General Somatosensory System: Sensory tracts for the back of the head, trunk, upper and lower extremities

Ascending Tract Sensation Receptor N1 N2 N3 (Thalamic Nuclei) Conveyed (DRG) (Spinal Cord) Free nerve Posterior root Lateral Fast Pain: via endings ganglion Spinothalamic fast conducting delta A-type fibers (axons form the at the medulla, is (sharp pain; posterolateral joined by the limited to skin) Delta A fibers: tract of Lissauer; anterior Substantia glutamate as enters Lamina II spinothalamic gelatinosa of the spinal cord and spinotectal neurotransmitter N2) tracts to form the Slow Pain: slowSPINAL Axons cross to LEMNISCUS conducting Copposite side at the thoracic part type fibers of the spinal (burning, aching cord and ascend pain in any body damage before Ventral tissue) as lateral decussation at posterolateral C fibers: spinothalamic/ thoracic part of nucleus of the glutamate and anterior spinal cord: thalamus contralateral substance P as spinothalamic damage (somatosensory neurotransmitters; tracts relay area) substance P for As tract ascends, after decussation: responsible ipsilateral slow pain fibers are added damage (axons pass medially with Temperature: through posterior sacral fibers in limb of the also via delta A the lateral aspect internal capsule and C fibers and cervical and the corona fibers in the Anterior Free nerve Posterior root Light/Crude radiata to reach medial aspect Spinothalamic endings ganglion Touch post-central Lamina V-VII gyrus) Pressure (axons contribute to posterolateral tract of Lissauer) Contralateral half of the body is represented inverted (hand Meissners Posterior root Nucleus Gracilis Posterior White Discriminatory and mouth Columns corpuscles ganglion of Medulla Touch represented (two-point (Fasciculus inferiorly) Nucleus Gracilis and Position-Vibratory discrimination), Short Pacinian descending Cuneatus of Fasciculus Sense corpuscles fibers: synapse Medulla Cuneatus) Conscious (pressure and w/ cells of Muscle Joint vibration), posterior gray (axons, called the

Decussation(s) Axons of N2 cross obliquely to the opposite side in the anterior gray and white commissures within one (1) spinal segment of the cord, sometimes within two (2) segments (Thoracic Part of Spinal Cord like the anterior spionothalamic tract)

Destination (N4) Somesthetic Area (BA 312) of cerebral cortex (post-central gyrus)

For slow pain, termination is in the Reticular Formation For visceral pain: Insular Gyrus For interpretation of emotional aspect of pain: Cingulate Gyrus

Axons of N2 cross very obliquely to the opposite side in the anterior gray and white commissures within several spinal segments of cord Axons of N2 cross the median plane at the Great Sensory Decussation

Somesthetic Area (BA 312) of cerebral cortex (post-central gyrus)

Somesthetic Area (BA 312) of cerebral cortex (post-central gyrus)

Fasciculus Gracilis: (T7 down) present all throughout the spinal cord Fasciculus Cuneatus: (T6 up) situated laterally in the upper thoracic and cervical segments of the cord Septum separates these fasciculi Posterior Spinocerebellar

Sense

muscle spindles and tendon organs

horn, internuncial neurons and anterior horn cells intersegmental reflex Long ascending fibers: also involved in intersegmental reflex but ascend as the fasciculus gracilis and cuneatus Ipsilateral ascent!!!

internal arcuate fibers, cross the median plane at the great sensory decussation at the inferior/caudal half of the medulla) Fibers ascend as the MEDIAL LEMNISCUS

Unconscious Muscle Joint Sense Feedback control for motor performance

Muscle spindles, tendon organs and joint receptors of the trunk and lower limbs

Posterior root ganglion in sacral, lumbar and lower thoracic levels (axons entering the spinal cord from the posterior roots of the lower lumbar and sacral segments ascend in the posterior white column until they reach L3/L4, where they enter the nucleus dorsalis) Posterior root ganglion in lumbar and sacral segments

