PART ONE FUNCTIONS OF THE ASCENDING SOMATOSENSORY PATHWAY

Ascending tracts arising from the head, neck, trunk, and lower CONSCIOUS SENSATION _
extremities • Lateral spinothalamic tract
o pain and temperature
SOMATIC SENSATIONS • Ventral spinothalamic tract
Pain o touch & pressure
• Elicited by noxious stimulation • Fasciculus gracilis & fasciculus cuneatus
Thermal Sensation o discriminative modalities: touch, form, texture, position
• Cold and warmth sense
Position Sense or Proprioception UNCONSCIOUS SENSATION _
• Evoked by mechanical changes in muscles and joints • Spinocerebellar pathways - provide information to cerebellum
• Sensations of static position and limb movements for coordination of voluntary movements
Touch-Pressure Sensation • Spinoreticular pathways - provide information to brainstem
• Elicited by mechanical stimulation applied to body surface tegmentum & reticular formation to mediate somatic & visceral
reflexes
RECEPTORS AND THEIR FUNCTION
Free Nerve Endings PAIN AND TEMPERATURE PATHWAY
• Main receptor for pain and temperature Pathway: Lateral Spinothalamic tract (LSTT)
• For pain, thermal stimuli, crude touch, pressure, and tickle
sensations Receptors: Free nerve endings (non-myelinated)
Hair Follicle Receptors
Pain & To impulses are transmitted by:
• Movements of the hairs = fast-conducting A fiber = initial sharp pain
Merkel’s Tactile Discs = slow-conducting C fibers = prolonged burning
• Sustained light touch aching pain
Vater-Pacinian Corpuscle
• Vibration and pressure N1: Dorsal root ganglion
Meissner’s Corpuscle
• Light discriminatory touch At tip of dorsal horn (dorsolateral sulcus), axons divide
Ruffini’s Corpuscle into short ascending/descending fibers forming the
• Stretch (tension) or twisting (torque) in the skin dorsolateral tract of Lissauer
Krause End Bulb
Fibers leave tract & enter posterior horn of spinal cord
• Low frequency vibrations
Neuromuscular (Muscle) Spindle N2: Posterior horn of spinal cord
• Proprioception regarding muscle length and rate of change in Axons from Lissauer’s tract synapse w/ Posteromarginal n.,
muscle length Substantia gelatinosa, & N. proprius (laminae I-V)
Neurotendinous Spindle (Golgi Tendon Organ): Interneurons connect w/ laminae VI-VIII & cross ventral
• Proprioception regarding tension of muscles white commissure to the lateral funiculus
Fibers ascend forming LSTT
sharp, pricking pain burning aching pain

N3: Ventral Posterolateral Reticular formation or

nucleus of thalamus Nuclei of Thalamus:
(VPLN) a) Intralaminar nuclei
b)Posterior Nuclear complex

Axons pass thru posterior limb of internal capsule &

corona radiata

3-NEURON PLAN OF SOMATOSENSORY PATHWAY

Sensory receptor ending 1o/2o Somesthetic area (Postcentral gyrus of cerebral cortex)

1st order neuron = N1 SOME FURTHER EXPLINATION

(dorsal root ganglion)
• from the dorsal root ganglion, it will enter first at the tip of the
2nd order neuron = N2 dorsal horn (dorsolateral sulcus) from where some fibers will
(spinal cord) ascend or descend 1 to 2 segments forming Lissauer’s tract
• From lamina VI-VIII, it will crossover through the ventral white
Decussate commissure specifically going to the lateral white column of the
3rd order neuron = N3 contralateral side that is why it is called the lateral
(thalamus)
spinothalamic tract
Sensory Cortex • sharp burning pain – VPLN
• burning aching pain – Reticular formation, intralaminar nuclei
• Spinal cord because there’s splitting of impulses arising from the or posterior nuclear complex of the thalamus
trunk and from the extremities
• Sensory cortex – Brodmann Area 3,1,2 or specifically the post
central gyrus
• With regards to the thalamus, stimulus will go to:
o Ventropostero lateral – back of the head up to the
extremities
o Ventropostero medial – face

