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ANATOMY
LUIS EMMANUEL O. ESGUERRA, MD || March 16, 2017
Content Outline: o Tracing the pathways for different general somatic
I. Objectives sensations from the face region
II. Review of Terms § Dorsal Trigeminothalamic Tract
III. Somatic Sensory (Ascending Pathways) § Ventral Trigeminothalamic Tract
IV. Modalities of Somatic Sensation o Tracing the pathway involved in the direct and
V. Somatic Sensory Receptors consensual corneal blink reflexes
a. Based on source of stimuli
b. Based on adequate stimuli REVIEW OF TERMS
VI. Peripheral Somatic Afferent Fibers
a. Fiber Specific Theories Functional Components of Peripheral Nerves
b. Classification of Peripheral Somatic • General vs. Special
Afferent Fibers o General – all spinal nerves and some cranial nerves
c. Dermatomal Map with similar function
VII. Ascending Fiber Tracts o Special – found only in some cranial nerves with
VIII. Thalamus special functions
IX. Primary Sensory Cortex • Somatic vs. Visceral
X. General Somatic Sensation of the Body o Somatic – innervates structures derived from
a. General Pattern somites
b. Spinothalamic Tract (Anterolateral System) o Visceral – innervates structures derived from GIT,
i. Lateral Spinothalmic Tract
brachial arches, smooth muscles, internal organs,
ii. Spinoreticular Tract
and glands.
iii. Spinotectal Tract
iv. Anterior (Ventral) Spinothalamic • Afferent vs. Efferent
Tract o Afferent – carries impulses from sensory organs
c. Dorsal Column (Medial Lemniscal System) towards the CNS
XI. Trigeminothalamic Tract (Face Region) (TTT) o Efferent – carries impulses from CNS towards
a. General Pattern effector organs
b. TTT for pain, temperature and light touch • Neuron – nerve cell body
c. TTT for tactile sensation and vibratory • Nucleus vs. Ganglion
sense o Nucleus – aggregated cell bodies in CNS
d. TTT for conscious proprioception o Ganglion – aggregated cell bodies in PNS
XII. Clinical Correlation: Corneal Blink Reflex
a. Direct Corneal Blink Reflex SOMATIC SENSORY (ASCENDING) PATHWAYS
b. Consensual Corneal Blink Reflex
XIII. Neuroanatomical Localization • Concerned with the conduction of afferent information
XIV. Quiz from body receptors to higher centers in the brain.
XV. References • & Some of the nerve fibers serve to link different
XVI. Appendix segments of the spinal cord, while others ascend from
the spinal cord to higher centers and thus connect the
th
LEGEND: spinal cord with the brain (Snell 7 ed.).
: U G & 2
Presentation Mentioned in Remember Book Other Sensory Receptors
the lecture Trans
Peripheral Somatic Afferent Fibers
OBJECTIVES (cranial and spinal nerves)
Given a case with somatosensory deficits, the student should Fiber tracts and their Nuclei of origin
localize the neurologic lesion by:
• Describing the components of the pathways for general Thalamus (relay center)
somatic sensation:
o Sensory receptors Primary Sensory Cortex
o Peripheral fiber tracts Table 1. General Pathway
o Ascending fiber tracts within the CNS
o Thalamus and Primary Sensory Cortex Modalities of Somatic Sensation
• Describing the pathways for general somatic sensation Pain
from the body • Noxious stimulation of the body surface
o Describe the general pattern • Transmitted by different fibers
o Trace the pathways: o First pain (&Fast-conducting pain)
§ Anterolateral (Spinothalamic Tract System) § Delta A-type fibers
§ Dorsal Column (Medial Lemniscal) System § Initial sharp, acute, or prickling pain
• Describing the pathways for unconscious proprioception § Called “fast” because it reaches consciousness
• Describing the pathways for general somatic sensation first to alert the individual of danger
from the face region o Second Pain (&Slow-conducting pain)
o Describing the general pattern § C-type fibers
§ Prolonged burning, aching, throbbing pain
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Dermatomal Map
• Used to localize lesions of the spinal cord
U For localization of the levels of sensory deficits
• Dermatome: area of the skin supplied by one dorsal root
• The dorsal root conveys to the spinal cord essentially all
sensations from receptors below the face
2 Fibers from PNS reach the CNS then attach to tracts
within the CNS reaching either systems:
o Spinothalamic/Anterolateral System
o Dorsal column/ medial meniscal system
• To remember the dermatomes easily, take note of
landmarks:
o T4: nipples
Figure 1. Classification of Peripheral Somatic Afferent Nerve o T7: xiphoid
Fibers. o T10: umbilicus
o L1: inguinal region
Muscle o L4: knees
• Somatic afferent fibers from muscle are the largest and o S2-S4: area surrounding the anal opening
myelinated – fast conductance U The back of the lower limbs are a bit irregular
• Used for proprioception of the limbs: body must react to
sensation coming from limbs to effect fine-tune
movement
• Make it possible to make real time adjustments on your
movement so you don’t even have to think about it.
Otherwise you will not be able to timely coordinate your
movements.
