1 sensation and its disorders

Strucrure of nS

1. Principles of structure and Principles 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, topical Subject 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 localize Determining the paresis or paralysis allows to localize
the level of the nervous system damage. Voluntary the level of the nervous system damage. Voluntary
movements violation is important in the diagnosis of movements violation is important in the diagnosis of
functional disorders. Knowledge of this section is functional 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 disorders 6. 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 come means all afferentation, that come
in organism, but not all of them are realized. in organism, but not all of them are realized.
The sensation The sensation is a part of reception, which is is a part of reception, which is
felt and analyzed by the proper regions of felt 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 cortex afferent (sensible) conducter and cortex
department of analyzerdepartment of analyzer

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

9. ReceptorsReceptors
ReceptorsReceptors are subdivided into are subdivided into
ExteroreceptorsExteroreceptors ((contactoreceptorscontactoreceptors in a in a
skin, mucous membranes and skin, 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 sensation simple sensation
higher-order aspects of sensation or higher-order aspects of sensation or
cortical cortical sensationsensation

12. The types of simple sensationThe types of simple sensation
1. 1. SuperficialSuperficial sensationsensation or exteroceptiveor exteroceptive
pain pain
temperaturetemperature
 tactiletactile
2. 2. Deep (profound) Deep (profound) sensationsensation or or pproprioceptiveroprioceptive
the sensation of muscle movement and joint positionthe sensation of muscle movement and joint position
( (… … is the sense of the relative position of is the sense of the relative position of
neighboring parts of the body,neighboring parts of the body, that is that is where the where the
various parts of the body are located in relation to various parts of the body are located in relation to
each othereach other))
This sense keeps track of body parts relative to each other.
vibration vibration
sense of pressure sense of pressure
sense of masssense of mass
kinesthetic sensekinesthetic sense

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

14. The types of The 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 sensation Methods of sensation
examinationexamination

16. simple sensation simple sensation

17. Tactile sensationTactile sensation
Use a piece of a cotton wool or your finger to touch the Use 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 a sensation (use a needle-pointneedle-point, pins or other sharp object). , pins or other sharp object).
The explorer must define their character (it is “sharp” or The explorer must define their character (it is “sharp” or
“dull”).“dull”).
TemperatureTemperature
Use Use a test-tube with hot or cold watera test-tube with hot or cold water and ask the patient and 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 on Important 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. .
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1 2
3 4

20. General rules for examination of General 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 side Ask the patient to tell you if there is difference from side
to side or other "strange" sensations. to side or other "strange" sensations.
Test Test 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 to Grasp 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 of With 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 a Use a low pitch tuning forklow pitch tuning fork (128 Hz). (128 Hz).
Place the stem of the fork over the Place the stem of the fork over the
distal interphalangeal joint of the distal interphalangeal joint of the
patient's big toes.patient's big toes.

23. PRESSURE SENSE PRESSURE SENSE
AND SENSE OF MASSAND SENSE OF MASS
Research Research of pressure sense of pressure sense is taken to the decision is taken to the decision
by explorer pressures of a different force on the by explorer pressures of a different force on the
surface of skin and its ability surface of skin and its ability to distinguish to distinguish
pressure from the simple touchpressure from the simple touch..
Sense of mass is Sense of mass is determined to those, how the determined to those, how the
explorer explorer distinguishes the difference between the distinguishes the difference between the
mass of two subjects,mass of two subjects, placed on the surface of placed on the surface of
stretching upper extremities. The ordinary man is stretching 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 of higher-order aspects of
sensation or sensation or cortical cortical sensationsensation

26. TWO-POINT DISCRIMINATION SENSETWO-POINT DISCRIMINATION SENSE
Use an Weber compasses to touch the patient's finger Use 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“ touch Ask the patient to identify "one" or "two“ touch
feelings. feelings.
Find the minimal distance at which the patient can Find 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 ability is 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 patient is explored by suggesting of the patient
aboutabout the letter, number, figure, the letter, number, figure, written on written on
his skin,his skin, with the patient’s closed eyes. with the patient’s closed eyes.

