NEUROSCIENCE Aug 11, 2014

Module No 2

ASCENDING PATHWAY
I-A BATCH2018
Alvin B. Vibar M.D
3
PROPRIOCEPTION
OUTLINE <Subject>
I. General Senses
Position / Posture sense
II. Receptors
o awareness of the position of parts of the body
III. Spinal Cord
o tested by passively moving a limb or one of its parts to a
IV. Ascending Tracts
certain position and moving the opposite limb to the same
V. Somatosensory System
position
VI. Pain and temperature
VII. Proprioception, Touch, Position Romberg sign - stand with the feet together and the eyes open
VIII. Other acending tracts butsways and falls when the eyes are closed
a. Spinotectal tract o indicates absence of position sense in the lower limbs
b. Spinoreticular tract
c. Spino-olivary tract Motion sense
IX. Clinical Correlation o awareness of active or passive movements of the parts of
a. Brown-Sequard Syndrome the body;
b. Syringomyelia o tested by passively flexing and extending individual fingers
c. TabesDorsalis and toes, hand and foot, forearm and leg
o with eyes closed recognize the direction, speed and
range of the movement
LEGEND
From the Lecture/powerpoint slides RECEPTORS
From the book/other resources Clinical Neuroanatomy (Snell,2010),
Clinical Neuroscience by Young and Young, Patestas Textbook of Sensory information - detected by specific receptors sensitive
to stimuli arises from both outside and within the body
Neuroanatomy, Atlas of Neuroanatomy and Neurophysiology
From AUDIO RECORDING OF LECTURER CLASSIFICATION ACCORDING TO STIMULUS SOURCE
GENERAL SENSES/COMMON SENSATION
EXTERORECEPTORS
Light Touch o Sensory information from the external world
Pressure o respond to pain, temperature, touch, vibration and
pressure
Pain
o Further classified as :
Temperature
teloreceptors (G. tele, distant) - receptors that respond to distant
Proprioception = Vibration sense stimuli (such as light or sound), and do not require direct physical
contact with the stimulus for stimulation;
TACTILE SENSE contact receptors - transmit tactile, pressure, pain, or thermal stimuli,
- awareness and precise location of very delicate mechanical require direct contact of the stimulus with the body.
stimuli
Includes: ENTERORECEPTORS
Twopoint sense - ability to distinguish stimulation by one o within the body
or two points applied to the skin o detect sensory information concerning the status of the bodys internal
Fine touch / Stereognosis - ability to recognize objects by environment, such as
touch alone Stretch
Graphesthesia - ability to recognize numbers or letters blood pressure
drawn on the skin pH
oxygen or carbon dioxide concentration
PRESSURE osmolarity.
Pressure = deep touch;
o stimuli applied to subcutaneous structures via: PROPRIOCEPTORS
firmly pressing on the skin with a blunt object o within the body
squeezing subcutaneous structures o signal awareness of body position and movement in space
static position sense - relating to a stationary position
PAIN kinesthetic sense (G. kinesis, movement) - relating to the movementof
-sensation that warns of potential injury and alerts the person to avoid or a body part.
treat it. receptors of the vestibular system (inner ear) - relaying sensory
Fast pain information about the movement and orientation of the head
o sharp, pricking sensation
o well localized
o felt after 0.1 second after stimulation, experienced by Mechanical or
thermal types of stimuli
o activation of A-delta (A) fibers (myelinated)

Slow pain
o burning sensation
o dull, and diffuse type
o felt 1.0 second or later after the stimulation, elicited by Mechanical,
thermal, and chemical stimuli
o activation of C fibers (unmyelinated)

TEMPERATURE
Hot
Cold
Fig 1. Different general sensory receptors in the skin

st
Jenika, Erika, Ia Checked by: PLC 1 SEM, S.Y. 2014-2015 Page 1 of 9
NEUROSCIENCE ASCENDING PATHWAYS Lecture #3 Module#2

CLASSIFICATION ACCORDING TO MODALITY

MECHANORECEPTORS
o touch, pressure and proprioception
o activated following physical deformation of the skin, muscles, tendons,
ligaments, and joint capsules in which they reside
o classified as nonencapsulated or encapsulated