Nucleus Dorsalis (Clarkes Column) Lamina VII Axons enter the lateral white column and ascend ipsilaterally to the medulla

---

NONE

Cerebellar cortex via the inferior cerebellar peduncles (terminate as mossy fibers) Information is used by cerebellar cortex in the coordination of limb movements and maintenance of posture

Anterior Spinocerebellar Double-crossing fibers

Unconscious Muscle Joint Sense Information skin from and

Muscle spindles, tendon organs and joint receptors of the upper and

Nucleus Dorsalis (Clarkes Column) Majority of axons: cross to opposite

---

Axons of N2 cross to contralateral side at the nucleus dorsalis at the same level of entry

Cerebellar cortex via the superior cerebellar peduncles (terminate as

Comparator between action of inhibitory & excitatory inputs to spinal motor neurons and interneurons

superficial fascia Provide cerebellum with information about the state of motor neuron excitation

lower limbs, skin and superficial fascia

side and ascend contralaterally BUT these axons cross back in the cerebellum Minority of axons: ascend ipsilaterally in the lateral white column Lateral/Accessory Nucleus Cuneatus of medulla Axons leave for the cerebellum as the posterior external arcuate fibers Unknown But fibers cross median plane at the same level of entry

mossy fibers) The same fibers cross back to original side in the cerebellum

Cuneocerebellar Fibers of the fasciculus cuneatus that proceed to the cerebellum instead of BA 312

Unconscious Muscle Joint Sense

Muscle spindles, tendon organs and joint receptors of the upper limb and upper part of thorax

Posterior root ganglion in cervical and upper thoracic region

---

NONE

Cerebellar cortex via the inferior cerebellar peduncles (terminate as mossy fibers)

Spinotectal

Spinoreticular

Afferent information for spinovisual reflexes brings about movement of eyes and head toward source of stimulation Influences level of consciousness Responsible for spread of pain sensation throughout brain Information from cutaneous and proprioceptive organs

Posterior root ganglion

---

N2 fibers cross the median plane

Superior Colliculus of Midbrain

Posterior root ganglion

Unknown Axons ascend in lateral white columns mixed with the spinal lemniscus Unknown but in posterior gray column Axons ascend in the contralateral anterolateral white column of the cord

Most fibers remain UNCROSSED

Reticular Formation in the medulla, pons and midbrain

Spino-olivary

Posterior root ganglion

Inferior Olivary Nuclei (Medulla) Axons cross midline back toward inferior cerebellar peduncle on same side of entry into the cord

N2 fibers cross the midline N3 fibers cross midline back toward original side

Cerebellar cortex via the inferior cerebellar peduncles

Visceral Sensory

Information thorax abdomen

from and

Visceral pain: Caused by ischemia, chemical damage, spasm of smooth muscle and distension NOTES:

Pain and stretch receptor endings in viscera Visceral afferent fibers usually take part in reflex activity

Posterior root ganglion

N2 in posterior or lateral gray columns Axons are believed to join the spinothalamic tracts as they ascend

Ventral posterolateral nucleus of the thalamus

Somesthetic Area (BA 312) of cerebral cortex (post-central gyrus)

In the thalamus, the lateral spinothalamic tract is joined by the posterior white column pathway (fasciculus gracilis and cuneatus) which mediates positionvibration sensem simple touch and conscious proprioception FIBERS for position-vibration sense will NOT GO TO GRAY MATTER but will terminate in the posterior columns (fasciculus gracilis and cuneatus) The periaqueductal gray area is where pain is masked (area of pain modulation) LESIONS MIDLINE LESIONS in the SPINOTHALAMIC TRACTS cause BILATERAL DEFICITS because fibers cross at the ventral gray commissure!!! Cervical

fibers are in the medial aspect while sacral fibers are in the most lateral so upper body is usually affected by these lesions aspect of the tracts Before entry to the thalamus, the MEDIAL LEMNISCUS and the LATERAL SPINOTHALAMIC TRACT are almost joined. It is only in the VPLN that there is COMPLETE FUSION OF THESE TWO TRACTS!!! CEREBELLAR LESIONS always manifest on the ipsilateral side!!! Lesions at POSTERIOR FOSSA LEVEL: ipsilateral head and contralateral body deficits loss of pain and temperature sensations! THALAMIC SYNDROME: Loss of all modalities of sensation on the contralesional side!!!

