multiple peripheral nerves lesionnerves lesion

loss all kinds of loss all kinds of sensation in distal parts sensation in distal parts of extremities -of extremities - ««glovesgloves» » andand « «sockssocks» »

painspains paresthesiasparesthesias distal peripheral paresisdistal peripheral paresis distal autonomic distal autonomic

disordersdisorders

Dorsal root Dorsal root lesionlesion

• loss all kinds of loss all kinds of sensation by sensation by segmental type insegmental type in innervative innervative segmentsegment

• painpain areflexionareflexion

Types of sensory disturbancesTypes of sensory disturbances

Types of sensory disordersTypes of sensory disorders

sensation kinds and types of sensory disturbance syndromes of lesion

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