15-general sensory pathways of the trunk and limbs...microsoft powerpoint - 15-general sensory...
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General Sensory Pathways of the Trunk and Limbs
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Lecture Objectives
• Describe gracile and cuneate tracts and pathways for conscious proprioception, touch, pressure and vibration from the limbs and trunk.
• Describe dorsal and ventral spinocerebellar tracts and pathways for unconscious proprioception from the limbs and trunk.
• Describe lateral spinothalamic tract and pathways for pain and temperature from the limbs and trunk.
• Describe ventral spinothalamic tract and pathways for simple touch from the limbs and trunk.
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Ascending Tracts
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Dorsal ColumnMedial Lemniscal System
• Functions• Touch
• Discriminative touch (calipers)• Fine touch (cotton ball)
• Vibration (tuning fork)• Conscious proprioception (with eyes closed, patient reports position of limbs as they are moved by examiner)
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Dorsal ColumnMedial Lemniscal System
• Neural components• Receptors – encapsulated receptors & hair shafts
• 1st order neuron• Cell body – DRG• Central Axon
• Lower body – fasciculus gracilis• Upper body (above T6) – fasciculus
cuneatus
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Dorsal ColumnMedial Lemniscal System
• Neural components• 2nd order neuron
• Cell body – Posterior column nuclei (gracilis & cuneatus)
• Axons • Decussate – internal arcuate
fibers• Ascend – medial lemniscus
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Dorsal ColumnMedial Lemniscal System
• 3rd order neuron• Cell body – ventral posterolateralnucleus of the thalamus (VPL)
• Axon• Internal capsule (posterior limb) • Corona radiata • Somatosensory cortex – Postcentral
gyrus
• Lesions • In the posterior column?• Above the decussation?
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Anterolateral (spinothalamic) System
• FunctionFree nerve ending
• Pain• Aδ fibers (small myelinated)
• Fast pain (sharp, will localized stabbing pain)
• C fibers (unmyelinated)• Slow pain (dull aching or burning pain)• Via spinoreticular tract
• Temperature• Crude touch
• Poorly localized & poorly identified• DO NOT compensate damage to dorsal column
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Anterolateral System• Neural components
• 1st• Cell body – DRG • Axon
• Branches ascend & descend in the Lissauer’s tract for 1‐2 segments
• 2nd• Cell body – posterior horn (substantiagelatinosa)
• Axons – cross midline at anterior white commissure
• 3rd – VPL – somatosensory cortex
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Somatotopic Organization of Anterolateral System
At Upper Cervical Level• Sensory modalities
• Anterior – crude touch • Lateral
• Medial – temperature • Lateral – pain
• Area• Lower limb – most lateral• Cervical – most medial
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Anterolateral System
• Lesions
• Segment sparing (lesion at T1 – deficit up to T2 or T3 dermatomes)?
• Partial lesion – effect of somatotopic organization?
• Lesion at anterior white commissure?
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Spinoreticular (Spinoreticulothalamic) Tract
• Slow pain• Forms part of the spinothalamic tract
• 1st order – DRG (C fibers)• 2nd order – substantia gelatinosa
• Project to reticular formationReticular formation (bilaterally)
Thalamus (inralaminar nuclei)
Cortex• postcentral gyrus – localization of pain• insula & anterior cingulate gyrus –affective
(suffering) aspect of pain
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SpinocerebellarPathways
• Function• Non‐conscious proprioception• Essential for normal motor function
• Lesions lead to severe motor deficits• Ataxia (uncoordinated movements)
• Origin – muscle spindles, golgitendon organs & joint receptors
• All terminate in the cerebellum at the same side
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Posterior Spinocerebellar TractFrom trunk and leg• 1st – DRG • 2nd –
• Cell body ‐ Clarke’s nucleus C8‐L2• Below L2 – ascend in the fasciculus gracilis until Clarke’s nucleus
• Axons – ascend in the same side• Inferior cerebellar peduncle
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The CuneocerebellarTract
From the arm & neck• 1st
• Cell body – DRG • Axon – ascend in the fasciculus cuneatus
• 2nd• Cell body – external (lateral or accessory) cuneate nucleus
• Axons – inferior cerebellar peduncle
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Anterior (Ventral) Spinocerebellar Tract
• 2nd• Cell body – around the border of the ventral horn
• axons – mostly cross the midline• Superior cerebellar peduncle• Then cross back through middle cerebellar peduncle
Rostral Spinocerebellar Tract• Same as ventral spinocerebellar tract except• From cranial region
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Other Ascending Tracts
• Spinoreticular tract (data affecting consciousness)• Mostly uncrossed • To reticular formation in medulla and pons
• Spinotectal tract• Crossed• To superior colliculus• Affect spinovisual reflexes
• Spinoolivary tract• Cross the midline• To the inferior olivary nuclei
• Then cross to the cerebellum• Inferior cerebellar peduncle
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Sensory Lesions
• In spinal cord• Anterior white commissure – loss of pain & temperature sensation bilaterally (ring of body)
• Hemisection – contralateral loss of pain and temperature & ipsilateral loss of discriminative touch
• In the medulla• Medial lesions – loss of discriminative touch for the contralateral body• Lateral lesions – loss of pain & temperature for contralateral body
• In the pons and above• All sensory modalities travel together• Small lesions – hemianasthesia for the contralateral half
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Sensory Lesions
• Pain & the thalamus• Ventral posterior thalamus
• Period (months) of analgesia followed by chronic pain (thalamic pain syndrome)
• Pain & the cortex• Somatosensory cortex
• Reduce ability to localize pain but does not eliminate the ability to feel pain
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Phantom Limb
• Results from loss of a limb• Patient feels that the limb is still present• Cortical representation stay intact for a period of time?
• Limb remain associated with the mental image
• Amputation could be followed by severe pain in the site of the limb• Due pressure on the nerve stumps