Referat trakt spinothalamikus

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Referat Kecil

TRAKTUS SPINOTALAMIKUS

Oleh:

Insan Gahayu

NIM. 0508111792

Pe!i!in":

#r. $"us %ri &'(') *+.*

KEPANITERAAN KLINIK SENIOR BAGIAN ILMU PENYAKIT SARAF

RUMAH SAKIT UMUM DAERAH ARIFIN ACHMAD

FAKULTAS KEDOKTERAN UNIVERSITAS RIAU

PEKANBARU

2013


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TRAKTUS SPINOTALAMIKUS

DEFINISI

%ra(tus s+in'talai(us a,alah suatu -alur asen,en yan" !erasal ,ari e,ula s+inalis

,an !er-alan ,i se+an-an" e,ula s+inalis sa+ai !ersina+s ,i talaus. %ra(tus ini e!aa

sensasi nyeri) suhu) ra!a halus ,an te(an. $,a 2 -alur yan" ter"a!un" ,i ,ala siste ini)

yaitu tra(tus s+in'talai(us anteri'r ,an tra(tus s+in'talai(us lateral. 1)2

%ra(tus s+in'talai(us eru+a(an -alur asen,en yan" en"antar(an i+uls sens'ri(

,ari rese+t'r. Rese+t'r sen,iri a,alah 'r"an sens'ri( (husus yan" a+u encatat

+eru!ahan fisi( ,an (iia) serta en"u!ahnya en-a,i i+uls yan" ,i+r'ses 'leh siste

saraf.1 /u!un"an anusia ,en"an ,unia luar ter-a,i elalui rese+t'r sens'ri() !eru+a

rese+t'r e(ster'rese+tif) +r'+i'se+tif ,an inter'se+tif. Rese+t'r e(ster'se+tif !eres+'n

terha,a+ stiulus ,ari ran"san"an lin"(un"an e(sternal) terasu( isual) au,it'ar ,an ta(til.

Rese+t'r +r'+i'se+tif e!aa inf'rasi en"enai +'sisi !a"ian tu!uh. *e,an"(an rese+t'r

inter'se+tif en,ete(si (e-a,ian internal se+erti +eru!ahan te(anan ,arah.

%er,a+at su!(elas ay'r ,ari sensasi s'ati() yaitu:

1. *ensasi nyeri yan" ,icetus(an 'leh ran"san"an yan" ence,erai

2. *ensasi suhu3teral yan" ter,iri ,ari +anas ,an ,in"in

. *ensasi si(a+ yan" ,icetus(an 'leh +eru!ahan si(a+ ,ari 't't ,an +ersen,ian) enca(u+

rasa si(a+ an""'ta "era( serta "era(an an""'ta "era( 4(inesthesia

. *ensasi te(an) ,icetus(an 'leh stiulasi e(anis yan" ,i!eri(an +a,a +eru(aan tu!uh.

6e!era+a rese+t'r sens'ri( tu!uh eli+uti:

(ster'se+tif: u-un" saraf !e!as yan" !erfun"si se!a"ai rese+t'r nyeri) !a,an ruffini

eru+a(an rese+t'r +anas) (rause se!a"ai rese+t'r ,in"in) !a,an er(el ,an !a,an ta(til

Meissner se!a"ai rese+t'r ra!a) ater +accini se!a"ai rese+t'r te(an. -un" saraf

+eritrichial ,iteu(an ,i seluruh tu!uh yan" ter,a+at f'li(el ra!ut ,an ,ia(tiasi 'leh

+er"era(an ra!ut.

Pr'+i'se+tif: muscle spindle) 'r"an ten,'n G'l"i ,an rese+t'r sen,i.

Inter'se+tif: !ar'rese+t'r) (e'rese+t'r ,an 's'rese+t'r.


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Ga!ar 1. Rese+t'r 5

Ran"san"an yan" ,iteria 'leh !er!a"ai rese+t'r selan-utnya a(an ,ilan-ut(an 'leh

neur'n +an-an" ,an interneur'n a(an en"('n,u(si stiulus ,ari rese+t'r 4atau u-un" !e!as

(e ('rte(s s'at'sens'ri(. neur'n terse!ut a,alah:

Neur'n +ertaa: !a,an sel ,ari neur'n +ertaa terleta( ,i "an"li'n ra,i(s ,'rsalis 4atau

"an"li'n aferen s'atis ,ari saraf (ranial.