Lecturer: Dra. Leona Melodia T. Matheus Page 1 of 5

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CRUDE (LIGHT) TOUCH AND PRESSURE PATHWAY
Pathway: Ventral Spinothalamic tract (VSTT)
Receptors: Meissner’s corpuscles
Pacinian corpuscles
N1: Dorsal root ganglion
At tip of dorsal horn (dorsolateral sulcus), axons
divide into short ascending/descending fibers
forming Lissauer’s tract
Fibers leave tract & enter posterior horn of spinal cord
N2: Posterior horn of spinal cord
From Lissauer’s tract synapse w/ laminae I-V
Interneurons connect w/ laminae VI-VIII & cross
ventral white commissure to ventral funiculus
Fibers ascend forming VSTT
N3: VPLN of the thalamus
Posterior limb of internal capsule & corona radiata
1o/2o Somesthetic area (Postcentral gyrus of cerebral cortex
SOME FURTHER EXPLINATION
• Crude touch – you cannot pinpoint exactly the shape, size,
texture of the object
• At the dorsal root ganglion, it follows the same pathway for
LSTT
• The difference is, it will go to the ventral white column of the
contralateral side that is why it is called the ventral
spinothalamic tract
Anterolateral system/Spinal Lemniscus
• Refers to both LSTT and VSTT since they lie alongside each
other
• It also includes the spinotectal (spinomesencephalic),
spinoreticular, spinohypothalamic
Doc Matheus:
*picture is wrong, it should land on the
ventral funiculus not the lateral funiculus
Lecturer: Dra. Leona Melodia T. Matheus
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DISCRIMINATIVE TOUCH AND PRESSURE PATHWAY
Pathway: Dorsal Column/Medial Lemniscal Pathway
Receptors: Meissner’s corpuscles
Pacinian corpuscles
N1: Dorsal root ganglion
Axons pass directly to dorsal column of same side,
travel upward as Fasc. gracilis/Fasc. cuneatus
N2: Nucleus gracilis or Nucleus cuneatus of medulla
Internal arcuate fibers (axons of N2) decussate
forming Medial lemniscus
Medial lemniscus ascend in brainstem
N3: VPLN of thalamus
Posterior limb of internal capsule & corona radiata
Somesthetic area (Postcentral gyrus of cerebral cortex)
SOME FURTHER EXPLINATION
• Discriminative touch – able to distinguish the size, shape and
texture of an object
• Meissner’s is used specifically because it is for light
discriminatory touch
• No formation of Lissauer’s tract
• No crossing over
• It is only at the N2 that it will decussate
FASCICULUS GRACILIS _
• Carry impulses from lower extremity
• Fibers enter spinal cord thru sacral, lumbar, & lower thoracic
segments
FASCICULUS CUNEATUS _
• Carry impulses from upper extremity
• Fibers enter spinal cord thru cervical & upper thoracic segments
FUNCTIONS OF THE PATHWAY _
• Two-point discrimination – ability to recognize 2 points at which
pressure is applied simultaneously
• Stereognosis – ability to recognize size, shape, & texture of an
object
• Vibratory sense – ability to recognize the vibration of a vibrating
tuning fork, usually over bony prominences
Page 2 of 5
 CONSCIOUS PROPOICEPTION POSTRIOR SPINOCEREBELLAR TRACT
Pathway: Dorsal Column/Medial Lemniscal Pathway Receptors: Muscle Spindles/Golgi Tendon organs/Joint receptors (LE)

Receptors: Muscle Spindles/Golgi Tendon organs/Joint receptors N1: Dorsal root ganglion
Axons enter spinal cord thru sacral, lumbar & lower 6
N1: Dorsal root ganglion thoracic segments
Axons pass directly to dorsal column of same side,
travel upward as Fasc. gracilis/Fasc. cuneatus N2: (Ipsilateral) Nucleus dorsalis of Clarke in laminae VII
Axons enter ipsilateral lateral white column & ascend as
N2: Nucleus gracilis or Nucleus cuneatus of medulla Posterior spinocerebellar tract to medulla
Internal arcuate fibers from nuclei cross midline
(decussate) forming Medial lemniscus Passes thru Inferior cerebellar peduncle
Medial lemniscus then ascend in brainstem
N3: Cerebellar cortex
N3: VPLN of thalamus (contralateral to N1 – N2)
Posterior limb of internal capsule & corona radiata
SOME FURTHER EXPLINATION
• No decussation at N2
Brodmann’s area 3, 1, 2 (contralateral to N1 – N3)
• 1-way only: ipsilateral
SOME FURTHER EXPLINATION •
• Pathway is exactly the same (medial lemniscal pathway) CUNEOCEREBELLAR TRACT
except we have a different receptor Receptor: Muscle Spindles/Golgi tendon organs/Joint receptors (UE)
• Same qualifiers – gracilis and cuneatus
N1: Dorsal root ganglion
Axons enter spinal cord at level of cervical & upper 6
Clinical Signs of Injury to Lemniscal Pathway _
thoracic segments
1. Inability to recognize limb position – whether a joint is in
Fibers travel upward thru ipsilateral dorsal white column
flexion or extension
as Fasciculus cuneatus
2. Astereognosis – inability to recognize familiar objects by touch
w/ eyes closed
N2: Nucleus cuneatus
3. Loss of 2-point discrimination – inability to recognize 2 points
Axons of N2 ascend on ipsilateral side as Cuneocerebellar
applied to the skin simultaneously
tract (Posterior external arcuate fibers)
4. Loss of vibratory sense – inability to recognize a vibrating
tuning fork from a non-vibrating one
Passes thru Inferior cerebellar peduncle
5. Positive Rhomberg sign – abnormal increase in degree of
body sway w/ eyes closed
N3: Cerebellar cortex
UNCONSCIOUS PROPOICEPTION
Pathway: Spinocerebellar Tract DIFFERENCES IN UNCONSCIOUS PROPIOCEPTION TRACTS
• Anterior spinocerebellar tract • Both spinocerebellar tracts, N2 is nucleus dorsalis, whereas for
o relays proprioceptive information regarding group cuneocerebellar, N2 is nucleus cuneatus
of muscles at the lower extremity • Posterior spinocerebellar and cuneocerebellar, ipsilateral,
• Posterior spinocerebellar tract anterior spinocerebellar, bilateral
o relays proprioceptive information regarding the
status of individual muscles at the lower extremity
• Cuneocerebellar tract
o relays proprioceptive information regarding the
status of muscles in the upper extremity