NOCIRECEPTORS
o pain
o rapidly adapting receptors that are sensitive to noxious or painful stimuli
o Three Subtypes:
1. Mechanosensitive nociceptors (A fibers) - sensitive to intense
mechanical stimulation (such as pinching with pliers) or injury to
tissues. Fig3. Spinal Cord Functional Levels
2. Temperature-sensitive (thermosensitive) nociceptors (A fibers) -
sensitive to intense heat and cold. Parts of the Gray Matter
3. Polymodal nociceptors (C fibers) - sensitive to noxious stimuli that Posterior horn
are mechanical, thermal, or chemical in nature. Lateral horn
Anterior horn
THERMORECEPTORS
o warm / cold The cell bodies in the gray substance are grouped into clusters
o Three Subtypes: of nuclei of laminae.
Cold receptors - consist of free nerve endings of lightly myelinated
A fibers. Table 2. Laminae of Rexed groupings
Warmth receptors - consist of the free nerve endings of Laminae Location
unmyelinated C fibers; respond to increases in temperature.
Temperature-sensitive - nociceptors sensitive to excessive heat or Laminae I-VI (1-6) POSTERIOR horn
cold. Lamina VII (7) LATERAL horn
Laminae VIII and IX (8 & 9) ANTERIOR horn
Table 1. General Sensation Receptors
Sensation Receptors gray substance surrounding the
Lamina X (10)
Touch Meissners corpuscles, central canal
Merkels disc
Hair follicle endings
Golgi Mazzoni

Pressure Pacinian corpuscles

Pain Free nerve endings

Temperature Cold Krause end bulb

Hot Ruffinis corpuscles

Proprioception Tendon and Muscle spindles

Fig 7. Spinal Cord Laminae

ASCENDING TRACTS

Fig 2. Sensory Receptors (See appendix for Larger Image

SPINAL CORD
3 Columns in the White Matter
Posterior funiculus
Lateral funiculus
Anterior funiculus

Each column is subdivided into tracts. These tracts are:

o Ascending tract
o Descending tract
o Intersegmental tracts Fig 8. Ascending and Descending Tracts found in Spinal Cord

Two Important Tracts:

1. Dorsal / Posterior Column
Position sense
2 pt discrimination
Fine, discriminative
Stereognosis

st
Jennica, Erika, Ia Checked by: PLC 1 SEM, S.Y. 2014-2015 Page 2 of 9
NEUROSCIENCE ASCENDING PATHWAYS Lecture #3 Module#2

Vibration sense Table 4. Principal Dermatomes

2. Spinothalamic tract Levels of principal dermatomes
Anterior Spinothalamic Tract(ASTT) touch Level Body Part
Lateral Spinothalamic Tract(LSTT) pain & temp C5 Clavicles
C5, 6, 7 Lateral parts of upper limb
Table 3. Ascending Tracts C8, T1 Medial sides of upper limbs
ASCENDING TRACTS C6 Thumb
Tract Location Origin Destination C6, 7, 8 Hand
C8 Ring and little fingers
ANTERIOR COLUMN
T4 Level of nipples
Free nerve T10 Level of umbilicus
Median to
Ventral endings for Post-central T12 Inguinal or groin regions
Anterior nerve
Spinothalamic light touch & gyrus L1, 2, 3, 4 Anterior and inner surfaces of
roots
pressure lower limbs
L4, 5, S1 Foot
junction of
Cutaneous & Inferior L4 Medial side of great toe
Anterior &
Spino-olivary Propriocepti Olivary S1, 2, L5 Posterior and outer surfaces of
Lateral white
ve organs Nuclei lower limbs
columns
S1 Lateral margin of foot and little
LATERAL COLUMN toe
S2, 3, 4 Perineum
Muscle
periphery of spindles,
Dorsal Cerebellar
Lateral white tendon
Spinocerebellar cortex
column organs, joint
receptors
Muscle
periphery of spindles,
Ventral Cerebellar
Lateral white tendon
Spinocerebellar cortex
column organs, joint
receptors
Medial to Free nerve
Lateral Ventral endings for Post-central
Spinothalamic Spinocerebe pain & gyrus
llar tract temperature
Anterior to
Lateral Midbrain
Spinotectal
Spinothalami Tectum
c
POSTERIOR COLUMN
Meissner's,
Pacinian,
beside
Fasciculus muscle Post-central
Dorsomedia
gracilis spindles, gyrus Fig 10. Anterior and Posterior Dermatomes
n Sulcus
tendon
organs
between Meissner's, REMEMBER!
Fasciculus Pacinian, Rule #1:
Fasciculus Gracilis& muscle Post-central Sensory information can either be
cuneatus Posterior spindles, gyrus
CONSCIOUS - make us aware of the sensation
Gray tendon
NONCONSCIOUS - serve to adjust the movement or
Column organs
function of our body
Rule #2:
Sensory information is bundled according to MODALITY
MECHANICAL STIMULI discriminative touch, pressure,
vibration and proprioception Posterior Column
Medial Lemniscus
NOCICEPTIVE STIMULI pain and temperature
Anterolateral System
PROPRIOCEPTION conveyed to the Cerebellum