General Somatosensory System: Sensory tracts for anterior part of the face Ascending Tract Sensation Receptor N1 N2 Conveyed From CNV1, Free nerve Pain & Ipsilateral Ipsilateral Main CNV2, CNV3 of endings temperature from Semilunar Sensory Nucleus Trigeminal of the 5th cranial the anterior part (Gasserian) Nerve of the head Ganglion nerve (sensory nucleus of the trigeminal)

N3 Ventral posteromedial nucleus of the thalamus

Decussation(s)

Destination (N4) Somesthetic Area (BA 312) of cerebral cortex (post-central gyrus)

Direct Activation Pathway: Motor tracts for the initiation and control of voluntary muscle activity Pyramidal Tracts Descending Movement Controlled N1 N2 N3 Decussation(s) Tract (Cerebral Cortex) (Spinal Cord) (Lower Motor Neuron) Corticospinal Internuncial Alpha motor and Junction of the Voluntary, discrete & Pyramidal (BETZ) th Tract neurons Gamma motor medulla and spinal skilled movements, cells in the 5 layer neurons in anterior cord at the especially those of the of the cortex in BA4 horn cells decussation of the distal part of the limbs Fiber origins: pyramids Majority of fibers are 1/3: from BA 4 Largest Lesion above myelinated and are 1/3: from BA 6 corticospinal fibers decussation relatively SMALL, SLOW- 1/3: from BA 312 can synapse contralateral deficit CONDUCTING fibers directly with the Descending fibers motor neurons converge on the Lesion below Form the pathway that corona radiata decussation confers speed and agility ipsilateral deficit to voluntary movements Act on all motor used in performing Posterior limb of internal capsule neuron pools but rapid, skilled movements Anterior especially on lateral Middle 3/5 of basis corticospinal tract portions of the pedunculi of the ventral horns (those uncrossed at midbrain (which then control the pyramidal the distal muscles decussation) cross Tract is broken in of the arm and over at the level of the pons by the hand) destination transverse pontocerebellar Fibers ventral fibers horn cells via glutamate Fibers regroup in (excitatory) the anterior of the medulla as the But ventral horn pyramids cell axons muscle fibers via 2/3 of fibers cross ACh midline at the decussation of pyramids and enter the lateral white columns to form lateral corticospinal tract Corticobulbar Innervate voluntary Supranuclear fibers Internuncial Brainstem motor Same level as exit Tract muscles of the larynx, neurons nuclei of cranial occupy a more pharynx, etc nerves

Branches

(1) Early fibers that return to the cortex to inhibit activity in the adjacent cortical regions (2) Branches to the caudate and lentiform nuclei, red nuclei, and the olivary nuclei and the reticular formation keep the subcortical regions informed about cortical motor activity Once alerted, subcortical regions can send their own nervous sinals to the alpha and gamma motor neurons by other descending pathways

