Strucrure of nS

1. Principles of structure andPrinciples of structure and
functions of the nervous system.functions of the nervous system.
Neuron, synapse.Neuron, synapse.
Sensitive analyzer.Sensitive analyzer.
Department of neurology and neurosurgeryDepartment of neurology and neurosurgery
Prof. GrybProf. Gryb ViktoriaViktoria

2. Prevelence of tPrevelence of topicopic
 Subject that is studied is a section of semiotics, topicalSubject that is studied is a section of semiotics, topical
diagnosis of the nervous system lesions.diagnosis of the nervous system lesions.
 Determining the paresis or paralysis allows to localizeDetermining the paresis or paralysis allows to localize
the level of the nervous system damage. Voluntarythe level of the nervous system damage. Voluntary
movements violation is important in the diagnosis ofmovements violation is important in the diagnosis of
functional disorders. Knowledge of this section isfunctional disorders. Knowledge of this section is
necessary for physicians of all specialties.necessary for physicians of all specialties.

3. Plan of lecturePlan of lecture
 1. The notions *reception* and *sensation*1. The notions *reception* and *sensation*
 2. Receptors2. Receptors
 3. Classification of sensation3. Classification of sensation
 4. Methods of sensation research4. Methods of sensation research
 5. Pathways of sensation5. Pathways of sensation
 6. Types of sensory system disorders6. Types of sensory system disorders
 7. The levels of sensory pathways disorders7. The levels of sensory pathways disorders
 Jackson’s sensory epilepsyJackson’s sensory epilepsy

7.  ReceptionReception means all afferentation, that comemeans all afferentation, that come
in organism, but not all of them are realized.in organism, but not all of them are realized.
 The sensationThe sensation is a part of reception, which isis a part of reception, which is
felt and analyzed by the proper regions offelt and analyzed by the proper regions of
cortex.cortex.
 Term “Term “sensation”sensation” is a part of “is a part of “reception”reception”..
 AnalyzerAnalyzer is a single functional system,is a single functional system,
consisting of perceiving apparatus (receptor),consisting of perceiving apparatus (receptor),
afferent (sensible) conducter and cortexafferent (sensible) conducter and cortex
department of analyzerdepartment of analyzer

8. ReceptorsReceptors
Any irritations are perceivedAny irritations are perceived by theby the
specialized nervous devicesspecialized nervous devices — by receptors.— by receptors.
These irritations are transformed inThese irritations are transformed in
nervous impulses, achieving thenervous impulses, achieving the
certain areas of cortex, as a result wecertain areas of cortex, as a result we
have feelings.have feelings.

9. ReceptorsReceptors
ReceptorsReceptors are subdivided intoare subdivided into
 ExteroreceptorsExteroreceptors ((contactoreceptorscontactoreceptors in ain a
skin, mucous membranes andskin, mucous membranes and
distantreceptorsdistantreceptors, perceiving the irritation on, perceiving the irritation on
the distance (the distance (sightsight,, tastetaste,, smellsmell,, hearinghearing,,
balancebalance))
 ProprioceptersPropriocepters (in muscles, periosteum,(in muscles, periosteum,
joint surfaces, tendons, chords)joint surfaces, tendons, chords)
 InteroreceptorsInteroreceptors (in internal organs and walls(in internal organs and walls
of blood vessels)of blood vessels)

10. Types of receptorsTypes of receptors

11. Сlassification of somatic sensation
 simple sensationsimple sensation
 higher-order aspects of sensation orhigher-order aspects of sensation or
corticalcortical sensationsensation

12. The types of simple sensationThe types of simple sensation
1.1. SuperficialSuperficial sensationsensation or exteroceptiveor exteroceptive
 painpain
 temperaturetemperature
 tactiletactile
2.2. Deep (profound)Deep (profound) sensationsensation oror pproprioceptiveroprioceptive
 the sensation of muscle movement and joint positionthe sensation of muscle movement and joint position
((…… is the sense of the relative position ofis the sense of the relative position of
neighboring parts of the body,neighboring parts of the body, that isthat is where thewhere the
various parts of the body are located in relation tovarious parts of the body are located in relation to
each othereach other))
This sense keeps track of body parts relative to each other.
 vibrationvibration
 sense of pressuresense of pressure
 sense of masssense of mass
 kinesthetic sensekinesthetic sense

