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General Somatic Afferents

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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General Somatic Afferents


§ It is less distinct, and is usually a residual of CLASSIFICATION OF SENSORY RECEPTORS
pain.
Based on Source of Stimuli
§ Produced when there is tissue destruction
Exteroceptive Receptors/Exteroceptors
Thermal
2 sense changes in temperature, cannot determine absolute • Senses stimuli from outside the body
value of temperature o Ex. Touch, visual cues, auditory signals
• Warmth – increase in temp. Interoceptive Receptors/Interoceptors
• Senses stimuli within the limits of the body like
• Cold – decrease in temp.
Position Sense (proprioception) visceral pain or joint receptors
o Ex. Stretch receptors, proprioception, pain inside
• For maintenance of posture, gait, and coordination
the gut, detecting changes in blood pressure
• Impulses resulting from mechanical changes in muscles
U Actually an Arbitrary classification
and joints
• Unconscious or conscious
Based on Adequate Stimuli (Energy nerve impulses)
o Conscious – reaches cerebral cortex
Mechanoreceptors
o Unconscious – reaches cerebellum (for
• Respond to mechanical deformation
coordination)
• Static limb position – knowing the position/placement Tactile – touch-pressure, vibration
of your limbs (flexed or extended joints) even without • Non-encapsulated – usually more superficial
visual cues. o Nerve Endings around hair follicles
• Kinesthesia (aka. Dynamic limb position) – “movement § Detects light touch by movement of hair
sense” or the awareness of actual movement of the follicles
body § Widely distributed
U Important for coordination of movement. § Afferent nerve fibers are alternating myelinated
U Allows fine coordination when the movement is and non-myelinated
concentrated § Most detect pain, others detect crude touch,
U Part of it is unconscious. pressure, and tickle sensations
U Testing Proprioception: o Merkel’s discs
o Keep eyes closed and raise right index finger. Use § Expanded tips on the epidermis; modified end
left index to approach tip of right index. of the free nerve endings
o In principle, one should know where his limbs are in § Found on hairless skin and hair follicles
space, so fingers will meet. § Slow-adapting
Touch Pressure § Transmits information about the degree of
• Occurs with mechanical stimulation of the body pressure on the skin
• Simple or crude or light touch (ex. Tickle) o Hair follicle receptor
• Tactile discrimination (discriminative touch) § Bending of hair stimulates the follicle receptor
o Deeper touch involving deeper pressure - While the hair is bent, the receptor is silent
o 2-point discrimination – ability to recognize 2 - Receptor is stimulated upon releasing the
distinct points when applied simultaneously even hair follicle
being near each other. § Fast adapting
o Higher cortical functions: • Encapsulated – usually underneath the dermis
§ Stereognosis – ability to identify objects by o Meissner’s Corpuscles
touch in the absence of vision (multiple inputs § Found in the dermal papillae, mostly on palms
like texture, size, form, etc.). of hands and soles of feet, as well as skin of
U ”Blindfolded, with an object placed on the nipples and external genitalia
palm and you will determine whether it is a § Very sensitive to touch
cube, sphere, or ball. You will identify the § Rapidly-adapting
object without seeing it from your hands” § Help in 2-point discrimination
§ Graphesthesia – ability to recognize o Pacinian Corpuscles
letters/numbers written on the surface of the § Abundant in skin, connective tissues
skin in the absence of vision. (A sequence of surrounding bones and joints
stimuli) § Sensitive to vibration
U “sequential stimulation of receptor fields § Rapidly-adapting
→ identification of the letter or the number o Ruffini’s Corpuscles
written” § Found in dermis of hairy skin
Vibration Sense § Slow-adapting
• Related to pressure and is usually connected to § Stretch receptors; respond when skin is
proprioception (they use the same pathway). stretched
• A series of alternating touch pressure o Krause’s end bulbs (22019A)
§ Cold receptors
• Stimulation of adjacent receptors
o Golgi-Manzoni (22019A)
• Similar to tactile discrimination because they make use
§ Found in subcutaneous tissues of fingertips
of the same receptors, but because of the alternating
§ Variant of pacinian corpuscle
stimulation and non-stimulation of adjacent receptors,
vibration is sensed