Fig 9. Primary Somatosensory Area: Post-central gyrus

DERMATOMES
Area of the skin supplied by the somatosensory fibers from a
single spinal nerve
for localizing levels of lesions

st
Jennica, Erika, Ia Checked by: PLC 1 SEM, S.Y. 2014-2015 Page 3 of 9
NEUROSCIENCE ASCENDING PATHWAYS Lecture #3 Module#2

THREE NEURON PLAN OF SOMATOSENSORY

PATHWAYS
Somatosensory pathways consist of three neurons:
o Number 1 in the sensory ganglia
o Number 2 in the spinal cord or brainstem
o Number 3 in the thalamus

Fig 12. Anterolateral Pathway

Fig 11. THREE NEURONS of the ASCENDING SENSORY PATHWAY

SOMATOSENSORY SYSTEM
SENSORY PATHWAYS

Table 5. Dorsal column-medial lemniscal and Anterolateral

Pathways (corticospinal tract-review of Descending tracts)

Fig 13. Dorsal Column-Lemniscal Pathway

PAIN AND TEMPERATURE

SPINOTHALAMIC TRACT
carries pain, temperature and crude touch sensations from the extremities
and trunk
consists of two pathways:
1. Anterior spinothalamic Tract(ASTT) light touch
2. Lateral spinothalamic Tract(LSTT) PAIN AND TEMPERATURE

st
Jennica, Erika, Ia Checked by: PLC 1 SEM, S.Y. 2014-2015 Page 4 of 9
NEUROSCIENCE ASCENDING PATHWAYS Lecture #3 Module#2

Lateral Spinothalamic Tract

Somatic Sensory arising from Face
Axons enter the SC travel in Trigeminal Gasserian or Semilunar ganglion
First Neuron the Lissauer tract synapse in o 3 divisions:
the posterior horn Opthalmic
Axons of secondary neuron Maxillary
crosses the midline in the Mandibular
Second Neuron anterior white commissure
and ascend as the
anterolateral tract in the SC
Terminates in the VPLN of
Third Neuron
thalamus
From the thalamus fibers project through the internal capsule
and corona radiata to terminate in the primary somatosensory
cortex

Fig 15. Pain and Temperature

PROPRIOCEPTION, TOUCH, POSITION

Position sense: 2 pt discrimination, Fine, discriminative,
Stereognosis, Vibration sense