13. Higher-order aspects of sensation, orHigher-order aspects of sensation, or
cortical sensationcortical sensation
It is based on ability of brain cortexIt is based on ability of brain cortex toto
make the complex analysismake the complex analysis andand
synthesissynthesis of irritations, perceived fromof irritations, perceived from
extero- and proprioreceptorsextero- and proprioreceptors

14. The types ofThe types of cortical sensationcortical sensation
 two-point discrimination sensetwo-point discrimination sense
 sense of localizationsense of localization
 two-spatial sense - gtwo-spatial sense - graphesthesiaraphesthesia
 three-spatial sense - stereognosisthree-spatial sense - stereognosis

15. Methods of sensationMethods of sensation
examinationexamination

16. simple sensationsimple sensation

17. Tactile sensationTactile sensation
 Use a piece of a cotton wool or your finger to touch theUse a piece of a cotton wool or your finger to touch the
skin lightly.skin lightly.
PainPain
Use a suitable sharp object to test "sharp" or "dull"Use a suitable sharp object to test "sharp" or "dull"
sensation (use asensation (use a needle-pointneedle-point, pins or other sharp object)., pins or other sharp object).
The explorer must define their character (it is “sharp” orThe explorer must define their character (it is “sharp” or
“dull”).“dull”).
TemperatureTemperatureUseUse a test-tube with hot or cold watera test-tube with hot or cold water and ask the patientand ask the patient toto
identify "hot" or "cold."identify "hot" or "cold."

18. Dermatomes – segmentsDermatomes – segments
Regions of peripheral nerve innervationRegions of peripheral nerve innervation
Important marks onImportant marks on
the body skinthe body skin
С4 –С4 – claviculeclavicule
Th5 –mammilaris lineTh5 –mammilaris line
ThTh7 –7 – costal archcostal arch
ThTh10 –10 – umbilical lineumbilical line
ThTh12 –12 – lig. inguinalislig. inguinalis

19. ..
.
..
.
..
.
.
.
.
.
1 2
3 4

20. General rules for examination ofGeneral rules for examination of
sensationsensation
 Test the symmetric areas on the face, upper extremities?Test the symmetric areas on the face, upper extremities?
trunk and lower extremities.trunk and lower extremities.
 Ask the patient to tell you if there is difference from sideAsk the patient to tell you if there is difference from side
to side or other "strange" sensations.to side or other "strange" sensations.
 TestTest the following areas:the following areas:
 Shoulders (C4)Shoulders (C4)
 Inner and outer aspects of the foreams (C6 and Th1)Inner and outer aspects of the foreams (C6 and Th1)
 Thumbs and little fingers (C6 and C8)Thumbs and little fingers (C6 and C8)
 Front of both thighs (L2)Front of both thighs (L2)
 Medial and lateral aspects of both shanks (L4 and L5)Medial and lateral aspects of both shanks (L4 and L5)
 Little toes (S1)Little toes (S1)

21. Position SensePosition Sense
Grasp the patient's big toe and hold it away from the other toes toGrasp the patient's big toe and hold it away from the other toes to
avoid friction.avoid friction.
Show the patient "up" and "down."Show the patient "up" and "down."
With the patient's closed eyes ask him to identify the direction ofWith the patient's closed eyes ask him to identify the direction of
moving the toe.moving the toe.
The sensation of muscle movement and joint position

22. VibrationVibration
Use aUse a low pitch tuning forklow pitch tuning fork (128 Hz).(128 Hz).
Place the stem of the fork over thePlace the stem of the fork over the
distal interphalangeal joint of thedistal interphalangeal joint of the
patient's big toes.patient's big toes.

23. PRESSURE SENSEPRESSURE SENSE
AND SENSE OF MASSAND SENSE OF MASS
 ResearchResearch of pressure senseof pressure sense is taken to the decisionis taken to the decision
by explorer pressures of a different force on theby explorer pressures of a different force on the
surface of skin and its abilitysurface of skin and its ability to distinguishto distinguish
pressure from the simple touchpressure from the simple touch..
 Sense of mass isSense of mass is determined to those, how thedetermined to those, how the
explorerexplorer distinguishes the difference between thedistinguishes the difference between the
mass of two subjects,mass of two subjects, placed on the surface ofplaced on the surface of
stretching upper extremities. The ordinary man isstretching upper extremities. The ordinary man is
able to distinguish 10 percent difference of mass.able to distinguish 10 percent difference of mass.