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

31. Pathway of superficialPathway of superficial sensationsensation
The tract is three-neurons The tract is three-neurons (blue colour). (blue colour).
The first-order neuron The first-order neuron is in the is in the
spinal node. Axons form a spinal spinal node. Axons form a spinal
nerve and then go to posterior horn nerve and then go to posterior horn
The second-order neuron The second-order neuron is at the is at the
posterior horn. Their axons, doing posterior horn. Their axons, doing
a crossing through a front white a crossing through a front white
joint, get in lateral rope of opposite joint, get in lateral rope of opposite
side, forming the side, forming the lateral lateral
spinothalamic tract. spinothalamic tract. Then go up Then go up
and are finished in thalamus (and are finished in thalamus (third-third-
order neuronorder neuron).).
Axons of the third neuron form Axons of the third neuron form
thalamocortical tract, which passes thalamocortical tract, which passes
through back third of back leg of through back third of back leg of
internal capsule, and in internal capsule, and in
composition of a radiant crown composition of a radiant crown
enters the postcentral gyrus. enters the postcentral gyrus.

32. Pathway of deepPathway of deep sensationsensation
Proprioceptive axons with cell bodies in spinal Proprioceptive 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 posterior in 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 on They synapse on second-order neuronsecond-order neuron in in
dorsal column nuclei (nuclei gracilis and dorsal column nuclei (nuclei gracilis and
cuneatus) in the medulla. cuneatus) in the medulla.
Axons of the II neurons do crossing and Axons of the II neurons do crossing and
together with tractus spinothalamicus form together with tractus spinothalamicus form a a
lemniscus mediaislemniscus mediais, , conducting impulses to conducting impulses to
thalamus. thalamus.
TheThe lemniscus mediais lemniscus mediais is ended in thalamus is ended in thalamus
((the third-order neuronthe third-order neuron), from the cells of ), from the cells of
which impulses by the thalamocortical fibers which impulses by the thalamocortical fibers
are sent through an internal capsule and are 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 distinguish In clinic it is accepted to distinguish kinds kinds
and typesand types of sensible disorders. of sensible disorders.
There are some kinds of them, which select There are some kinds of them, which select
depending on the depending on the quality or quantitative quality 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 pain Depending 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 in partial 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 of increase of sensation as a result of
decline of threshold of excitability in the cortex decline of threshold of excitability in the cortex
DysesthesiaDysesthesia – “– “perverted” perception of the irritation, for perverted” perception of the irritation, for
example, the touch causes the pain feelings, thermal example, 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 of perception and feeling of
irritation not only in place of its causing but also in some irritation 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 of unpleasant 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 of cold, electric digits, often are the early signs of disease of
the nervous systemthe nervous system

39. KINDS KINDS
OF SENSIBLE DISORDERS OF SENSIBLE DISORDERS
Pain,Pain, signaling about an unhappiness in an signaling about an unhappiness in an
organism, arises up at the irritation by the organism, arises up at the irritation by the
pathological process of sensible analyzers at pathological process of sensible analyzers at
any level, including receptors, conductors any level, including receptors, conductors
and centers. and centers.
Pain is especially intensive at the defeat of Pain 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 of Pain, connected with the place of defeat of
nervous trunk or root is considered as nervous trunk or root is considered as local painlocal pain..
Irradiational painIrradiational pain arises up when the irritation arises 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 irritation arises 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 from is marked far from
localization of pathological process, usually localization of pathological process, usually
it spreads in the area of innervation, for it spreads in the area of innervation, for
example shooting pain in foot at vertebrae example shooting pain in foot at vertebrae
disorders. Also happens in case of phantom disorders. Also happens in case of phantom
pain.pain.

43. Reflex painReflex pain is related with the transmission of is related with the transmission of
irritation on the horn level from inner organ by irritation on the horn level from inner organ by
its nerve on other nerve which innervates the its 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 Захар гіперестезиії (зоні Захар’’ііна- Геда) при захворюваннях на- 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
Distinguish Distinguish peripheral, segmental and peripheral, 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 - plural or 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 of is marked at the defeat of dorsal (back) root, back horn, front white dorsal (back) root, back horn, front white
joint.joint.
 The root typeThe root type is marked at the defeat of back root, when is marked at the defeat of back root, when
all types of sensation fall out in the areas of their all types of sensation fall out in the areas of their
innervation (dermatomes). + paininnervation (dermatomes). + pain
 The lesion of The lesion of back horn and front white jointback horn and front white joint is is
accompanied by a split or accompanied by a split or dissociation type.dissociation type. It is shown It 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 of At the defeat of front white jointfront white joint the sensation the sensation
disturbances show up asdisturbances show up as jacket jacket..

