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The State Education Institution of Higher Professional Training
The First Sechenov Moscow State Medical University
under Ministry of Health of the Russian Federation
Department of Pathophysiology
Pathophysiology of the
nervous system
Lecture presentation
Professor Pirozhkov S.V.
2015-2016 education year
Typical forms of functional pathology
of the nervous system
► Disorders of locomotion
► Disorders of sensation
► Disorders of autonomic functions control
► Disorders of trophicity
► Disorders of higher nervous functions
Pyramidal neurons
Capsula interna
Midbrain
Pons
Pyramidal decussation
Lateral corticospinal
tract
Medulla
Anterior corticospinal
tract
White commissure
Cervical segment of the
spinal cord
Thoracic segment of the
spinal cord
Motor neurons of the anterior
horns of the spinal cord
Lumbar segment of the
spinal cord
Pyramidal pathways
Typical manifestations of lesion of the
central neuron of the pyramidal pathway
● Muscle weakness with spasticity
● Hyperreflexia
● Clonus
● Pathologic segmental reflexes
● Pathologic synkinesis
Typical manifestations of lesion of the
peripheral neuron of the pyramidal
pathway
● Muscle weakness with atonia (flaccid
type)
● Areflexia
● Skeletal muscles atrophy
● Fasciculations (isolated small twitches)
● Changes in excitability of the muscle
fibers
MECHANISMS OF THE NERVOUS SYSTEM EFFECTS
ON CELLULAR METABOLISM
Changes in
the rate of
impulse
generation by
a neuron
Release of a
small (trophic)
amount of
neuromediator
Axoplasmic flow of
trophogens
Changes in the
value of the electric
potential of the preand postsynaptic
membranes
Modulation of the ionic
permeability of the target cell
plasma membrane
Locomotion disorders after injury of
extrapyramidal pathways
■ Rigidity of skeletal muscles
■ Abnormal distribution of muscle tone
■ Abnormal amplitude, speed and amount
of movements
■ Discoordinated movements (ataxia)
■ Unintended movements
■ Disorders of postural reflexes
■ Disorders of gait
Typical forms of locomotion disorders
resulting from injury of extrapyramidal
pathways
► Muscle dystonia
► Extrapyramidal movement disorders:
- hypokinetic
- hyperkinetic
Manifestations of the hypokinetic movement
disorders
● Bradykinesia
● Disturbance of fluency and speed of voluntary
movements
● Loss of associated limbs movements during walking
● Atonia of mimic muscles (expressionless facial
appearance)
● Rigidity of sceletal muscles (increased tone throughout
the range of motion)
● Impaired postural reflexes
Manifestations of the hyperkinetic
movement disorders
● Increased amplitude and amount of
movements
● Unintended movements
● Abnormal coordination of movement
TYPES OF EXTRAPYRAMIDAL HYPERKINESIA
RHYTHMICAL
IRREGULAR
● Tremors
● Athetosis
- rest tremors
● Chorea
- postural tremor
● Tics
- intention tremor
● Myoclonuses
CLASSIFICATION OF SENSORY
DISORDERS
ABNORMAL PERCEPTION OF THE QUANTITATIVE
CHARACTERISTICS OF SENSATION
HYPERESTHESIA
HYPOESTHESIA
HYPERPATHIA
ANESTHESIA
CLASSIFICATION OF SENSORY
DISORDERS
ABNORMAL PERCEPTION OF THE QUALITATIVE
CHARACTERISTICS OF SENSATION - DYSESTHESIAS
LOCALIZATION OF THE
APPLICATION SITE OF
THE STIMULUS
● TOPOANESTHESIA
● SYNALGESIA
NUMBER OF
STIMULI APPLIED
SIMULTANEOUSLY
● POLYESTHESIA
THE MODE OF
SENSATION (TYPE OF
THE AFFECTED
RECEPTOR)
● SYNESTHESIA
● ALLODYNIA
SENSATION PERCEIVED WITHOUT AN APPARENT
STIMULUS (peripheral origin disorder) - PARESTHESIA
CLASSIFICATION OF SENSORY
DISORDERS
TYPES OF SENSORY DISORDERS WITH REFERENCE
TO THE LEVEL (LOCUS) OF INJURY TO THE SENSORY
PATHWAY
PERIPHERAL TYPE
DISORDERS
● RECEPTOR-ASSOCIATED
● CAUSED BY INJURY TO
AFFERENT PERIPHERAL
NERVE FIBERS
SEGMENTARY
TYPE DISORDERS
SENSORY PATHWAY
TYPE DISORDERS
● AT THE SPINAL
CORD (LOW) LEVEL
● AT THE LEVEL OF
THALAMUS (HIGH)
CENTRAL (CORTEX)
TYPE DISORDERS