24. SENSE OF MASSSENSE OF MASS
1000 г 950 г
1000 г 850 г

25.  higher-order aspects ofhigher-order aspects of
sensation orsensation or corticalcortical sensationsensation

26. TWO-POINT DISCRIMINATION SENSETWO-POINT DISCRIMINATION SENSE
Use an Weber compasses to touch the patient's fingerUse an Weber compasses to touch the patient's finger
pads in two places simultaneously.pads in two places simultaneously.
Decreased the interval between the legs of compasses.Decreased the interval between the legs of compasses.
Ask the patient to identify "one" or "two“ touchAsk the patient to identify "one" or "two“ touch
feelings.feelings.
Find the minimal distance at which the patient canFind the minimal distance at which the patient can
discriminate (or distinguish two touch feelings).discriminate (or distinguish two touch feelings).

28. Localization sLocalization senseense
 …… is abilityis ability to identify exactly the placeto identify exactly the place
of irritation.of irritation.

29. Two-spatial sense (gTwo-spatial sense (graphesthesia)raphesthesia)
 …… is explored by suggesting of the patientis explored by suggesting of the patient
aboutabout the letter, number, figure,the letter, number, figure, written onwritten on
his skin,his skin, with the patient’s closed eyes.with the patient’s closed eyes.

30. StereognosisStereognosis
(three-spatial) sense(three-spatial) sense
 …… is exploredis explored by object recognition with theby object recognition with the
help of touchinghelp of touching with the closed patient’swith the closed patient’s
eyes.eyes.

31. Pathway of superficialPathway of superficial sensationsensation
 The tract is three-neuronsThe tract is three-neurons (blue colour).(blue colour).
 The first-order neuronThe first-order neuron is in theis in the
spinal node. Axons form a spinalspinal node. Axons form a spinal
nerve and then go to posterior hornnerve and then go to posterior horn
 The second-order neuronThe second-order neuron is at theis at the
posterior horn. Their axons, doingposterior horn. Their axons, doing
a crossing through a front whitea crossing through a front white
joint, get in lateral rope of oppositejoint, get in lateral rope of opposite
side, forming theside, forming the laterallateral
spinothalamic tract.spinothalamic tract. Then go upThen go up
and are finished in thalamus (and are finished in thalamus (third-third-
order neuronorder neuron).).
 Axons of the third neuron formAxons of the third neuron form
thalamocortical tract, which passesthalamocortical tract, which passes
through back third of back leg ofthrough back third of back leg of
internal capsule, and ininternal capsule, and in
composition of a radiant crowncomposition of a radiant crown

32. Pathway of deepPathway of deep sensationsensation
 Proprioceptive axons with cell bodies in spinalProprioceptive axons with cell bodies in spinal
node (node (the first-order neuronthe first-order neuron), enter the cord), enter the cord
in the dorsal root and ascend in the posteriorin the dorsal root and ascend in the posterior
columns of the cord:columns of the cord: fasciculus gracilisfasciculus gracilis - from- from
the leg;the leg; fasciculus cuneatusfasciculus cuneatus - from the arm.- from the arm.
They synapse onThey synapse on second-order neuronsecond-order neuron inin
dorsal column nuclei (nuclei gracilis anddorsal column nuclei (nuclei gracilis and
cuneatus) in the medulla.cuneatus) in the medulla.
 Axons of the II neurons do crossing andAxons of the II neurons do crossing and
together with tractus spinothalamicus formtogether with tractus spinothalamicus form aa
lemniscus mediaislemniscus mediais,, conducting impulses toconducting impulses to
thalamus.thalamus.
 TheThe lemniscus mediaislemniscus mediais is ended in thalamusis ended in thalamus
((the third-order neuronthe third-order neuron), from the cells of), from the cells of
which impulses by the thalamocortical fiberswhich impulses by the thalamocortical fibers
are sent through an internal capsule andare sent through an internal capsule and
radiant crown in postcentral gyrus.radiant crown in postcentral gyrus.

33. Pathway of superficialPathway of superficial
sensationsensation
Pathway of deepPathway of deep
sensationsensation
Lemniscus medialisLemniscus medialis
Spinal cord
Medulla
oblongata

34. Sensoric homunculusSensoric homunculus
Postcentral gyrusPostcentral gyrus

35. Simple sensationSimple sensation
Cortex sensationCortex sensation

36. SENSATION DISORDERSSENSATION DISORDERS
 In clinic it is accepted to distinguishIn clinic it is accepted to distinguish kindskinds
and typesand types of sensible disorders.of sensible disorders.
 There are some kinds of them, which selectThere are some kinds of them, which select
depending on thedepending on the quality or quantitativequality or quantitative
changeschanges of feelings.of feelings.