anterior location in the posterior limb of the internal capsule occupy a more medial location in the basis pedunculi leave the pyramidal tract at several levels, with some crossing and others not terminates in the medulla and does not pass through pyramids NOTES: At birth, corticospinal tract is not yet fully myelinated Projection fibers in the posterior limb of the internal capsule from anterior to posterior face, arm, leg, bladder and rectum Because of the decussation of most of the fibers of the pyramidal tracts, voluntary movements of one side are under the control of the opposite cerebral hemisphere EXCEPT: muscle groups of the two sides of the body that habitually act in unison bilateral cortical innervation: paraspinal muscles, upper facial muscles muscle groups that act alone in isolated, delicate and especially, in learned movements unilateral innervation DISTURBANCES Disturbances of the corticospinal system may be irritative (positive) or paralytic (negative) Damage to the corticospinal system results in weakness, with loss of voluntary movements, especially fine, skilled movements, but preservation of other forms of movements including segmental reflexes Cremasteric and abdominal reflexes rely on intact pyramidal pathways; when tract is damaged reflexes are lost on one side

(CN 3, 4, 5, 6, 7, 10, 11, 12) Trigeminal Facial Vagus Spinal Accessory Hypoglossal

Ventral horn cells via glutamate (excitatory)

LESIONS Seizures: irritative = excitation contralesional manifestation Paralysis: hemiplegia > hemiparesis distal muscles in extremities, not associated with atrophy Babinskis Sign: stretch reflex sign contralesional abnormal dorsiflexion + spreading of toes because of loss of inhibition from the corticospinal tracts If lesion is localized in a limited area of the cortex, then a single limb or one side of the face only may be involved - afterdischarge attributed to reverberation within cortical circuits peripheral tonic (maintained contractions) or clonic (alternating contractions due to loss of cerebral inhibitory dominance) manifestations - massive lesion of one hemisphere can cause severe weakness of the opposite side of the body but not of the upper facial or paraspinal muscles If lesion involves only the pyramidal tract fibers in the pyramids of the medulla then one side of the body below the level of the lesion will be affected Distribution of weakness may also depends on whether innervation is unilateral or bilateral - upper face is spared when corticobulbar lesions involve facial fibers - if frontal eye fields are involved, paralysis of conjugate eye movement on the opposite side

Indirect Activation Pathway: Motor tracts for involuntary muscle control of posture, coordination and equilibrium Extrapyramidal Tracts Descending Movement Controlled N1 N2 N3 Decussation(s) Branches Tract (Spinal Cord) (Lower Motor Neuron) Medial Indirect Activation Pathways Medullary Medial interneurons Posterolateral part Inhibitory Area of Inhibition of extensor Crosses over at Give off multiple Reticulospinal the Reticular motor neurons of anterior horn various levels branches as they Tracts Formation in the alpha and gamma descend Ventromedial Part Excitation of flexors motor neurons of the Caudal Depends on Medulla descending Inhibition of tendon (lower medulla) stimuation form reflexes supretentorial descend in lateral Hypothalamus controls motor structures white column sympathetic & SACRAL parasympathetic outflows Tectospinal Reflex postural Superior Colliculus Internuncial Anteromedial Cross midline soon ? Tracts movements in response of Midbrain neurons in anterior portion of anterior after origin to visual stimuli gray column in the horn on both alpha upper cervical cross midline soon and gamma motor segments after origin neurons descends through the anterior white columns close to anterior median fissure does not extend below the cervical levels Lateral Vestibular Nuclei (beneath the floor of the 4th ventricle) descends uncrossed through medulla in the anterior white column

Vestibulospinal Tracts

Excitation of motor neurons Inhibit flexors

extensor

Medial interneurons of the anterior gray column

Anteromedial portion of anterior horn on both alpha and gamma motor neurons

Most descend uncrossed

Receive input from inner ear through vestibular nerve and from the cerebellum

Maintains balance

Lateral Indirect Activation Pathways Pontine Excitation of extensor Reticulospinal motor neurons Tracts