Neur'n (e,ua: sel neur'n (e,ua enyilan" ,an !era(hir !iasanya ,i thalaus.

Neur'n (eti"a: sel neur'n (eti"a terleta( ,i thalaus ,an e+r'ye(si(an ran"san"an (e

('rte(s sens'ri( 4untu( nyeri (r'nis ,i+r'ye(si(an ,i thalaus. alu 'ta( a(an

e+r'ses inf'rasi yan" ,ihantar(an 'leh neur'n ini) en"inter+retasi(an l'(asi)

(ualitas ,an intensitas lalu e!eri(an res+'n yan" sesuai.

*era!ut saraf s'at'sens'ris easu(i e,ula s+inalis elalui ;'na asu( ra,i(s

,'rsalis 4dorsal root entry zone< !isa -u"a ,ise!ut ;'na Re,lich=O!ersteiner. alu (eu,ian

a(an ter!entu( !anya( ('lateral yan" a(an e!entu( sina+s ,en"an neur'n=neur'n lain

,i,ala e,ula s+inalis. *era!ut saraf yan" en"hantar(an !er!a"ai aca ',alitas

sens'ri( ene+ati +'sisi yan" !er!e,a ,i ,ala e,ula s+inalis.

Per-alanan sera!ut saraf aferen yan" en"hantar(an ',alitas sens'ri( ,i ,ala

e,ula s+inalis ter,iri atas tra(tus s+in'sere!ellaris +'steri'r ,an anteri'r) ('luna +'steri'r)

tra(tus s+in'thalai(us anteri'r ,an lateral) serta tra(tus aferen lainnya yaitu s+in'reti(ular)

s+in'te(tal) s+in'='liary ,an tra(tus s+in'esti!ular.


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Ga!ar 2. Pen"aturan s'at't'+i( ,ari -alur=-alur ,i,ala e,ula s+inalis +a,a +'t'n"an

elintan"2.

ANATOMI DAN FISIOLOGI

A. Medull S!"#l"$

#ari !atan" 'ta( !er-alan suatu silin,er -arin"an saraf +an-an" ,an ra+in") yaitu

e,ulla s+inalis) ,en"an u(uran +an-an" 5 c 418 inci ,an "aris ten"ah 2 c 4seu(uran

(elin"(in". #ari e,ulla s+inalis s+inalis (eluar saraf=saraf s+inalis !er+asan"an elalui

ruan"=ruan" yan" ,i!entu( 'leh len"(un"=len"(un" tulan" iri+ saya+ erte!ra yan"

!er,e(atan. *araf s+inal !er-ulah 1 +asan" ,a+at ,i+erinci se!a"ai !eri(ut : 8 +asan" saraf

seri(al 4>) 12 +asan" saraf th'ra(al 4%) 5 +asan" saraf lu!al 4) 5 +asan" saraf sa(ral4*) ,an 1 +asan" saraf ('(si"eal 4>'.5

*u!stansia "risea ,i e,ulla s+inalis e!entu( ,aerah se+erti (u+u=(u+u ,i !a"ian

,ala ,an ,i(elilin"i 'leh su!stansia al!a ,i se!elah luar. *e+erti ,i 'ta() su!stansia "risea

e,ulla s+inalis terutaa ter,iri ,ari !a,an=!a,an sel saraf serta ,en,ritnya antarneur'n

+en,e() ,an sel=sel "lia. *u!stansia al!a tersusun en-a,i tra(tus 4-aras) yaitu !er(as serat=

serat saraf 4a(s'n=a(s'n ,ari antarneur'n yan" +an-an" ,en"an fun"si seru+a. %ia+=tia+

!elahan su!stansia "risea ,i!a"i en-a,i ('rnu ,'rsalis 4+'steri'r) ('rnu entralis 4anteri'r)

,an ('rnu lateralis. K'rnu ,'rsalis en"an,un" !a,an=!a,an sel antarneur'n te+at


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!era(hirnya neur'n aferen. K'rnu entralis en"an,un" !a,an sel neur'n 't'ri( eferen

yan" e+ersarafi 't't ran"(a. *erat=serat 't'n' yan" e+ersarafi 't't -antun" ,an 't't

+'l's serta (elen-ar e(s'(rin !erasal ,ari !a,an=!a,an sel yan" terleta( ,i tan,u( lateralis.