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Proprioception o Sensations associated with taste and smell
• Golgi tendon organs o Oxygen and Carbon Dioxide concentrations in the
o Located in tendons blood
o Important in detecting position and movement of
1. Pain/Nociceptors
joints
o Naked/free nerve endings react to chemicals (i.e.
o Responds to muscle stretch
Substance P)
• Neuromuscular Spindles
o These are released when there is trauma or
o Found in muscle fibers, mostly towards its
distortions
tendinous attachment
2. Taste
o Detects tension or tone in the muscles o Taste buds on the tongue (SVA)
o Provide information on static limb position (muscle
3. Olfaction
length, rate of change in its length)
o Olfactory epithelium in nasal cavity (SVA)
o Important in controlling muscle activity, fine-tuning
movements, and maintaining muscle tone.
o Types of Sensory Innervation of muscle spindles:
PERIPHERAL SOMATIC AFFERENT FIBERS
§ Annulospiral – found beside the nuclear bag Fiber Specific Theories
§ Flower Spray Endings – found on the nuclear • Doctrine of Specific Nerve Energies
chain o Different receptors and their fibers each detect a
• Encapsulated receptors particular quality of sensation
o Found in joints o Nature of perception is defined by the pathway over
o Helps detect position bye sensing how deep and which the sensory information is carried.
how tense the contraction is on joints § Difference in perception of seeing, hearing, and
o Pressure receptor for vibration of joints touch are not caused by differences in the
o Similar to Pacinian and Meissner’s corpuscles stimuli themselves but by the different nervous
(2019A). structures that these stimuli excite.
• Labeled Line Principle
Auditory o Separate neural channels carry this information
• Organ of Corti (cochlea) from the specific receptors to the place in the brain
o Detects movement of fluid within cochlea specific to the sensation.
o Senses vibration or displacement of hair cells in o With stimulation along the path not by that particular
response to different sound pitches. stimulation but a different factor (e.g. external
U Mechanoreceptor but is a Special Somatic Afferent pressure), the brain may still be made to think that
stimulus. there is that particular stimulation.
Thermoreceptors § “Pain sensation may still be felt even if there is
• Respond to temperature differences ~2 degrees Celsius really no pain stimuli”
(cold/hot). § Basis for the Phantom Limb Phenomenon:
• for Warmth : when there is an irritation or stimulation on the
o Not yet identified, probably naked endings of small stump of an amputee, he feels an itch on his
unmyelinated nerve fibers foot that is actually no longer there.
o Slower sensation compared to cold, hence
designating them as unmyelinated Classification of Peripheral Somatic Afferent Fibers
• for Cold : • Based on conduction velocity and size/diameter of fiber
o Naked endings of myelinated nerve fibers • What makes them faster and larger are their level of
branching into skin myelination
• Greater myelination (more layers of myelin surround the
Notes: fiber) = larger diameter and conduction velocity is faster
1. Naked = no modifications • The fastest ones are those with lower numbers or
2. Thermoreceptors do NOT detect absolute temperature letters
levels, but changes in temp. • Two classification of peripheral nerve fibers:
3. Transduction – a process in which a stimulus for which G Roman numerals – carry sensory (afferent) fibers;
a receptor is specialized is transformed by the receptor to classify fiber diameter
membrane (and/or intracellular organelles) into a G Letters – carry motor (efferent) fibers; to classify
generator potential (receptor potential) speed of impulse propagation
4. Sensory receptors act as transducers transforming a § Depending on speed of impulse
physical stimulus into a nerve impulse. propagation/myelination: A, β, δ

Photoreceptors
• Detects electromagnetic radiation, sensitive to light
intensity and wavelengths
• Ex. Rods and Cones of the retina (light receptors)
Chemoreceptors
• Respond to specific chemical changes

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Notes: § A-alpha is faster than A-beta
G Fibers can be classified according to DIAMETER OF o A-delta (III)
FIBER and VELOCITY OF IMPULSE § Responsible for first fast pain, cold
temperature, light touch
• The greater the diameter of the fiber or the larger
§ Not as myelinated as A-alpha and A-beta
is the fiber, the faster will be the conduction of
o C (IV)
impulses
§ Responsible for second slow pain and warm
• Velocity of impulse is dictated by the myelination of
sensation
the fiber: myelinated – fast conductance across
§ Nerve endings that have fibers that are small,
the fiber; unmyelinated – slow conductance
unmyelinated: SLOWEST
across the fiber.
§ Warmth is thought to be in this category
G Fibers are grouped according to the organs they
because of the slower conduction velocity of
innervate (muscle or non-muscle)
the sensation to reach the CNS
§ Slower than receptors that carry cold
temperature

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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ASCENDING FIBER TRACTS
• The fibers reach CNS from periphery, and attach to
particular fiber tracts/systems within CNS, attach to one
of two ascending fiber tracts:
Spinothalamic (Anterolateral) System
• Pain
• Thermal sense
• Crude touch
• Light touch

Dorsal Column (Medial Lemiscal) System


• Conscious proprioception
• Vibration sense
• Pressure – deep touch
• Tactile discrimination

U from the spinal cord, they go up to reach the rlay center,


which is the thalamus. From the thalamus, it will then send its Figure 3. Divisions of Thalamus
fibers to the cortex.
DIVISIONS OF THE THALAMUS
THALAMUS • Thalamus: divided by the internal medullary lamina
& a large, egg-shaped mass of gray matter that forms the • Internal medullary lamina (connective tissue)
dorsal and major part of the diencephalon. There are two o Separates the medial and lateral nuclear masses
thalami, and one is situated on each side of the third ventricle o Bifurcates anteriorly to encompass the anterior
& Constitute <2% of the neuroaxis nuclear group
FUNCTIONS
• Relay center to reach the cerebral cortex • Intralaminar Group
• Modifies and integrates afferent impulses o Centromedian: between medial and lateral group
• Recognize pain and burning sensation o G Intralaminar nuclei: enclosed within the
• Adds emotional tone to perception internal medullary lamina
• Anterior Nuclear Group
• Regulates cortical activity by increasing excitability
• Medial Nuclear Group
• Facilitates motor activity of cerebral cortex.
o Median
o Medial
G Has different nuclear groups, therefore it is really mostly
o Medial dorsal (MD) or dorsomedial (DM)
gray matter
2 It is organized because of the division by the internal • Lateral Nuclear Group
medullary lamina o Lateral (dorsal) nuclear masses
& separates the medial and lateral nuclear masses § Lateral dorsal (LD)
& bifurcates anteriorly to encompass the anterior § Lateral posterior (LP)
nuclear group § Pulvinar
o Ventral Nuclear Masses
MAJOR PARTS § Ventral Anterior (VA)
• Epithalamus § Ventral Lateral (VL)
o which consists of habenular nuclei and their § Ventral Posterior (ventrobasal complex)
connections and the pineal gland - Ventral Posterolateral (VPL): relay
afferents from the BODY
• Thalamus
- Ventral Posteromedial (VPM): relays the
o dorsal thalamus
afferents from the FACE

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Figure 4. Schematic Section of the Thalamus

U From the thalamus, they send the axons towards the


Figure 5. The sensory homunculus: the body representation on
primary sensory cortex in the postcentral gyrus in the parietal the primary sensory cortex
lobe.