Excitatory Dorsolateral Reticular Formation

Lateral interneurons

Anteromedial portion of anterior horn on both alpha

Descend uncrossed in the medial part of the

Multiple branches as they descend

Inhibits neurons

flexor

motor

from Pons descend in anterior white column Red Nucleus in the Tegmentum of the midbrain at the level of the Superior Colliculus descend through pons and medulla to enter the lateral white column Inferior Olivary Nucleus descend in the lateral white column of the spinal cord Cerebral Cortex, Hypothalamus, Amygdaloid Complex, Reticular Formation descends in lateral white column Internuncial neurons in the anterior gray column

and gamma (but mostly gamma) motor neurons

anterior white column

Maintains postural tone Rubrospinal Tracts Facilitates activity in arm flexors But has little effect on legs Inhibits extensor antigravity muscles or

Alpha and gamma motor neurons of the spinal cord

Decussate immediately in the anterior tegmetnal decussation at the level of the superior colliculus

? Receive input from cerebral cortex and cerebellum

Olivospinal Tracts There are doubts that these tracts exist Descending Autonomic Fibers Control sympathetic and parasympathetic systems

Motor neurons in the anterior gray column

Cross in brainstem

----

Autonomic motor cells in the lateral gray columns in the Thoracic and Upper Lumbar levels (Sympathetics) Midsacral levels (Parasympathetics)

Cross midline in brainstem

---

NOTES:
Gamma motor neurons have lower response thresholds to all forms of stimulation than alpha motor neurons stimuli insufficient to produce alpha motor neuron discharge may be sufficient to discharge gamma neurons Lower motor neurons give off collateral branches as they pass through the white matter to reach the anterior roots of spinal nerve collaterals synapse on Renshaw Cells Renshaw cells in turn synapse on the same lower motor neurons feedback inhibition on lower motor neurons Reticular formation is a field of dispersed cells or small nuclei between large nuclei and tracts throughout the midbrain, the medulla and the pontine tegmentum mediates ascending sensory activity and consciousness has complex effects on spinal cord motor neurons

LESIONS - ABOVE the MIDBRAIN and RED NUCLEUS DECORTICATE POSTURE: increased flexor tone in arms, increased extensor tone in legs because of loss of inhibiton in all descending pathways - Bilateral lesions BELOW the RED NUCLEUS DECEREBRATE POSTURE: overactivity of gamma efferent nerve fibers to the muscle spindles release of neurons from inhibition from higher centers generalized increased extensor tone to the loss of arm flexor excitation associated with coma - BELOW THE MEDULLA GENERALIZED FLACCIDITY loss of all descending input

Cerebellar Afferent Fibers Cerebellar Afferent Fibers from the Cortex Important in control of voluntary movements - Information on initiation of movement transmitted from cerebral cortex to the cerebellum so that movement can be monitored and muscle adjustments can be made Further pathway Function Pathway Origin Cerebellar Descends Terminates where? Afferent fibers through (from the cortex) Corticoponto Nerve cells in the Corticopontine corona pontine nuclei and Pontine nuclei give rise to Converys cerebellar frontal, parietal, fibers radiata mossy fibers to transverse fibers of the pons control form Pathway temporal, & occipital and cerebellar cortex (will cross the midline and cerebral cortex lobes of cerebral cortex internal enter opposite cerebellar capsule hemisphere as the middle cerebellar peduncle) Cerebroolivocerebell ar Pathway Nerve cells in the frontal, parietal, temporal, & occipital lobes of cerebral cortex Cortico-olivary fibers corona radiata and internal capsule Terminate bilaterally on the inferior olivary nuclei Inferior olivary nuclei give rise to fibers that will cross the midline & enter opposite cerebellar hemisphere through inferior cerebellar peduncle (these fibers terminate as climbing fibers in the cerebellar cortex) Cell in reticular formation give rise to reticulocerebellar fibers and will enter the cerebellar hemisphere on the same side through inferior and middle cerebellar peduncles Converys control form cerebral cortex

Cerebroretic ulocerebellar Pathway

Nerve cells from sensorimotor areas of cerebral cortex

Corticoreticula r fibers

Reticular formation on the same & opposite side in the pons and medulla

Converys control form cerebral cortex