#ala e,ulla s+inalis leat ,ua tra(tus ,en"an fun"si tertentu) yaitu tra(tus

,esen,en ,an asen,en. %ra(tus ,esen,en !erfun"si e!aa sensasi yan" !ersifat +erintah

yan" a(an !erlan-ut (e +erifer. *e,an"(an tra(tus asen,en secara uu !erfun"si untu(

en"antar(an inf'rasi aferen yan" ,a+at atau ti,a( ,a+at enca+ai (esa,aran. Inf'rasi

ini ,a+at ,i!a"i ,ala ,ua (el'+'() yaitu:

41 inf'rasi e(ster'se+tif) yan" !erasal ,ari luar tu!uh) se+erti rasa nyeri) suhu) ,an ra!a

42 inf'rasi +r'+ri'se+tif) yan" !erasal ,ari ,ala tu!uh) isalnya 't't ,an sen,i

B. Tl%u$

&auh ,i ,ala 'ta( ,e(at ,en"an nu(leus !asal ter,a+at ,iensefal'n) suatu stru(tur

"aris=ten"ah 4i,line yan" e!entu( ,in,in"=,in,in" r'n""a entri(el (eti"a) salah satu

ruan" te+at leatnya cairan sere!r's+inalis. #iensefal'n ter,iri ,ari ,ua !a"ian utaa)

talaus ,an hi+'talaus.

%alaus !erfun"si se!a"ai stasiun +enya!un" ,an +usat inte"rasi sina+s untu(

+en"'lahan +en,ahuluan seua asu(an sens'ri( ,ala +er-alanannya (e ('rte(s. 6a"ian

ini enyarin" sinyal=sinyal yan" ti,a( !era(na ,an en"arah(an i+uls=i+uls sens'ri(

+entin" (e ,aerah s'at'sens'ri( yan" sesuai) serta (e ,aerah=,aerah lain.7

Ga!ar . $nat'i %alaus8


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I+uls sens'ri( a(an ,isalur(an elalui ra,i(s +'steri'r e,ulla s+inalis yan"

,i(enal se!a"ai "an"li'n s+inalis) (eu,ian i+uls ti!a ,i nucleus +r'+ius ,ise"en e,ulla

s+inalis. Nu(leus +r'+ius eru+a(an neur'n yan" en"hu!un"(an e,ulla s+inalis ,en"an

nucleus entr'=+'ster'=lateral ,an entr'=+'ster'=e,ial thalaus sisi ('ntralateral yan"

,i(enal ,en"an tra(tus s+in'talai(us. #i ('rnu +'steri'r ere(a enyilan" "aris ten"ah

elalui ('isura al!a ,an selan-utnya !er(u+ul ,i funi(ulus anter'lateral. Pa,a tin"(at

seri(al sera!ut yan" !erasal ,ari tun"(ai en,u,u(i ,aerah lateral) !a"ian t'ra(al

en,u,u(i ,aerah e,ial ,an !a"ian !ra(i'seri(al en,u,u(i !a"ian +alin" e,ial. Pa,a

tin"(at e,ulla '!l'n"ata -aras s+in'talai( terleta( ,ise!elah ,'rs'lateral 'lia inferi'r. #i

P'ns ia !era,a ,iantara leni(us e,ialis ,an !ra(iu ('n-un"tiu ,an ,iesensefal'n

,iatas u-un" ,'rsal lenis(us e,ialis ,e(at ('li(ulus su+eri'r.

e!ih (er'stral sera!ut=sera!ut s+in'talai( ti,a( !er(u+ul la"i se!a"ai !er(as)

(arena secara !ertaha+ en"a(hiri +er-alanannya ,ise+an-an" nucleus entr'=+'ster'=lateral

,an entr'=+'ster'=e,ial ,i thalaus. ntu( -aras sens'ri( +a,a a-ah ,i!aa 'leh nerus

tri"einus. *etelah !ersina+s ,i nu(leus entr'+'ster'lateral talaus selan-utnya e!entu(

tra(tus tala'('rti(al) tra(tus ini !er-alan nai( elalui (a+sula interna yan" terleta( ,i

+'steri'r ,ari tra(tus +irai,alis ,an enye!ar ,i c'r'na ra,iata enu-u (e ('rte(s sens'ri(

,i "irus +'st sentralis.