PRIMARY SENSORY CENTER GENERAL SOMATIC SENSATION OF THE BODY


• Located in the post-central gyrus General Somatic Sensation of the body
• Also known as the Brodmann areas 3,1, 2 General Pattern (Excluding Face Region)
• Represents the Somesthetic center or the • Receptors
Somatosensory area I (SI) o No synapse in the receptor
• Receive projection of fibers from the VPL and VPM of o The receptor is part of the nerve/axon
the thalamus • Neuron 1 [N1]: Dorsal Root Ganglion – No synapse
• Can be traced medially as it goes inside to the medial occurs
side of the cerebral hemisphere o Always DRG
FUNCTIONS o From the receptor in whatever part of the body, the
• Interprets the quality of sensory information at the level nerve fibers finds its way to the pseudounipolar
of consciousness neuron in the dorsal root ganglion
• Inferior part of post-central gyrus: tongue, pharyngeal o Pseudounipolar neuron has another axon that
and jaw regions synapses with N2
• Somesthetic area II: for face • Neuron 2 [N2]: (Axon Decussation)
• Receive projection fibers from the VPL and VPM of the o Dorsal horn of spinal cord (Anterolateral system)
thalamus o Nucleus gracilis or nucleus cuneatus of medulla
(Dorsal column system)
SENSORY HOMONCULUS o Decussation – crossing of the nerve fiber
• the representation of the input that arises from the body o Axon of N2 is the one decussates (Approximately 1-
onto the cortex. Each part of the body is mapped to a 2 segments above)
particular area. • Neuron 3 [N3]: VPL of the thalamus of the opposite
side
U At each part of the cortex, there is an area that is o Neuron 3 is always VPL
designated for a particular part of the body where the o VPL has connections to the postcentral gyrus (i.e.
sensation is coming from. BA 3,1,2) through the corona radiata specifically the
• Face – lateral surface close to Sylvian Fissure (larger fibers that go through the posterior limb of the
representation for lips due to many fiber sensations) internal capsule
• Hand and arm– midway at the dorso-lateral surface of o Contralateral side of the N2
cerebral hemisphere (larger representation for fingers) • Sensory cortex: Post central gyrus (Brodmann area 3,
• Trunk and hip – area of the vertex/ top of the head 1, 2)
• Extremities – medial surfaces
• Genitalia– deeper into the medial surfaces
• Tongue, pharynx, larynx – near the lips of the Sylvian
Fissure; Somatosensory Area 2

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Lateral Spinothalamic Tract
G The system is crossed. Sensory information from one • Subserves pain and thermal sensation
side of the body projects to the opposite thalamus and
• Pathway for “fast” sharp pain
cortex. E.g if it is a right foot sensation, it is the left cortex
o In clinics, a pin prick is used to elicit pain (to not
that gets the sensation.
puncture)
• N1 in Dorsal Root Ganglion (DRG) • Pathway:
o No synapse means that the receptor is o Receptor : Free Nerve Endings (Chemoreceptor
part of the nerve fiber. The receptor is based on adequate Stimuli)
the end of one of the axons for § Chemoreceptor – Pain
pseudounipolar neuron § Thermoreceptor –warm/cold
o N1: Dorsal Root Ganglion
• N2 in dorsal horn or homologous nuclei
§ Axons from DRG will enter the spinal cord via
o Decussation – crosses the midline to
the lateral division of the dorsal root
opposite side to reach N3
§ Close to Lissauer’s tract, when the fibers come
o N1 and N2: same side of the body
in, they will go up or down 1 to 2 spinal cord
• N3 in thalamus (VPL)
levels before they go in to connect with Neuron
o Opposite side
2
- U Overlapping of dermatome (Can go
Spinothalamic (Anterolateral System) from C6 to T1)
• Lateral Spinothalamic Tract o N2: Dorsal horn cells of spinal cord
o Carries pain and thermal sensation § They go first to the substantia gelatinosa then
• Anterior (ventral) Spinothalamic Tract connect to the tract cells
o For light touch, itch, tickle, sexual sensation § Decussation via the ventral/white commisure
then ascend to the lateral funiculus
• Spinotectal Tract
§ Fibers that come from the lower cord(Sacrum)
• Spino reticular Tract
are located DORSOLATERALLY
o special tract, doesn’t reach the thalamus but
§ Fibers that come from the upper levels (arm,
terminates by synapsing with the reticular
upper limbs) are located VENTROMEDIALLY
formation.
§ This tract will continue as the spinal lemniscus
Other structures that are of importance
once it reaches the brain stem
• Posterior columns/funiculus o N3: VPL of the thalamus
o Fasciculus gracilis(medial) § Will send the thalamic radiations, first passing
o Fasciculus cuneatus (Lateral) by the posterior limb of the internal capsule,
§ There is no fasciculus cuneatus in the lower six then forming the corona radiate which will
(6) thoracic and lumbas segments, it is only synapses with the sensory cortex
one big fasciculus gracilis on either sides of the o Sensory Cortex: Post-Central Gyrus (Brodmann
midline. areas 3,1,2)
• Anterior funiculus
• Lateral funiculus
• Ventral White Commisure
o Area of white matter below the area of the central
canal where there is crossing of fibers from left to
the right and right to the left
• Lissauer’s tract/posterolateral fasciculus
• Lamina II of the Rexed Laminae