37. KINDS OF SENSATION DISORDERSKINDS OF SENSATION DISORDERS
AnesthesiaAnesthesia -- complete loss of some types of sensation.complete loss of some types of sensation.
Depending on the defeat of analyzer there are painDepending on the defeat of analyzer there are pain
anaesthesia (anaesthesia (analgesiaanalgesia), temperature (), temperature (thermanesthesiathermanesthesia),),
tactile (topanestesiatactile (topanestesia), joint-muscular (), joint-muscular (batianestesia)batianestesia)..
HypoesthesiaHypoesthesia -- partial loss of sensation, when inpartial loss of sensation, when in
combination with the increase of threshold of excitabilitycombination with the increase of threshold of excitability
enough strong irritants cause the weak feeling only.enough strong irritants cause the weak feeling only.
HyperesthesiaHyperesthesia -- increase of sensation as a result ofincrease of sensation as a result of
decline of threshold of excitability in the cortexdecline of threshold of excitability in the cortex
DysesthesiaDysesthesia – “– “perverted” perception of the irritation, forperverted” perception of the irritation, for
example, the touch causes the pain feelings, thermalexample, the touch causes the pain feelings, thermal
irritations - sense of touch.irritations - sense of touch.
PolyesthesiaPolyesthesia -- perception of one irritation as a few.perception of one irritation as a few.

38. KINDS OF SENSIBLE DISORDERSKINDS OF SENSIBLE DISORDERS
SynesthesiaSynesthesia —— perception and feeling ofperception and feeling of
irritation not only in place of its causing but also in someirritation not only in place of its causing but also in some
other region.other region.
HyperpathiaHyperpathia —— feeling of diffuse, badly localized,feeling of diffuse, badly localized,
unpleasant irritation which arises up after causing ofunpleasant irritation which arises up after causing of
irritation and lasts after its stopping.irritation and lasts after its stopping.
ParestheiaParestheia —— feelings of numbness, burning, heatfeelings of numbness, burning, heat ((і)і),,
cold, electric digits, often are the early signs of disease ofcold, electric digits, often are the early signs of disease of
the nervous systemthe nervous system

39. KINDSKINDS
OF SENSIBLE DISORDERSOF SENSIBLE DISORDERS
 Pain,Pain, signaling about an unhappiness in ansignaling about an unhappiness in an
organism, arises up at the irritation by theorganism, arises up at the irritation by the
pathological process of sensible analyzers atpathological process of sensible analyzers at
any level, including receptors, conductorsany level, including receptors, conductors
and centers.and centers.
 Pain is especially intensive at the defeat ofPain is especially intensive at the defeat of
spinal, cranial nerves (their roots and nodes)spinal, cranial nerves (their roots and nodes)
and thalamusand thalamus

40. PAINPAIN
 Pain, connected with the place of defeat ofPain, connected with the place of defeat of
nervous trunk or root is considered asnervous trunk or root is considered as local painlocal pain..
 Irradiational painIrradiational pain arises up when the irritationarises up when the irritation
from one branch (a) of nerve is passed on other.from one branch (a) of nerve is passed on other.

41.  Irradiational painIrradiational pain arises up when the irritationarises up when the irritation
from one branch (a) of nerve is passed on other.from one branch (a) of nerve is passed on other.

42.  Projectional painProjectional pain is marked far fromis marked far from
localization of pathological process, usuallylocalization of pathological process, usually
it spreads in the area of innervation, forit spreads in the area of innervation, for
example shooting pain in foot at vertebraeexample shooting pain in foot at vertebrae
disorders. Also happens in case of phantomdisorders. Also happens in case of phantom
pain.pain.

43. Reflex painReflex pain is related with the transmission ofis related with the transmission of
irritation on the horn level from inner organ byirritation on the horn level from inner organ by
its nerve on other nerve which innervates theits nerve on other nerve which innervates the
certain area on skin (certain area on skin (Zacharian—Had areasZacharian—Had areas).).
It is explained by visceral-sensory reflexes.It is explained by visceral-sensory reflexes.
 Рис. 4. ЗонРис. 4. Зонии гіперестезиії (зоні Захаргіперестезиії (зоні Захар’’ііна- Геда) при захворюванняхна- Геда) при захворюваннях
внутрішніх органів:внутрішніх органів:
1 —серця; 2 - легень; 3 — печінки; 4 — нирок;1 —серця; 2 - легень; 3 — печінки; 4 — нирок;
5 сечоводу; б — сечового міхура, 7- тонкого кишківника; 8 —5 сечоводу; б — сечового міхура, 7- тонкого кишківника; 8 —
шлунку і підшлункової золози; 9 - маткишлунку і підшлункової золози; 9 - матки