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T&'(u$ $!"#)(l%"'u$

Ga!ar . %ra(tus s+in'thalai(us secara anat'is2


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Ga!ar 5. P't'n"an elintan" tra(tus s+in'thalai(us +a,a e,ula s+inalis ,an

"yrus +'st=sentralis7


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Ga!ar . %ra(tus *+in'talai(us.2

T&'(u$ $!"#)(l%"'u$ #(e&")&

%ra(tus s+in'talai(us anteri'r !erhu!un"an ,en"an +erse+si ra!a ,an te(anan

rin"an. Per-alanan ',alitas sens'ri( +a,a tra(tus s+in'talai(us anteri'r a,alah se!a"ai

!eri(ut) ran"san"an yan" uncul +a,a rese+t'r ,i +eru(aan (ulit 4u-un" saraf +eritrichial)

('r+us ta(til ,ihantar(an elalui sera!ut saraf +erifer yan" !eryelin te!al 4neur'n


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+ertaa (e sel "an"li'n +seu,'uni+'lar ra,i(s ,'rsalis) ,an (eu,ian elalui ra,i(s

+'steri'r (e ,ala e,ula s+inalis.

#i ,ala e,ula s+inalis) +r'ses sentral ,ari sel "an"li'n ra,i(s ,'rsalis !er-alan

elalui ('rnu +'steri'r se(itar 2=15 se"en (eatas) seentara yan" ('lateral !er-alan 1 atau

2 se"en (e !aah) enci+ta(an ('nta( sina+s +a,a sel=sel ,i!er!a"ai tin"(at ,ari se"en

,i su!stansia ni"ra ,ari ('rnu +'steri'r. *el=sel 4neur'n (e,ua (eu,ian e!an"(it(an

ran"san"an ,i tra(tus s+in'talai(us anteri'r) yan" ana sera!ut=sera!ut terse!ut enyilan"

,i ('issura s+inalis anteri'r) (eu,ian nai( ,i funi(ulus anter'lateral ('ntralateral ,an

!era(hir ,i nu(leus entr' +'ster'lateral 4?P talaus) !ersaa ,en"an sera!ut=sera!ut

saraf ,ari tra(tus s+in'talai(us lateral ,an leniscus e,ialis. Neur'n (eti"a ,i nu(leus

talaus ini a(an e+r'ye(si(an a(s'n=a(s'nnya (e "yrus +'st sentralis ,i l'!us +arietal

elalui tra(tus tala'('rti(alis.

Ga!ar 7. %ra(tus s+in'talai(us anteri'r

T&'(u$ $!"#)(l%"'u$ l(e&l

%ra(tus ini e!aa sensasi nyeri ,an suhu. Rese+t'r +erifer a,alah u-un" saraf

!e!as ,ala (ulit)yan" eru+a(an 'r"an a(hir ca!an" +erifer ,ari neur'n +seu,'uni+'lar

"an""uan s+inalis. -un" saraf ini eru+a(an a(hir ,ari sera!ut=sera!ut saraf "ru+ $ yan"

ti+is ,an -u"a se,i(it sera!ut=sera!ut saraf "ru+ > yan" ti,a( !eryelin) !eri(utnya +r'ses

+erifer ,ari sel "an"li'n +seu,'uni+'lar +a,a "an"li'n s+inalis. Pr'ses sentral ,ari ra,i(s


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+'steri'r (e e,ula s+inalis ,an (eu,ian ter!a"i secara l'n"itu,inal en-a,i ('lateral yan"

+en,e( ,an !era(hir ,ala satu atau ,ua se"en +a,a su!stansia "elatin'sa) enci+ta(an

('nta( sina+s ,en"an neur'n funicular 4neur'n (e,ua. Neur'n ini enyilan" +a,a "aris

ten"ah ,i ('issura anteri'r e,ula s+inalis se!elu nai( +a,a funi(ulus lateral

('ntralateral (e talaus. %ra(tus s+in'talai(us lateral tersusun secara s'at't'+i() sera!ut

saraf ,ari e(streitas inferi'r terleta( ,i !a"ian lateral) seentara sera!ut saraf ,ari !a,an

,an e(streitas su+eri'r terleta( le!ih e,ial.