All spinocerebellar pathways end in the cerebellum, the difference is

their entry into the cerebellum
• Anterior spinocerebellar tract enters via superior cerebellar
peduncles
• Posterior spinocerebellar tract and Cuneocerebellar tract
enters via inferior cerebellar peduncles

ANTERIOR SPINOCEREBELLAR TRACT

Receptors: Muscle Spindles/Golgi Tendon organs/Joint receptors (LE)

N1: Dorsal root ganglion

Axons enter spinal cord at sacral, lumbar, & lower 6 thoracic
segments. • Fuschia pink – have thick fibers (majority) and thinner fibers
o represents the anterior spinocerebellar tract
N2: Posterior horn cells = N. dorsalis (laminae V – VII)
• Red – Posterior spinocerebellar and cuneocerebellar
Majority Minority

Decussate* in white commisure Ascend as Anterior Spinocerebellar

ascend as Anterior Spinocerebellar tract in ipsilateral lateral white
tract in contralateral lateral white column
column

Passes through superior cerebellar peduncle

N3: Cerebellar cortex

*Fibers that crossed over in the spinal cord cross back within
cerebellum that is why lesions in cerebellum is ipsilateral

Lecturer: Dra. Leona Melodia T. Matheus Page 3 of 5

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 PART TWO Receptors: Free nerve endings = for pain & temperature
Ascending tracts arising from the anterior parts of the head
N1: Trigeminal ganglion of CN V
3-NEURON PLAN OF SOMATOSENSORY PATHWAY (FACE) Geniculate ganglion of CN VII
Superior glossopharyngeal or Jugular ganglion o CNs IX and X
Sensory receptor ending

1st order neuron = N1

(sensory ganglion) N2: Spinal Nucleus of CN V (Association neuron)
Axons of N2 cross to the opposite side in the lower
2nd order neuron = N2 brainstem
(brainstem nucleus) Ascend to form the Trigeminal spinal tract
of the opposite side
Decussate
3rd order neuron = N3
(thalamus) N3: Ventroposteromedial Nucleus of thalamus (VPMN)
Axons of N3 ascend thru posterior limb of
Sensory Cortex internal capsule and corona radiata

N4: Primary Somesthetic area (Post-central gyrus /

SOMATOSENSORY PATHWAY TO THE FACE Brodmann area 3,1,2)
• All sensory modalities (discriminative touch, proprioception, pain
and temperature) enters the brainstem via the trigeminal nerve SOME FURTHER EXPLINATION
CN V = major somatic sensory nerve for the face
CN VII = few sensory fibers to the back of ears
CN IX/X = supply skin of the ears

• Most sensory fibers enter the trigeminal ganglion

(N1), regardless of which division they are coming
from (ophthalmic, maxillary, mandibular)
• Axons of the neurons in the ganglion then enter the brainstem
in the mid-pons
• The trigeminal nucleus in the brainstem (N2) is huge – it
stretches from midbrain to medulla
o Mesencephalic – midbrain level, for propioception form muscles
of mastication
o Main sensory – pontine level, for touch and pressure
o Spinal – medullary level, for pain and temperature Example: Press a lighted cigarette butt on the cheek
(Pain stimulus)
PAIN AND TEMPERATURE PATHWAY N1: Trigeminal ganglion, same side

N2: Spinal nucleus of Trigeminal nerve

Ascending pathway in contralateral lower brainstem
Ascending tract: Trigeminal spinal tract

N3: VPMN of thalamus (opposite side)