• Highly important for fine movement
• Types:
o Ia
§ Found in Annulospiral endings from muscular
spindles
§ Fastest velocity
U Largest diameter
§ More myelin = faster impulse generation
o Ib
§ Fibers that come from Golgi tendon organs
o II (A-beta)
§ Smaller, found in rom flower spray endings
muscular spindles
§ Slowest among the muscle group
Non-muscles
• From skin and deep tissues
• Types:
o A-alpha or A-beta (Ib & II) Figure 2. Dermatomal Map
§ Larger ones carrying 2 point discrimination,
vibration, conscious proprioception
§ Myelinated
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Receptors
• Meissner’s corpuscles
o U deep pressure
• Pacinian corpuscles
o Vibration sense
• Joint encapsulated receptors
o U position sense and vibration
• Golgi tendon organs
o U proprioception and muscle tone
• Neuromuscular spindles
o U muscle tone
Figure 9. Discriminative touch, vibratory sense, and N1: Dorsal Root Ganglion
conscious muscle joint sense pathways (Snell 2010). • Axons enter ipsilateral dorsal funiculus via medial
division of dorsal root
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U Medulla
• Resembles a t-shirt with tie (refer to Figure 9,
fourth illustration [Upper part of medulla
oblongata])
• Bottom part of “tie” (two bands) is the medial
lemniscus
o Crossed over already so that the right side
came from the left, and vice versa Figure 11. Somatotopic representation of DCP. (Haines 2012 -
• The “embroidery” is the inferior olivary nucleus Neuroanatomy: An Atlas of Structures, Sections, and Systems, 7th
• The “tucked-in parts” are the pyramids Edition)
U Cervical dorsal column: NuGr = nucleus gracilis, NuCu = nucleus
cuneatus, N = neck, A = arm, T = thorax, L = leg; leg is most medial,
N3: VPL of the thalamus neck is most lateral. Medulla (ML): Leg is more ventral than neck
rd and arms; lower limbs more ventral, upper limbs more dorsal. Pons:
• 3 order neurons terminate at the VPL nuclei of the there is a twist so that the leg is more lateral, the neck is more
thalamus medial.
• Leaves the thalamus and passes through the thalamic Postcentral gyrus
radiations in the posterior limb of the internal capsule • Brodmann Areas 3, 1, 2
• Axons form corona radiata to sensory cortex (BA. 3,1, 2)
In case of unilateral spinal cord transection, Light touch
U Medial lemniscus in the thalamus: sensation may never be completely lost because it may be
• No longer medial mediated also by the Dorsal Column System.
Ataxia
• Unsteady, awkward, and poorly coordinated movement
• U 2 Mostly cerebellar problems
• "Sensory" Ataxia
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TRIGEMINOTHALAMIC TRACT
• Face region
• Pattern is similar to DCP, with exceptions
General Pattern
• Receptors
• Neuron 1
o Equivalent to DRG – receptor does not synapse
with neuron 1, instead the receptor is an axon of
neuron 1 ganglia namely the following:
§ Gasserian ganglion [CN V] (U main)
§ Geniculate ganglion [CN VII]
§ Superior ganglia [CN IX and X]
§ Mesencephalic nucleus of CN V
(proprioception only)
• Neuron 2
o Sensory nuclei of CN V at brainstem
§ Fibers cross to form Ventral Trigeminothalamic
Figure 13. Somesthetic System of the Head.
Tract Nerve cells bodies for touch, pressure, pain, and temperature in the
§ Some fibers do not cross and form Dorsal head are in the trigeminal (semilunar) ganglion of the trigeminal (CN V)
Trigeminothalamic nerve (blue and red lines in figure). Neuronal cell bodies mediating
• Neuron 3 proprioception reside in the mesencephalic nucleus of CN V (purple
o Ventral posteromedial nucleus (VPM) of the fibers). Most relay neurons project to the contralateral VPM nucleus of
thalamus the thalamus and thence to the postcentral gyrus of the cerebral
cortex, where they are somatotopically represented (Netter et al.
o Also known as arcuate nucleus or semilunar
2002).
nucleus (in old books)
§ We shy away in using these terms because Tract for Pain, Temperature, and Light Touch
there are other nuclei that have the same name
• Equivalent of Anterior and Lateral Spinothalamic Tract
• Sensory Cortex
• Pattern:
o Postcentral gyrus (Brodmann areas 3,1,2)
o Receptors
§ U same types as in the body
Trigeminal Nuclear Complex
§ On facial areas (ophthalmic, maxillary, and
• Nuclei located in the area of the pons, midbrain, in the
mandibular divisions of CN V), ear canal
face, and all the way to your spinal cord sensation (CN VII, IX & X)
• Sensory nuclei § All have fibers for pain, temperature and light
o Main sensory touch
§ U rostral part o N1
§ in the area of pons § Gasserian (CN V), geniculate (CN VII), and
o Spinal superior ganglia (CN IX & CN X)
§ U caudal part - Fibers enter brainstem at appropriate level
§ U extends from pons to upper cervical spinal for each nerve
cord
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Figure 20. Anterior Spinothalamic Tract
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Figure 21. Spinotectal and Spinoreticular Tract
Figure 22. Spinocerebellar Tract
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Figure 24. Trigeminothalamic Tract
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