44. The types of sensation disturbancesThe types of sensation disturbances
DistinguishDistinguish peripheral, segmental andperipheral, segmental and
conductiveconductive types.types.
The peripheral type:The peripheral type:
 MononeuropathyMononeuropathy - the damage of one nerve- the damage of one nerve
- sensory disorders of all types of sensation in- sensory disorders of all types of sensation in
the area of innervations of the given nerve;the area of innervations of the given nerve;
 PolyneuropathyPolyneuropathy or distal neuropathy - pluralor distal neuropathy - plural
defeat of distal nerves as “gloves” or “socks”.defeat of distal nerves as “gloves” or “socks”.

45. The peripheral typeThe peripheral type of sensation disturbancesof sensation disturbances ::
а)а) MononeuropathyMononeuropathy
б)б) PolyneuropathyPolyneuropathy

46. The types of sensation disturbancesThe types of sensation disturbances
The segmental type:The segmental type:
 is marked at the defeat ofis marked at the defeat of dorsal (back) root, back horn, front whitedorsal (back) root, back horn, front white
joint.joint.
 The root typeThe root type is marked at the defeat of back root, whenis marked at the defeat of back root, when
all types of sensation fall out in the areas of theirall types of sensation fall out in the areas of their
innervation (dermatomes). + paininnervation (dermatomes). + pain
 The lesion ofThe lesion of back horn and front white jointback horn and front white joint isis
accompanied by a split oraccompanied by a split or dissociation type.dissociation type. It is shownIt is shown
up as a loss of superficial sensation at saving deep sensation.up as a loss of superficial sensation at saving deep sensation.
..
 At the defeat ofAt the defeat of front white jointfront white joint the sensationthe sensation
disturbances show up asdisturbances show up as jacketjacket..

47. The segmental typeThe segmental type of sensation disturbancesof sensation disturbances ::
11.. Homolateral segmental impairment of all types of sensation byHomolateral segmental impairment of all types of sensation by
the segmental type at the left back roots disturbances at the Th7-the segmental type at the left back roots disturbances at the Th7-
Th11 levels.Th11 levels.
2. Homolateral segmental impairment of superficial sensation by the2. Homolateral segmental impairment of superficial sensation by the
segmental type at the left back horns disturbances at the Th7-Th11segmental type at the left back horns disturbances at the Th7-Th11
levels.levels.

48. The segmental typeThe segmental type of sensation disturbancesof sensation disturbances ::
Bilateral segmental impairment ofBilateral segmental impairment of
superficial sensation by the segmentalsuperficial sensation by the segmental
type occurs in the case of the defeat attype occurs in the case of the defeat at
the back horns disturbances at the C2 –the back horns disturbances at the C2 –
Th12 in left side and C2 – Th10Th12 in left side and C2 – Th10 in rightin right
levels.levels.

49. The segmental typeThe segmental type of sensation disturbancesof sensation disturbances ::
Bilateral segmental impairment ofBilateral segmental impairment of
superficial sensation by thesuperficial sensation by the
segmental type occurs in the case ofsegmental type occurs in the case of
the defeat at the front white jointthe defeat at the front white joint
disturbances at the Th7 – Th11 levels.disturbances at the Th7 – Th11 levels.

50. The types of sensation disturbancesThe types of sensation disturbances
 The conductive typeThe conductive type arises up as a resultarises up as a result
of sensation conducters defeat within theof sensation conducters defeat within the
spinal cord or brain.spinal cord or brain.
 For this type following isFor this type following is typical:typical:
- -- disturbances of superficial sensationdisturbances of superficial sensation
show up on the opposite side to the lesionshow up on the opposite side to the lesion
focus locationfocus location
-

51. Pathway of superficialPathway of superficial
sensationsensation
Pathway of deepPathway of deep
sensationsensation
Lemniscus medialisLemniscus medialis

52. The conductive types ofThe conductive types of
sensation disturbances :sensation disturbances :
Homolateral impairment ofHomolateral impairment of deepdeep
sensationsensation by the conductive typeby the conductive type
occurs in the case of the defeatoccurs in the case of the defeat ofof
posterior rope at the Th10 levelposterior rope at the Th10 level..