Tactile Sensation
a. Light touch detection of contact with skin
b. Tactile discrimination perception of siza and shape of objects
Stereognosis write something in the hand and ask the patient to
identify what was written
Two point discrimination ask the patient to point the area where
stimulus was applied
Complex tactile discrimination what is written in the palm
Fig 14. Lateral Spinothalamic tract Flutter and vibration
Proprioceptive sensation kinesthesia, joint or limb position
Free nerve endings Dorsal root ganglion
Postero-lateral funiculus
Mechanoreceptors
Posterior horn
Laminae V VII Muscle spindle afferents static limb position
Lateral spinothalamic tract Joint receptor afferents kinesthetic
VPLN of the thalamus Pacinian corpuscles vibration
Primary somatosensory area ( Broadmanns area 3,1,2) Meissners corpuscles superficial phasic touch sensation
Free nerve endings sense of touch
TRIGEMINAL/FACE PATHWAY
DORSAL COLUMN-MEDIAL LEMNISCUS PATHWAY
Gasserian / Semilunar
First Neuron Axons enter the SC and pass
Ganglion
Nucleus of Trigemino Spinal directly to ipsilateral posterior
Second Neuron column (caudal fibers below
tract
Ventral Postero Medial nucleus First Neuron T6 enter Fasciculus gracilis
Third Neuron and rostral fibers above T6
of Thalamus
Post central gyrus ( B.A. 3,1,2) enter Fasciculus cuneatus to
ascend)
Terminate in Nucleus gracilis
Second Neuron
and Nucleus cuneatus
Axons of secondary nuclei cross the midline as Internal arcuate
fibers and form the Medial Lemniscus
Terminates in the VPLN of
Third Neuron
thalamus

Receptors Dorsal root ganglion

Cuneate fasciculus and Gracile fasciculus
Cuneate and Gracile nuclei
Medial lemniscus
Fig 15. Innervation by CN V Trigeminal Nerve and sub-branches VPLN of the thalamus

st
Jennica, Erika, Ia Checked by: PLC 1 SEM, S.Y. 2014-2015 Page 5 of 9
NEUROSCIENCE ASCENDING PATHWAYS Lecture #3 Module#2

Primary Somatosensory cortex( BA 3, 1, 2 )

Fig 16. Lateral Spinothalamic tract Fig 19. Motor and Sensory area sequence

Fig 17. Somatotopic distribution of fibers in the Posterior Colum-Medial Lemniscus

system PROPRIOCEPTION
Receptors
Muscle spindles
Tendon spindles

Concious Proprioception
fibers each the cerebellum

Unconcious Proprioception
fibers each the cerebrum
Receptors Dorsal root ganglion
posterior column
Cuneate fasciculus and Gracile fasciculus
Cuneate and Gracile nuclei
Medial lemniscus
VPLN of the thalamus
Precentral Gyrus (BA 3, 1, 2 )

OTHER ASCENDING PATHWAYS

SOMATOSENSORY CORTEX
Somatosensory information from Ventral Posterior Lateral
Nucleus (VPL) and Ventral Posterior Medial (VPM) of the
thalamus is conveyed to the primary somatosensory cortex

Fig 18. Somatosensory Cortex

Information is somatotopically organized

o Face most lateral
Fig 20. Other Ascending Pathways
o Legs most medial
Information is also carried to association areas
o Also organized somatotopically SPINOTECTAL TRACT
o Brodmans Areas 5 and 7 The pathway provides afferent information for spinovisual reflexes and brings
about the movement of the eyes and head toward the source of the stimulation.
Both primary and association areas have extensive connection
with motor cortex
Lesions produced deficits referred to as cortical sensory loss
The axon enter the spinal cord from the posterior root
First Neuron ganglion and travel to the gray matter where they synapse
on unknown second order neuron
Cross the median plane and ascend as spinotectal tract in
Second Neuron the anterolateral white column lying close to the lateral
spinothalamic tract
st
Jennica, Erika, Ia Checked by: PLC 1 SEM, S.Y. 2014-2015 Page 6 of 9
NEUROSCIENCE ASCENDING PATHWAYS Lecture #3 Module#2

after passing though medulla oblongata and pons they

Third Neuron terminate by synapsing with neurons in the superior
colliculus of the midbrain

SPINORETICULAR TRACT
Plays and important role in influencing levels of consciousness