N4: Somesthetic area or B.A. 3,1,2 (opposite side)

*Remember that the trigminal spinal tract is contralateral to its
original begining

DISCRIMINITIVE TOUCH AND PRESSURE PATHWAY

Pathway: Dorsal and Ventral Trigeminothalamic Tract

Receptors: Merkel’s Tactile Discs, Meissner’s corpuscles,

• Small diameter fibers carrying pain and T0 enter at mid-pons Pacinian corpuscles
• The fibers then turn down the brainstem until they reach the
caudal medulla N1: Trigeminal ganglion
• The tract that the descending axons travel in is called spinal Fibers enter midpons
tract of V
• Spinal tract of V eventually synapses with the spinal nucleus N2: Main sensory nucleus of CN V
Axons of N2 cross to opposite side in the pontine
of V (may reach as far down as the upper cervical cord)
tegmentum
• From the spinal nucleus, the fibers cross to the opposite side Ascend to form Ventral Trigeminothalamic tract
to ascend to the thalamus (opposite side) (contralateral)
Uncrossed fibers ascend to form Dorsal Trigemino-
thalamic tract (ipsilateral)
*both ascends at the same time

N3: VPMN of thalamus

Lecturer: Dra. Leona Melodia T. Matheus Page 4 of 5
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 Bilateral axons ascend thru posterior limb
of internal capsule and corona radiata
N4: Primary somesthetic area (3, 1, 2), bilateral
Example: Kiss on the right cheek (Touch)
N1: Trigeminal ganglion, right
N2: Main sensory nucleus of CN V, right
Ascending tract: contralateral VTTT &
ipsilateral DTTT
N3: VPMN, bilateral
N4: Primary somesthetic area, bilateral
CONSCIOUS PROPIOCEPTION
CLINICAL CORRELATIONS
• Lesions of Trigeminal ganglion result in:
1. Loss of pain, temperature, and tactile sensations from
ipsilateral face, oral cavity, and teeth
2. Ipsilateral loss of corneal reflex
3. Ipsilateral paralysis of masticatory muscles
• Trigeminal neuralgia (Tic doloreaux)
o Severe, but brief pain, restricted to the distribution
of CN V, usually the Maxillary division (V2)
o Pain is initiated by any contact to the face (shaving,
putting make-up on), chewing or even smiling
• PICA syndrome
o In the medulla, fibers of the Trigemino-spinal tract
& Anterolateral system are served by the posterior
inferior cerebellar artery (PICA)
o Any obstruction to the artery may cause the
symptoms
o A characteristic feature of the syndrome,
Alternating Hemianesthesia, is seen here
▪ hemianesthesia affecting the head on
one side and the body and
extremities on the other side
▪ If right hemianesthesia: affected is right
head and left body and extremities

• From stretch and tendon receptors in the muscles of mastication,
axons enter brainstem via a small branch of trigeminal nerve that
bypasses the trigeminal ganglion
• The fibers turn upward towards the mesencephalic nucleus leave
the nucleus immediately, and pass to the nearby main sensory
nucleus
• From the main sensory nucleus, fibers cross to the opposite side
and ascend to the thalamus
• Pontine gliomas
o Glioma: a type of tumor that starts in the glial cells
of the brain or the spinal cord
o These may produce paralysis of the muscles of
mastication (Trigeminal damage) and some loss
of tactile input (Main Sensory nucleus damage)

Pathway: Dorsal and Ventral Trigeminothalamic Tract

• Impulses from: Muscles of mastication, Pressure in the teeth,
periodontal membrane, and joint capsule of cranio-mandibular joint

Receptors: Muscle Spindles/Golgi Tendon organs/Joint receptors

Peripheral processes enter mid-pons and turn

upwards toward N1

N1: Mesencephalic nucleus of CN V

Central processes pass on to N2

N2: Main Sensory nucleus of CN V

Axons of N2 cross to opposite side in the pontine
tegmentum
Ascend to form Ventral Trigeminothalamic tract
(opposite side)
Uncrossed fibers ascend to form Dorsal Trigemino-
thalamic tract (ipsilateral)

N3: VPMN of thalamus, bilateral

Bilateral axons ascend thru posterior limb of
internal capsule and corona radiata

N4: Primary and Secondary Somesthetic areas of

cerebral cortex, bilateral

Example: Awareness of chewing (Proprioception)

N1: Mesencephalic nucleus of CN V

N2: Main sensory nucleus of CN V

Ascending tract: contralateral VTTT and
ipsilateral DTTT

N3: VPMN of thalamus, bilateral

N4: Primary and Secondary somesthetic areas, bilateral

Lecturer: Dra. Leona Melodia T. Matheus Page 5 of 5

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