SISTEM MOTORIKPenyusun : Willy Wijaya, dr Pembimbing: Henny. A.S, dr, SpS(K) Elements of Motor System Effectors Skeletal Muscle → MOTOR SYSTEM SOMATIC MOTOR SYSTEM Smooth Muscle → AUTONOMIC MOTOR SYSTEM Glands (sympathetic and Parasympathetic) KORTEX PUSAT MOTORIK . . spinal nerve axon terminal: neuromuscular junction Effector: skeletal muscle .Lower Motor Neuron cell body: anterior horn axon: anterior root. . Somatic Motor System Upper Motor Neuron Auxiliary Motor Pathways descending pathways from brain stem pyramidal tract Lower Motor Neuron motor nerve Skeletal Muscle reflex arc . . Upper Motor Neuron Pyramidal Tract Corticospinal Tract Origin: Cerebral Cortex Brodmann Area 4 (Primary Motor Area. PM ) Brodmann Area 3.2 (Primary Somesthetic Area. Middle Portion Longitudinal Pontine Fiber Pyramid . Parietal Lobule) Corona Radiata lnternal Capsule. Posterior Limb Crus Cerebri. S I) Brodmann Area 5 (Anterior Portion of Sup.1.Lateral and Anterior Termination: Spinal Gray (Rexed IV-IX) . M I) Brodmann Area 6 (Premotor Area.pyramidal decussation Corticospinal Tract . T R A K T U S P I R A M I D A L I S . pyramid 6. longitudinal pontine fiber 5.Upper Motor Neuron Pyramidal Tract 1. internal capsule. lateral corticospinal tract 8. anterior corticospinal tract . corona radiata 2. crus cerebri 4. posterior limb 3. pyramid decussation 7. anterior corticospinal tract . internal capsule 3. lateral corticospinal tract 8.Upper Motor Neuron Pyramidal Tract 1. crus cerebri 4. pyramid 6. pontine longitudinal fiber 5. corona radiata 2. pyramid decussation 7. T R A K T U S E X T R A P I R A M I D A L I S . . Corticospinal Tract • completion of myelination in 2nd year of life • time of standing and walking . facial motor. ambiguus. solitary tract nucleus 3) reticular formation (corticoreticular fiber) . trochlear and oculomotor nucleus 2) sensory relay nuclei nuclei gracilis and cuneatus.Upper Motor Neuron Pyramidal Tract Corticobulbar Tract . trigeminal motor.Termination: 1) motor nuclei (upper motor neuron pathway) hypoglossal.Corticofugal fibers projecting to. trigeminal sensory nucleus. abducens. and terminating in the portions of lower brainstem . trochlear (IV) and oculomotor (III) nucleus ambiguus (IX. trigeminal motor (V) nucleus .Corticofugal fibers projecting to.largely bilateral laryngeal.Pseudobulbar Palsy --.syndrome of bilateral UMN lesion .Upper Motor Neuron Pyramidal Tract Corticobulbar Tract (UMN Pathway) . palatal and upper facial muscles of mastication and extraocular muscles .unilateral lower facial musculature (facial palsy) SCM and trapezius (uncrossed) --. facial motor (VII). abducens (VI). cranial motor nuclei GSE SVE - hypoglossal (XII). X. XI).spinal accessory . pharyngeal. Upper Motor Neuron vs Lower Motor Neuron Syndrome LMN syndrome UMN Syndrome Type of Paralysis Flaccid Paralysis Spastic Paresis Atrophy Severe Atrophy No (Disuse) Atrophy Deep Tendon Reflex Absent DTR Pathological Reflex Absent Superficial Reflex Present Absent Fasciculation and Could be Absent Fibrillation Present Increase Positive Babinski Sign . Upper Motor Neuron Syndrome Spasticity . no increased DTR Cogwheel Phenomenon . Rigidity .symptom of basal ganglia or cerebellar lesion .Increased resistance to passive movement in antigravity muscle (flexor in arm.increased muscle tone.Sign of Upper Motor Neuron Syndrome. especially internal capsule lesion cf. extensor in leg) Clasp Knife Phenomenon . . . Terlibat kortikonuklearis→ paralisis fasialis kontralateral.okulomotoris isilateral. c. Lesi kortikal : parese kontralateral. Lesi kapsula interna : hemiplegi spastik kontralateral.LESI SESUAI TINGKATAN a. b. jarang plegi. Lesi pedunkel : hemiplegi spastik kontralateral + paralisis n. . mungkin bilateral. Nervus kranial mungkin tidak terkena. Lesi piramidalis : hemiparesis flasid kontralateral. Lesi servikal : traktus piramidalis lateral terlibat → hemiplegi spastik ipsilateral. jaras ekstrapiramidalis utuh. e.d. Lesi pons : hemiplegi kontralateral. f. Lesi torakalis : monoplegi spastik ipsilateral tungkai. Lesi radix anterior : kelumpuhan flasid ipsilateral.g. bila bilateral → paraplegi. h. . . • Mengakibatkan paralisis flasid disertai atrofi otot. .SINDROMA CORNU ANTERIOR • Paling sering terkena pada poliomielitis akut dan atrofi muskular spinalis progresif kronik.