Figure 7. Lateral Spinothalamic Tract.

Figure 6. Cross sectional view of spinal cord.

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Spinoreticular Tract Anterior (Ventral) Spinothalamic Tract
• Recall the definition of Tract: bundle of nerve fibers that • Subserves light (crude) touch, itch, tickle, sexual
have a common origin and termination sensation
o Origin – Spinal Cord (posterior root ganglion) • Some authors do not differentiate from lateral
o Termination – Second part of the brainstem spinothalamic tract and group them all together as
• For general alertness and arousal in response to painful anterolateral system.
stimuli • At lower medulla, the level of the inferior olive, they fuse
• Follows the same pathway as the lateral spinothalamic into one tract, the spinal lemiscus.
tract but, instead of going to the thalamus, they go to the • Pathway :
reticular formation which is found in the brain stem o Receptors : hair follicle nerve endings, Merkel’s
extending from the pons to the medulla. disc (receptors in the epidermis) and Meissner’s
• These fibers will go to the ascending reticular Corpuscle (receptor in the dermal papilla)
activating system (ARAS) in the reticular formation o N1: Dorsal Root Ganglion
which is responsible for the control of consciousness § Axons enter spinal cord via lateral division of
• U Classmate pinches you while asleep, you wake up dorsal root
and be alert. Your body will make us of this tract. § Enter at zone of Lissauer with fibers running 1
• 2 This tract also mediates the dull aching pain that is a to 2 segments up or down to go to N2.
residual pain from the pain initially felt, some fibers from o N2: Dorsal horn cells
ARAS go to the intralaminar thalamic nuclei then § Rexed Lamina I-V
thalamus adds some emotional tone, resulting to dull § Axons cross to contralateral side in ventral
aching pain. commissure (some do not) & ascend along the
Spinotectal Tract anterior funiculus
• Similar to spinoreticular § Instead of crossing, some will go to the anterior
• From the spinal cord (posterior root ganglion) funiculus on the same side.
• Goes to the tectum or roof of the midbrain, and the area § Fibers from lower cord located dorsolaterally,
of the superior (rostral) colliculus related for eye higher levels ventromedially
movement and head orientation/neck movement § Join LST at medulla as spinal leminscus
§ If you have an extramedullary tumor
• For orientation towards potentially harmful painful stimuli
compressing the cord from lateral to medial,
• U Classmate pinch you while sleeping, you wake up
the lower fibers will be affected first, patients
and look towards the source
presenting this symptom will show loss of
o Reflex to protect from harmful stimuli
sensation in the lower limbs of the opposite
Pain theories
side.
• Intrinsic Pain Supression Mechanism
o N3: VPL of the thalamus
o Neurons in substantia gelatinosa secrete
§ Thalamic radiations in the posterior limb of the
substance P for pain sensation (Augment pain in
internal capsule
dorsal horn)
- Axons from corona radiata to sensory
o Brain secretes morphine-like substances
cortex
(enkepahlins, endorphins) to act on opiate o Sensory Cortex: Post central gyrus (Brodmann
receptors in Lamina II (substantia gelatinosa) so areas 3,1,2)
they don’t respond that much to substance P.
• Gate Control Theory of Pain
o Stimulation of myelinated fibers with rubbing of G In case of unilateral spinal cord transaction, light
pain-stimulated area suppresses fine pain fibers. touch sensation may never be completely lost because it
o Pain is mediated by U fibers. has bilateral representation by the anterior spinothalamic
§ You stimulate a fiber that is faster than A-delta tract. Some fibers have not crossed yet, you can still feel
(A-alpha, A-beta) that go to the same area in sensation from the same side (Main Distinction).
the dorsal horn and because of the sensation
in from the dorsal horn, the brain will perceive
that sensation more, suppressing the fine pain Localization exercise
fibers. RECEPTOR Mechanoreceptor (Meissner’s
- E.g. little shobe gets a bruise, mama corpuscle/Merkel’s discs)
kisses/rubs the knee, pain goes down (A- LATERALITY LOCATION
beta suppresses A-delta) st
1 order neuron L DRG
Localization Exercise (N1)
RECEPTOR Chemoreceptor nd
2 order neuron L Dorsal Horn
(Free Nerve Endings) (N2)
LATERALITY LOCATION rd
st
3 order neuron R VPL of thalamus
1 order neuron (N1) R DRG (N3)
nd
2 order neuron (N2) R Dorsal Horn Functional Cortical R Post Central
rd
3 order neuron (N3) L VPL of thalamus Area Gyrus [BA 3, 1, 2]
Functional Cortical L Post Central Table 3. Scenario: Tickle to left big toe
Area Gyrus
Table 2. Scenario: Pinprick to right thumb