53. The conductive typesThe conductive types ofof
sensation disturbancessensation disturbances ::
Contrlateral impairment ofContrlateral impairment of
superficial sensationsuperficial sensation by theby the
conductive type occurs in theconductive type occurs in the
case of the defeatcase of the defeat ofof the lateralthe lateral
spinothalamic tract at the Th12spinothalamic tract at the Th12
levellevel..

54. The conductive typesThe conductive types of sensationof sensation
disturbancesdisturbances ::
Contrlateral impairment ofContrlateral impairment of
superficial sensationsuperficial sensation by theby the
conductive type (on the 1 – 2conductive type (on the 1 – 2
segments below the lesion focus)segments below the lesion focus)
and homolateral impairment ofand homolateral impairment of
deep sensationdeep sensation by the conductiveby the conductive
type occurs in the case of thetype occurs in the case of the
transversal defeat of a half oftransversal defeat of a half of
spinal cord on the Th11-Th12spinal cord on the Th11-Th12
level on the left side.level on the left side.

55. The conductive typesThe conductive types of sensationof sensation
disturbancesdisturbances ::
Contrlateral impairment ofContrlateral impairment of
superficial sensation by thesuperficial sensation by the
conductive type occurs inconductive type occurs in
the case of the defeat ofthe case of the defeat of
lemniscus medialislemniscus medialis – total– total
hemianesthesiahemianesthesia

56. Topical diagnostics of sensation disturbancesTopical diagnostics of sensation disturbances
 The defeat of thalamusThe defeat of thalamus causes acauses a “syndrome of three“syndrome of three
hemi”hemi” -- hemihemianesthesia of superficial sensation,anesthesia of superficial sensation,
- sensitive- sensitive hemihemiataxia (loss of muscle - articularataxia (loss of muscle - articular
sense on opposite side)sense on opposite side)
-- hemihemianopsia of opposite eyeshots.anopsia of opposite eyeshots.
It is accompanied byIt is accompanied by thalamic painthalamic pain in the opposite half ofin the opposite half of
body, showing up as badly localized, extremelybody, showing up as badly localized, extremely
unpleasant diffuse feelings (parestezia, dysestezia,unpleasant diffuse feelings (parestezia, dysestezia,
hyperpathy).hyperpathy).
Thalamus

57. Topical diagnostics of sensation disturbancesTopical diagnostics of sensation disturbances
 The defeat of internal capsuleThe defeat of internal capsule also causesalso causes
hemianesthesia,hemianesthesia,
hemiataxia,hemiataxia,
hemianopsia on opposite side.hemianopsia on opposite side.
Capsula
interna

58.  The defeat ofThe defeat of sensation region of cortexsensation region of cortex (postcentral(postcentral
gyrus)gyrus) results in the loss of all types of sensation byresults in the loss of all types of sensation by
hemitype on opposite side.hemitype on opposite side.
 Practically more frequent there is the loss of sensationPractically more frequent there is the loss of sensation
by a monotypeby a monotype (on a hand or leg or face), than by(on a hand or leg or face), than by
hemitype, because not all postcentral gyrus is usuallyhemitype, because not all postcentral gyrus is usually
struck, but only its separate areas. So, at the defeat ofstruck, but only its separate areas. So, at the defeat of
its overhead area anesthesia or hypesthesia of footits overhead area anesthesia or hypesthesia of foot
(rarer than all leg) is revealed,(rarer than all leg) is revealed,
middle area — handmiddle area — hand
on the party opposed to the focuson the party opposed to the focus
Topical diagnostics of sensation disturbancesTopical diagnostics of sensation disturbances

59. The phenomenon of irritation of cortexThe phenomenon of irritation of cortex
 Except for the phenomenon of loss (anaesthesia) thereExcept for the phenomenon of loss (anaesthesia) there
can be the phenomenon of irritation (can be the phenomenon of irritation (paresthesiaparesthesia). It). It
appears in parts of body (hand, leg, trunk, face) onappears in parts of body (hand, leg, trunk, face) on
contrlateral side in proper to localization of pathologicalcontrlateral side in proper to localization of pathological
focus.focus.
 This phenomenon is called ofThis phenomenon is called of Jackson’ sensoryJackson’ sensory
epilepsyepilepsy attackattack-- epilepsy partialis s. corticalis - isepilepsy partialis s. corticalis - is
revealed by partial attack of paresthesia or pain spreadingrevealed by partial attack of paresthesia or pain spreading
in the areas of body accordance with the nidus in ain the areas of body accordance with the nidus in a
postcentral gyrus.postcentral gyrus.