*era!ut saraf yan" ee,iasi ran"san"an nyeri ,an suhu terleta( san"at !er,e(atan

satu saa lain sehin""a ti,a( !isa ,i+isah(an secara anat'is. esi +a,a tra(tus

s+in'talai(us eye!a!(an (erusa(an +a,a +en"hantaran (e,ua ',alitas sens'ri()

alau+un ti,a( selalu +a,a tin"(at yan" saa.

*era!ut saraf ,ari tra(tus s+in'talai(us lateral !er-alan elalui !atan" 'ta( !ersaa

,en"an sera!ut saraf ,ari leniscus e,ialis +a,a leniscus s+inalis) yan" !era(hir +a,a

nu(leus entr' +'ster'lateral talaus. Neur'n (eti"a ,i nu(leus entr' +'ster'lateral

e+r'ye(si(an elalui tra(tus thala'c'rticalis (e "irus +'st=sentralis ,i l'!us +arietal.

Ran"san"an nyeri ,an suhu ,iteria ,i rough manner,i talaus) teta+i ran"san"an yan"

le!ih halus ti,a( !isa ,i+erse+si(an hin""a i+uls enca+ai ('rte(s sere!ri.

Ga!ar 8. %ra(tus s+in'talai(us lateral


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Ga!ar 9.

&alur asen,en sens'ri( ,an (elan-utannya (e tar"et stru(tur ,i sere!ru

Le$" !d (&'(u$ $!"#)(l%"'u$

l. esi +a,a tra(tus s+in'talai(us anteri'r

*era!ut saraf sentral ,ari neur'n +ertaa ,ari tra(tus ini nai( +a,a -ara( yan" !er!e,a

secara i+silateral ,i ('luna +'steri'r) enci+ta(an ('lateral se+an-an" -alan (e neur'n

(e,ua. neur'n (e,ua a(an enyilan" ,i !a"ian ten"ah ,an nai( le!ih tin""i ,i !a"ian

('ntralateral ,ari tra(tus s+in'talai(us anteri'r. esi +a,a tra(tus ini yan" ter-a,i setin""i

lu!al atau th'ra(al secara uu a(an enye!a!(an (erusa(an yan" inial atau ti,a( a,a

(erusa(an saa se(ali terha,a+ ran"san"an yan" !eru+a sentuhan (arena !anya(nya i+uls

yan" nai( !isa en-auhi ,ari lesi ,en"an elalui -alur yan" i+silateral. esi tra(tus

s+in'talai(us anteri'r setin""i seri(al) !a"aiana+un -u"a a(an enye!a!(an hi+estesia

yan" rin"an ,ari sisi e(streitas inferi'r yan" ('ntralateral. 2)

2. esi +a,a tra(tus s+in'talai(us lateral

%ra(tus s+in'talai(us lateral a,alah -alur utaa untu( ran"san"an nyeri ,an suhu.

%ra(tus ini !isa ,itranse(si secara neur'sur"i(al untu( en"hilan"(an rasa sa(it

4c'r,'t'y) '+erasi ini ti,a( !anya( ,ila(u(an se(aran") (arena su,ah ,i"anti(an ,en"an

et',e yan" ti,a( inasif ,an -u"a (arena hilan"nya rasa sa(it le!ih serin" te+'rer.

@en'ena selan-utnya selaa +en"alaan (linis) enyi+ul(an !aha nyeri yan"

,ia(i!at(an 'leh i+uls) -u"a !isa nai( elalui e,ula s+inalis +a,a -alur lain. *e!a"ai

c'nt'h neur'n s+in's+inalis yan" !era,a +a,a fasciculus +r'+rius) -i(a tra(tus s+in'talai(us

lateral ,ila(u(an transe(si +a,a !a"ian entral e,ula s+inalis) ran"san"an nyeri ,an suhu

le!ih se,i(it terasa +a,a !a"ian yan" !erlaanan satu atau ,ua se"en ,i!aah lesi)

seentara ran"san"an yan" !eru+a sentuhan teta+ a,a 4,efisit sens'ri( ,is'siasi.