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Dorsal Column Pathway
• Also known as Medial Lemniscal System
• For conscious proprioception, vibration, deep
pressure, deep touch, and tactile discrimination
• Proprioception includes joint position sense, kinesthetic
sense, and vibratory sense

Figure 8. Medial Lemniscus System



Figure 10. Somesthetic System of the Body.
Pain, temperature, and pressure sensations below the head ultimately
are conveyed to the primary somatosensory cortex (post-central gyrus)
by the anterolateral system (spinothalamic and spinoreticular tracts).
The fasciculus gracilis and cuneatus of the spinal lemniscal system
convey proprioceptive, vibratory, and tactile sensations to the thalamus
(ventral posterolateral nucleus), whereas the lateral cervical system
mediates some touch, vibratory, and proprioceptive sensations (blue
and purple lines show these dual pathways). Ultimately, these fibers
ascend as parallel pathways to the thalamus, synapse, and ascend to
the cortex (Netter et al. 2002).

U Tests for DCP:


1. Two-point discrimination test for tactile
discrimination
• uses a caliper or paper clip (tips)
2. Tuning fork against bony prominences (e.g., elbow,
knee, ankle, finger, jaw) for vibration sense

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 Still on the same side of the site of stimulus and the
spinal cord
• Fasciculus gracilis
o Fibers from sacral, lumbar, and lower 6 thoracic
o U More medial than fasciculus cuneatus
• Fasciculus cuneatus
o Fibers from UPPER 6 thoracic and ALL cervical
o U More lateral than fasciculus gracilis, pushing the
fibers of fasciculus gracilis inside

U Posterior Intermediate Sulcus


• Separates the fasciculus gracilis from fasciculus
cuneatus
U Posterolateral Sulcus
• Sulcus where dorsal root comes in

N2: Nucleus gracilis and nucleus cuneatus in medulla


• Fibers of the fasciculus gracilis and cuneatus ascend
ipsilaterally
• Terminates in the respective nucleus gracilis and
cuneatus
nd
• Axons of the 2 order neurons are called the internal
arcuate fibers
o Crosses over at the decussation of the medial
lemniscus thus forms the medial lemniscus in the
contralateral side.

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.

U Complete transection of the spinal cord


• The only possible cause of complete loss of
sensation on both sides (aside from anesthesia).

Ataxia
• Unsteady, awkward, and poorly coordinated movement
• U 2 Mostly cerebellar problems
• "Sensory" Ataxia

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o E.g. unsteady gait due to a lesion in the Dorsal General Pattern of Pathways for Unconscious Proprioception
Column Pathway (you cannot sense the position of ASCT* PSCT RSCT CCT
limbs or joints) 1. Receptor: Neuromuscular spindle, Golgi tendon, touch endings
o Can be elicited thru Romberg Sign 2. N1: Dorsal root ganglion (via fasciculus
• Romberg Sign cuneatus [C1-T5])
o With eyes closed, patient sways or falls to one side 3. N2:
when asked to stand with feet placed close together Spinal Cord Medulla
o U Do not know that the input is missing Dorsal Nucleus Nucleus Accessory cuneate
o U Fall on the side where the problem is horn dorsalis of centrobasalis nucleus
o Used to detect dorsal column ataxia Clark L-VI (dorsal • U lateral to
L-VII (medial horn at nucleus cuneatus
Localization Exercise intermediate cervical • U do not make
RECEPTOR Joint encapsulated receptors horn) [T1-L2] enlargement) a bump
LATERALITY LOCATION Lateral funiculus Ext. arcuate fibers
1st order neuron R Dorsal root 4. Cerebellum and Vermis
(N1) ganglion Table 6. General Pattern of Pathways for Unconscious
2nd order neuron R Nucleus gracilis Proprioception.
(N2)
3rd order neuron L Ventral * with crossed fibers (caudal midbrain – superior cerebellar
(N3) posterolateral peduncle)
nucleus Note: Two-neuron linkage (U third neuron is the thalamus,
Functional L Postcentral gyrus but will not reach thalamus and goes to the cerebellum)2
cortical area (BA 3, 1, 2)
Table 4. Scenaio: Vibrating tuning fork to right knee. • 2 “Unconscious” because it goes directly to the
cerebellum
Pathways for Unconscious Proprioception • 2 DSCT, CCT, and RSCT pathways’ ascending fibers
Lower Limbs Upper Limbs → enter the cerebellum through the inferior cerebellar
General Anterior/ventral Rostral peduncle
aspects of spinocerebellar [ASCT] spinocerebellar nd
• ASCT and PSCT have 2 order neurons in the spinal
movement • 2 most peripheral [RSCT] cord collectively known as the nucleus dorsalis (clarke’s
tract in the ventral • 2 double column)
margin of the lateral crossed pathway • 2 ASCT ascending fibers → continue through the
funiculus • 2 mediates pons and ascend to the cerebellum through the superior
• 2 believed to information chiefly cerebellar peduncle
transmit information from Golgi tendon • 2 SCT, DSCT, and CCT consist of two-neuron
from skin and organs and from linkages
superficial fascia to pressure and pain • 2 All four tracts project especially heavily to the
cerebellum receptors anterior lobe but also to the caudal part of the posterior
Fine Posterior/dorsal Cuneocerebellar lobe and are concerned with processes that govern
coordination spinocerebellar [PSCT] [CCT] or Posterior standing and walking.
of individual • 2 receive muscle External/Dorsal • 2 There is no decussation except for ASCT
muscles joint information Arcuate Fibers o 2 There is a double crossing for ASCT: at the
concerning tension of (22019A) nd
level of 2 order neuron of the spinal cord and
muscle tendons • 2 mediates inside the cerebellum
• 2 begins at the L2 information chiefly • 2 The manifestation of unconscious proprioception is
segment of the spinal from muscle represented on the same side of the cerebellum
cord - information spindles, because there is no crossing (or double crossing) unlike
used by cerebellum cutaneous touch in conscious proprioception
for maintenance of receptors, and • 2 e.g. problem in cerebellar cortex on the right will
posture and joint receptors manifest imbalance on the right side as well
coordination of lower
limb movement
• U 2 e.g., foot
painting, ballet
dancing (control of
toes)