The axon enter the spinal cord from the posterior root
First Neuron ganglion and terminate on unknown second order neuron
in the gray matter
ascend as spinoreticular tract in the lateral white column
Second Neuron
mixed with the lateral spinothalamic tract
Most of the fibers are uncrossed and terminate by
Third Neuron synapsing with neurons of the reticular formation in
medulla oblongata, pons, and midbrain
Fig 22. Affected area in Brown Sequard
SPINO-OLIVARY TRACT
Conveys information to the cerebellum from cutaneous and proprioceptive
SYRINGOMYELIA
organs
progressive cavitation around the central canal;
The axon enter the spinal cord from the posterior root loss of pain & temperature sensations in hands & forearm
First Neuron ganglion and terminate on unknown second order neuron (common in cervical)
in the posterior gray column
Cross the midline ansascemd as spino-olivary tract in the
Second Neuron white matter at the junction of the anterior and lateral
column
Inferior olivary nuclei in the medulla oblongata. The axon
Third Neuron of the third order neuron cross the midline and enter the
cerebellum through the inferior cerebellar peduncle.

CLINICAL CORRELATION
CASE Fig 23. Central canal cavitation in Syringomyelia/Damage of decussating
pain and temperature fibers
A 25 y/o male fell to the ground hitting his lower back against
the gutter when his motorbike skidded on the wet road. When
he tried to get up, he was unable to move his right leg. He was
brought to the hospital and upon examination, he could NOT
FEEL PAIN on the left side up to the level of the umbilicus. He
could NOT FEEL the VIBRATION of the tuning fork on his right
foot
Classic example of Brown Sequard

BROWN-SEQUARDS SYNDROME

Spinal Cord Hemisection

Features:
o Contralateral loss of pain & temperature Fig 24. Skin area in which there is loss of pain and temperature
o Ipsilateral loss of proprioception sensation following the development of syringomyelia.
o Ipsilateral manifestations of upper and
o lower motor neuron lesions TABES DORSALIS
caused by neurosyphilis;
dorsal root involvement with secondary degeneration of
dorsal columns ( loss of vibration and position sense)

Fig 21. Affected area of Spinal Cord in Brown Sequard

Fig 24. Problem in Tabes Dorsalis

st
Jennica, Erika, Ia Checked by: PLC 1 SEM, S.Y. 2014-2015 Page 7 of 9
NEUROSCIENCE ASCENDING PATHWAYS Lecture #3 Module#2

DISORDERS OF SENSORY SYSTEM

Anesthesia loss of sensitivity to pain in all / part of the

body
Hypoesthesia an abnormally reduced sensitivity to touch
Hyperesthesia an abnormally heightened sensitivity of
partof the body
Paresthesia an abnormal or unexplained tingling, pricking
or burning sensation of the skin

Spinal Cord Lesions

st
Jennica, Erika, Ia Checked by: PLC 1 SEM, S.Y. 2014-2015 Page 8 of 9
NEUROSCIENCE ASCENDING PATHWAYS Lecture #3 Module#2

The main somatosensory pathways to consciousness

First Order Second Order

Sensation Receptor Third Order Neuron Pathways Destination
Neuron Neuron
Lateral
Ventral
Pain and Free nerve Posterior Spinothalamic, Posterior
Substansiagelatinosa posterolateralnucleas
temperature endings ganglion Spinal Central Gyrus
of thalamus
lemniscus
Anterior
Ventral
Light touch and Free nerve Posterior root Spinothalamic, Posterior
Substansiagelatinosa posterolateralnucleas
pressure endings ganglion Spinal Central Gyrus
of thalamus
lemniscus
Meissners
corpuscles, Fasciculi
pacinian Ventral gracilis and
Posterior root Nuclei gracilis and Posterior
Discriminative corpuscles, posterolateralnucleas cuneatus,
ganglion cuneatus Central Gyrus
muscle of thalamus medial
spindles, lemniscus
tendon organs

Muscle joint sense pathways to the cerebellum

First Order Second Order

Sensation Receptor Pathways Destination
Neuron Neuron
Muscle spindles, Anterior and
Unconscious Posterior root
tendon organs, joint Nucleus dorsalis posterior Cerebellar cortex
muscle joint ganglion
receptor spinocerebelar

Fig 2. Sensory Receptors

st
Jennica, Erika, Ia Checked by: PLC 1 SEM, S.Y. 2014-2015 Page 9 of 9