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

48. The segmental type The segmental type of sensation disturbancesof sensation disturbances : :
Bilateral segmental impairment of Bilateral segmental impairment of
superficial sensation by the segmental superficial sensation by the segmental
type occurs in the case of the defeat at type 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 right in right
levels. levels.

49. The segmental type The segmental type of sensation disturbancesof sensation disturbances : :
Bilateral segmental impairment of Bilateral segmental impairment of
superficial sensation by the superficial sensation by the
segmental type occurs in the case of segmental 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 result arises up as a result
of sensation conducters defeat within the of sensation conducters defeat within the
spinal cord or brain. spinal cord or brain.
For this type following is For this type following is typical:typical:
--- disturbances of superficial sensation disturbances of superficial sensation
show up on the opposite side to the lesion show 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 of The conductive types of
sensation disturbances :sensation disturbances :
Homolateral impairment of Homolateral impairment of deep deep
sensationsensation by the conductive type by the conductive type
occurs in the case of the defeatoccurs in the case of the defeat of of
posterior rope at the Th10 levelposterior rope at the Th10 level..

53. The conductive typesThe conductive types of of
sensation disturbancessensation disturbances : :
Contrlateral impairment of Contrlateral impairment of
superficial sensationsuperficial sensation by the by the
conductive type occurs in the conductive type occurs in the
case of the defeat case of the defeat of of the lateral the lateral
spinothalamic tract at the Th12 spinothalamic tract at the Th12
level level..

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

55. The conductive typesThe conductive types of sensation of sensation
disturbancesdisturbances : :
Contrlateral impairment of Contrlateral impairment of
superficial sensation by the superficial sensation by the
conductive type occurs in conductive type occurs in
the case of the defeat of the case of the defeat of
lemniscus medialis lemniscus medialis – total – total
hemianesthesia hemianesthesia

56. Topical diagnostics of sensation disturbancesTopical diagnostics of sensation disturbances
The defeat of thalamusThe defeat of thalamus causes a causes a “syndrome of three “syndrome of three
hemi”hemi” - - hemihemianesthesia of superficial sensation, anesthesia of superficial sensation,
- sensitive - sensitive hemihemiataxia (loss of muscle - articular ataxia (loss of muscle - articular
sense on opposite side) sense on opposite side)
- - hemihemianopsia of opposite eyeshots. anopsia of opposite eyeshots.
It is accompanied by It is accompanied by thalamic painthalamic pain in the opposite half of in the opposite half of
body, showing up as badly localized, extremely body, 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 causes also causes
hemianesthesia, hemianesthesia,
hemiataxia,hemiataxia,
hemianopsia on opposite side. hemianopsia on opposite side.
Capsula
interna

58. The defeat of The defeat of sensation region of cortex sensation region of cortex (postcentral (postcentral
gyrus)gyrus) results in the loss of all types of sensation by results 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 sensation Practically 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 usually hemitype, because not all postcentral gyrus is usually
struck, but only its separate areas. So, at the defeat of struck, but only its separate areas. So, at the defeat of
its overhead area anesthesia or hypesthesia of foot its overhead area anesthesia or hypesthesia of foot
(rarer than all leg) is revealed, (rarer than all leg) is revealed,
middle area — hand middle 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) there Except 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) on appears in parts of body (hand, leg, trunk, face) on
contrlateral side in proper to localization of pathological contrlateral side in proper to localization of pathological
focus. focus.

This phenomenon is called of This phenomenon is called of Jackson’ sensory Jackson’ sensory
epilepsy epilepsy attackattack-- epilepsy partialis s. corticalis - is epilepsy partialis s. corticalis - is
revealed by partial attack of paresthesia or pain spreading revealed by partial attack of paresthesia or pain spreading
in the areas of body accordance with the nidus in a in the areas of body accordance with the nidus in a
postcentral gyrus.postcentral gyrus.