Table 5. Pathways for Unconscious Proprioception.

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§ U Lateral aspect of brain stem
§ U extends all the way down to lamina I and II
o Mesencephalic
§ U in midbrain, beside periaqueductal gray
§ U a little bit extending to the pons
• Motor nucleus of CN V
o U Controls muscles of mastication (masseter,
temporalis, pterygoids)

Figure 12. Funiculus cuneatus (FC), Nucleus Dorsalis (ND) of


Clark, and Rexed Lamina VI (VI)

G Endpoint of Unconscious Propioception: CEREBELLAR


Cortex
G Endpoint of Conscious Propioception: CEREBRAL Cortex

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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- Descend and enter ipsilateral spinal tract of Notes:
CN V For unconscious proprioception, N2 fibers pass into
- U 2 On facial area: ophthalmic, maxillary, cerebellum
and mandibular divisions (CN V; main); ear
canal sensation (CN VII, IX, and X)
o N2 Localization Exercise
§ Spinal nucleus of V Receptor Free nerve endings for cold
- Fibers cross to form Ventral Laterality Location
Trigeminothalamic Tract First order Left Gasserian
- Some fibers do not cross and forms the neuron (N1) ganglion
dorsal trigeminothalamic tract (V1)
o N3 Second order Left Spinal nucleus of
§ VPM of the thalamus neuron (N2) CN V
- Fibers then enter posterior limb of internal Third order Right Ventral
capsule towards the sensory cortex neuron (N3) posteromedial
o Sensory Cortex
nucleus
§ Postcentral gyrus
Functional Right Postcentral gyrus
- “Face area” of Brodmann Areas 3, 1, 2
cortical area (BA 3, 1, 2) face
Tract for Tactile Sensation and Vibratory Sense
region
• Pattern: Table 7. Scenario: Ice pack to the left forehead.
o Receptors
§ Same as in the body CORNEAL BLINK REFLEX
§ 2 Pressure receptors, encapsulated
receptors of skin • Sensory fibers that enter the upper part of the spinal
o N1 tract of CN V with the spinal nucleus of CN V. They will
§ Gasserian (V), geniculate (VII), and superior then project to CN VII nucleus of both sides.
ganglia (IX & X) • CN VII innervates the orbicularis oculi muscle, which
o N2 closes the eye
§ Main sensory nerve of V and rostral part of • Reflex tests that allow you to determine if there is a
spinal nerve of V deficit or an absent blink, and will help you determine if
§ Most fibers cross to form ventral afferent or efferent part is affected.
trigeminothalamic tract (TTT)
§ Some do not cross and form Dorsal TTT Direct Corneal Blink Reflex
o N3
§ VPM of the thalamus
- Fibers enter posterior limb of internal
capsule
o Sensory Cortex
§ Postcentral gyrus
- “Face area” of Brodmann Areas 3, 1, 2
Tract for Conscious Proprioception
• Pattern:
o Receptors
§ Same for proprioception on the body
- 2 Encapsulated receptors,
neuromuscular spindles and Golgi tendon
organs
- 2 E.g. Opened jaw, determining the
position of you jaws as you chew
o N1 Figure 14. Direct Corneal Blink Reflex
§ Mesencephalic nucleus of V
o N2 • Stimulus: light touch on Right cornea
§ Main sensory nerve of V or reticular formation • Receptors: free nerve endings (pain)
- fibers ascend ipsilateral brainstem in dorsal • Afferent (sensory) arm: CN V (ophthalmic division)
TTT • N1: Gasserian Ganglion
o N3 • N2: Spinal nucleus of CN V through Spinal Tract
§ VPM of the thalamus • Efferent (motor) arm: Motor Nucleus of CN VII
o Sensory Cortex • Effect: Ipsilateral eye will close/blink (orbicularis oculi
§ Postcentral gyrus muscle closing)
- “Face area” of Brodmann Areas 3, 1, 2

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Notes:
1. Does not go to thalamus anymore, since it is a
reflex.
2. “Direct” – Blinking occurs on the SAME EYE that
was stimulated
3. The afferent arm is the CN V and the efferent arm
is the CN VII