13/15

De*"$"( $)%()$e#$)&"' +#, d"'&e#'# )le- le$" $!e$"*"' $e!##, lu&

$)%()$e#$)&"'


14/15

Ga!ar 10. 6e!era+a leta( +'tensial lesi se+an-an" -alur s'at'sens'ri(

Ga!ar 10 enun-u((an !e!era+a lesi ti+i(al se+an-an" -alur s'at'sens'ri() ,efisit

sens'ri( yan" !erhu!un"an ,i!ahas ,i!aah ini:

1 esi ('rti(al atau lesi su!('rti(a ,i area sens'ri='t'r !erhu!un"an ,en"an tan"an

atau len"an 4 ,an / enye!a!(an +aresthesia ,an (e!as +a,a tun"(ai ('ntralateral)


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terutaa !a"ian ,istal. esi yan" iritatif +a,a aerah ini !isa enye!a!(an !an"(itan

f'(al sens'ri() (arena ('rte(s 't'ri( terleta( lan"sun" !er,e(atan. Oleh (arena itu

serin" -u"a ter-a,i "an""uan 't'ri( 4Jacksonian seizure.

2 esi ,ari seua -alur sens'ri( ,i!aah thalaus 4 en"hilan"(an seua (ualitas

ran"san"an ,ari !a"ian tu!uh yan" !erlaanan. &i(a seua -alur s'at'sens'ri( ter(ena (ecuali -alur yan" en"hantar(an nyeri ,an

suhu 4d) ter,a+at hi+estesia ,ari !a"ian tu!uh yan" !erlaanan ,an -u"a !a"ian

a-ah) teta+i ran"san"an nyeri ,an suhu ti,a( en"alai (erusa(an.

*e!ali(nya) lesi +a,a leniscus tri"einalis ,an tra(tus s+in'talai(us lateral 4e ,i

!atan" 'ta( enye!a!(an hilan"nya ran"san"an nyeri ,an suhu +a,a !a"ian tu!uh

,an a-ah yan" !erlanan) teta+i ti,a( en"hilan"(an ran"san"an ',alitas sens'ri(

yan" lain.

5 &i(a lenis(us e,ialis ,an tra(tus s+in'talai(us anteri'r 4* ter(ena lesi) seua

',alitas s'at'sens'ri( ,ari !a"ian tu!uh yan" ('ntralateral a(an rusa( (ecuali

nyeri ,an suhu.

esi +a,a nu(leus s+inalis ,an tra(tus ,ari nerus tri"einalis serta tra(tus

s+in'talai(us lateral 4, a(an enye!a!(an rusa(nya ran"san"an nyeri ,an suhu

+a,a sisi a-ah i+silateral ,an +a,a !a"ian tu!uh yan" ('ntralateral.

7 esi +a,a ('luna +'steri'r 4- enye!a!(an hilan"nya sensasi +'sisi ,an sensasi

i!rasi serta ,is(riinasi) yan" !er('!inasi ,en"an ata(sia i+silateral.

8 esi +a,a ('rnu +'steri'r ,ari e,ula s+inalis 4") ran"san"an nyeri ,an suhu yan"

i+silateral hilan") teta+i ',alitas sens'ri( yan" lain teta+ utuh 4,efisit s'ns'ri(

,is'siasi.

9 esi ulti+el yan" !er,e(atan ,en"an ra,i( +'steri'r 4' enye!a!(an nyeri

ra,i(uler ,an +arestesia) serta hilan"nya seua ',alitas sens'ri( +a,a area tu!uh

yan" ter(ena) ,en"an ta!ahan hi+'t'nia atau at'nia) arefle(sia serta ata(sia -i(a

ra,i(s terse!ut e!eri(an su+lai (e e(streitas su+eri'r atau+un inferi'r.

Referat trakt spinothalamikus

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