Consensual Corneal Blink Reflex

Figure 16. Neuroanatomical Localization

Figure 15. Consensual Corneal Blink Reflex

• Stimulus: light touch on Right cornea


• Receptors: free nerve endings (pain)
• Afferent (sensory) arm: CN V1
• N1: Gasserian Ganglion
• N2: Spinal nucleus of CN V through Spinal Tract
o Then goes via Medial Longitudinal Fasciculus to
stimulate the motor nucleus of the Left (opposite
side) Facial Nerve.
§ MLF – many pathways enter and exit through
it.
• Efferent (motor) arm: LEFT Motor Nucleus of CN VII Figure 17. Neuroanatomical Localization
• Effect: simultaneous blinking of BOTH eyes
• Where is the Lesion?
o Neuroanatomical Localization:
§ Ventroposterolateral (VPL) and
NEUROANATOMICAL LOCALIZATION Ventroposteromedial (VPM) nuclei of the
CASE: thalamus.
• V.J. is a 61 year old woman with numbness in her right § This is the common location of all tracts
face, arm and leg combined
o 2 days prior to consult (PTC), the patient awoke in o Side: Left
the morning with decreased sensation in her right o Sensory deficit is a classic symptom of a thalamic
face and arms “as if they haven’t woken up yet.” lesion.
She had no difficulties in speech, gross
movements, or vision. QUIZ
o Her symptoms persisted until the next morning From 2018 B Transcription
when she also noted numbness over her right foot. 1. Which pathway is for unconscious proprioception
She came to the clinic because of her concern. (fine) of the upper limbs?
• Neurologic examination revealed: a. Anterior Spinocerebellar
o Decreased pin prick, temperature and light touch b. Posterior Spinocerebellar
sensation ver the right face, especially around the c. Rostral Spinocerebellar
mouth. d. Cuneocerebellar
o Intact direct and consensual corneal reflex with 2. Where does the anterolateral spinothalamic system
cotton wisp on both corneas decussate?
o Decreased light touch, temperature and vibration a. Medulla
sense on R body especially on right hand and foot. b. Spinal Cord
o 2-point discrimination 15mm on tip of R index finger c. Cerebellum
vs 4mm on tip of L index finger d. Midbrain

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3. In terms of somatotopy, you would expect to see on both eyes. However, when he stimulated the left
afferent fibers from th Dorsal Medial Lemniscal cornea, he saw that the patient’s left eye blinked as
Pathway of the legs in what orientation to arm fibers? well as the right eye. Worried that he probably didn’t
a. More medial touch the cornea enough, he then repeated the
b. More lateral procedure on patient’s right eye. No blink was noted
c. Ipsilatral on both eyes. Feeling confident now of his neuro
d. Nearly the same at neuron 2 exam, the JI concluded that the patient’s medial
4. Which branch if the Trigeminal Nerve is associated longitudinal fasciculus in not intact. Is the JI’s
with the first neuron of the corneal blink reflex? conclusion correct?
a. V1 6. Localization Exercise: Q.I. was brought to the ER
b. V2 confused, disoriented, and cursing after being shot at
c. V3 the back after a drunken argument with a drug dealer
d. DRG about who is a better superhero. You observed he lost
5. Which of the following os a function of the thalamus? pain and thermal sensations on his R side & two-point
a. Relay center to reach the cerebral cortex discrimination in his L foot from dermatomal level T4
b. Modifies and integrates afferent impulses and down. He was also observed to thrash around
c. Recognize pain and burning sensation with both his arms and R leg but the L seems to be
d. Adds emotional tone to perception flaccid at best. Through your awesome clinical
e. All of the above reasoning and knowledge of neuroanatomy, you
ANSWER KEY: DBAAE conclude that he has:
a. L unilateral cord lesion at around T2-T3
From 2019 A Transcription b. R unilateral cord lesion at around T2-T3
1. Choose the correct receptor:classification pair. c. L unilateral cord lesion at around T4-T5
a. Krause end bulb: thermoreceptor d. R unilateral cord lesion at around T4-T5
b. Organ of Corti: mechanoreceptor e. I don’t care. I will not treat him to further
c. Merkel’s disc: encapsulated; photoreceptor emphasize how wrong his delusions of
d. Ruffini’s Corpuscle: chemoreceptor grandeur are. It’s for the best of everyone
e. Meissner’s Corpuscle: non-encapsulated; concerned.
nociceptor Answer Key:
2. The following statements relate sensations with 1. B. Organ of Corti - Mechanoreceptor
appropriate nervous pathways. Which of the following Krause end bulb – mechanoreceptor
is correct? Merkel’s disc –non encapsulated; mechanoreceptor
a. Two-point tactile discrimination travels in the Ruffini’s corpuscle – mechanoreceptor
lateral spinothalamic tract. Meissner’s corpuscle – encapsulated;
b. Pain travels in the anterior spinothalamic mechanoreceptor
tract. 2. C. Unconscious muscle joint sense travels in the
c. Unconscious muscle joint sense travels in anterior spinocerebellar tract. Two-point
the anterior spinocerebellar tract. discrimination travels in the fasciculus cuneatus.
d. Pressure travels in the posterior Pain travels in the lateral spinothalamic tract.
spinothalamic tract. Pressure travels in the anterior spinothalamic tract.
e. Vibration travels in the posterior Vibration travels in the fasciculus gracilis.
spinocerebellar tract. 3. False. Destruction of the Lateral Spinothalamic tract
3. True or False. Destruction of the Lateral produces contralateral loss of pain and thermal
Spinothalamic tract produces ipsilateral loss of pain sensibilities below the level of the lesion. Therefore,
and thermal sensibilities above the level of the lesion. patient will not respond to pinprick or recognize hot or
4. Which of the following statements correctly concern cold objects placed in contact with the skin.
the gating theory of pain? 4. B. Massage applied to skin over a painful joint
a. Stimulation of small non-pain-conducting may reduce pain sensitivity. Stimulation of large
fibers in a peripheral nerve may reduce pain non-pain-conducting fibers in a peripheral nerve may
sensitivity. reduce pain. Stimulation of delta A- and C-type fibers
b. Massage applied to the skin over a painful in a posterior root of a spinal nerve and degeneration
joint may reduce pain sensitivity. of large non-pain-conducting fibers in a peripheral
c. Stimulation of delta-A and C-type fibers in a nerve increase pain sensitivity. Inhibition of pain
posterior root of a spinal nerve may conduction in the spinal cord could be brought
decrease pain sensitivity. about by means of connector neurons.
d. Degeneration of large non-pain conducting 5. No. JI’s conclusion is incorrect. Problem might be
fibers in a peripheral nerve decreases pain on the afferent part (right; might be the ophthalmic
sensitivity. division or the spinal nucleus).Patient’s medial
e. Inhibition of pain conduction in the spinal longitudinal fasciculus is still intact as evidenced by
cord does not involve connector neurons. the blinking of the right eye as the left eye was
5. Yes or No. A junior intern performed neurologic stimulated.
examination on a patient. He tried eliciting the blink 6. A. L unilateral cord lesion at around the area of
reflex using a cotton wisp for each eye. When he T2-T3 Based from the sxs, the lesion can be localized
stimulated the right cornea, no response was noted at the level of T3 given that pain and temperature

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sensation, carried by the LST, was lost from T4 and From 2018 ANUNA
below. Remember that these fibers would decussate 1. Choose the correct receptor:classification pair.
1-2 levels above. Furthermore, two-point a. Krause end bulb : thermoreceptor
discrimination at the left sides was also lost signifying b. Merkel’s disc: encapsulated capsule
that the L dorsal column (w/c decussates at the c. Organ of Corti : mechanoreceptor
medulla) was affected as well. Motor signs also help 2. An MRI on a hit and run victim who sustained a spinal
as the lateral corticospinal tract, as we’ll soon learn, cord injury due to showed LEFT hemisection of the
decussates at the medulla before it reaches the spinal spinal cord at C2-3 vertebral level. His neurologic
cord. The fact that his L leg cannot move further point exam will most likely show loss of which of the
out the likelihood that the lesion was to the left. following sensations?
a. 2-point discrimination of the left foot
From 2017 ANUNA b. Joint position sense on right knee
1. Which of the following is an unencapsulated fiber? c. Thermal sensation on left hand
a. Krauss Bulb d. Vibratory sense on right elbow
b. Meissner’s Fiber 3. What tract ascends with the spinotectal tract?
c. Pacinian Corpuscle a. Anterior spinothalamic
d. Merkel’s Fiber b. Dorsal Column
2. Which of the following stimulus is transmitted by the c. Latral spinothalmic
fiber with largest diameter? d. Posterior spinocerebellar
a. Cold 4. What kind of receptor: Flower-spray ending
b. Muscle tone a. Ia
c. 2-point discrimination b. II
d. Warmth c. C
3. The big toe somatopically represented on which area d. A-alpha
of the sensory cortex? 5. Unconscious proprioception of general movement of
a. Superior edge of the interhemispheric fissure the lower limb
b. Deep medial surface of cerebral hemisphere a. CCT
c. Lip of Sylvian fissure b. ASCT
d. Midway in the dorsolateral cerebral c. DSCT
hemisphere d. RSCT
4. What white matter structure carries fibers from Answer Key: CCCBB
thalamic nuclei that carries pain sensation
a. Dorsal Column REFERENCES:
b. Internal Capsule
1. Esguerra, LE. (2017). General Somatic Afferents.
c. Spinal Lemniscus
Anatomy. Lecture conducted at the UERM Memorial
d. Zone of Lissauer
Medical Center, College of Medicine, Quezon City,
Philippines
5. Guitarist needing fine motor coordination. What tract?
2. Snell, RS. (2010). Clinical Neuroanatomy. 7th edition.
a. Anterior Cerebellar
Lippincott Williams and Wilkins. Philadelphia.
b. Posterior Cerebellar
3. Netter FH, Craig JA, Perkins J, Hansen JT, Koeppen
c. Cuneocerebellar
BM. 2002. Atlas of Neuroanatomy and
d. Rostral Cerebellar
Neurophysiology: Selections from the Netter
6. Which of the following exhibits a lower motor neuron
Collection of Medical Illustrations, Special Edition.
lesion
USA: Icon Custom Communications.
a. Decreased muscle tone of the triceps
4. Lansang Notes
b. Dorsiflexion of the big toe upon stroking the
5. 2018B Transcription
sole of the foot
6. 2019 A and C Transcription
c. Beating of the foot upon sudden dorsiflexion
d. Weakening of the right half of the body
“Pain is temporary but Med is forever… Forever
Answer Key: DBCBCA mahirap L ”

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APPENDIX:

Figure 18. Summary of different receptors

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Figure 19. Lateral Spinothalamic Tract

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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 23. Dorsal Column Pathway














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Figure 24. Trigeminothalamic Tract

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