3-1.

Hypothalamus Viscerosensory Pathway

CH. 19 Viscerosensory Pathway Viscerosensory Receptors nociceptors: tissue damage pain . physiologic receptors: innocuous() stimuli . (reflex ex: baro & chemoreceptors) Viscerosensory Fibers -sympathetic fibers cardiac splanchnic nerves parasym fibers vagus pelvic nerves GVE GVA . - VA fiber unmyelinated or thinly myelinated slow conducting - sympathetic nerves: nociceptors input. parasympathetic nerves: physiologic receptors (innocuous) input . Ascending Pathway for Sym. Afferents (nociceptors pain) -& nociceptive info. sym. n. cardiac splanchnic n. . -VE VA . 19.2 pg 305 EX) stomach nociceptive info. greater splanchnic n. sym. trunk white ramus spinal n. DRG (T1~L2 sym trunk) sensory cell body (pseudounipolar neuron) post. root spinal cord lamina 1 4 (tract cell): direct-contralat. & AL syst. (cross ) or lamina 7 8: indirect-bilat. & spinoreticular fibers ~ *Visceral sense somatic sense . referred pain * sym. pain 2 pathway ! 19.3 306 <Projections to Thalamus: Direct pathway-ALS- pain sensation> Direct pathway (THALAMUS VPL): lam. 1 4 cross ipsilat. .

 ALS (spinal lemniscus: spinothalamic & spinotectal) VPL of Thalamus int. capsule corona radiata cerebral cortex (postcentral gyrus & insular cortex) * insula : Viscera

visceral pain poorly localized: b/c receptor density , receptive field , input convergence in pathway <Projections to Reticular Formation: Indirect pathway-Spinoreticular- pain> *reticular formation spinoreticular input spinoreticular tract also ALS collateral ALS input . *multisynaptic higher level of brain . * reticular formation periaqueductal gray neuron hypothalamus intralaminar nuclei of thalamus cortex . ) Specific thalamic nu.: cerebral cortex ~ (ex: VPL => postcentral gyrus) Nonspecific thalamic nu.: cerebral cortex ~ (ex: CM-Pf) Olfaction thalamus ! * spinoreticular tract ARAS(ascending reticular activation syst.:) awakening ~ Indirect pathway (Reticular formation): spinoreticular input lam. 7 8 Dorsal longitudinal fasciculus(periaqueductal gray origin) mammillary peduncle, medial forebrain bundle(mesencephalic reticular formation) hypothalamus intralaminar nuclei (CM-Pf) of Thalamus * midbrain center viscerosensory somatosensory input(ALS , pain &temp~) . hypothalamic centers projection sensory syst. . <Referred Pain=Haines> -: harmful stimuli that originate in a visceral structure, are perceived by the patient as pain arising from a somatic portion of the body wall such as the skin, bones or skeletal mm. -EX) Angina: pain resulting from heart disease. Nociception form the left side of the heart is referred to the left side of the body. (Angina pectoris)

Aff: from the heart (cervical cardiac/ thoracic cardiac n.) sym. chain @ sup. mid. Inf. cervical ganglia & T1~5 gang lam. 1 4 of spinal cord post. horn tract cell ( pain post horn tract cell T1~5 dermatome ~ pain perceived~) ~ ~ - pain sympathetic sensory fiber , sympathetic sensory fiber post. root of spinal cord afferent fibers somatic structures referred pain . -Mechanism: involve a convergence of somatic and visceral afferent information onto pools of post. horn neurons, the axons of which ascend to higher levels of the neuraxis. -visceral nociceptive fibers(deep viscera pain) spinothalamic tract tract cell synapse. tract cell axon VPL synapse cerebral cortex~ ** VA fibers post. horn tract cell(body wall pain ) . post. horn tract cell somatosensory info. ! , visceral aff. collateral post. horn tract cell VPL info somatosensory cortex . deep structure pain body referred . Visceral sense somatic sense pathway Referred pain.

Ascending Pathway for Parasym. Afferents (physiologic rptrs input REFLEX *parasym : cranial nerves 3 7 9 10 s2~4 (pelvic n.) <Sacral Parasym. Afferents> -sacral level: - prostate, - vagina & uterus -pelvic nerves(s2~4) are parasym. & contain viscerosensory fibers pg 308 19-7 -: Pelvic nerves spinal n. DRG (s2~4 cell bodies) central process 1) post. root 2) ant. root(recurrent fiber) spinal cord terminate a) post. horn b) VE preganglionic motor neurons a) post. horn cells: relay info. on bladder (fullness) via ALS & spinoreticular pathways to

VPL (thalamus) insular & parietal opercular cortices full bladder ! b) hypothalamus for the initiation of SUPRASPINAL AUTONOMIC REFLEXES GVE preganglionic motor neurons (S234) postganglionic cells in pelvic viscera; spinal autonomic reflexes <Cranial Parasym. Afferents> -CN 3 7 9 10 GVEF . 7 9 10 sensory nu. . BUT 9 10 parasym. aff. Fiber . CN 9 visceral afferent fibers: a) carotid body (chemoreceptor): O2, CO2, acidity, drug . b) carotid sinus (baroreceptor): arterial + nociceptive & tactile input from oropharynx: gag reflex CN 10 visceral afferent fibers: a) aortic arch (chemoreceptor) b) physiologic info from thoracic viscera and from all viscera of abdominal cavity (splenic flexure) : BUT pain X fibers jugular foramen skull~ Jugular foramen CN 9 & 10 sup. & inf. ganglion . CN 9 GSA GVA, SVA Sup. ganglion Inf. petrous ganglion CN 10 Sup. ganglion Inf. nodose ganglion

CN 9 10 visceral afferent fiber solitary tract medulla NTS synapse . 2nd order neurons in NTS a) dorsal vagus nu.(thoracic & ab viscera), nu. ambiguus ( & 9& 10 pharyngeal arch mm.), & b) rostral areas of anterolat. medulla ** NTS: VA NTS~ pars oralis (SVA), pars caudalis (GVA) NTS Cortex~ GVA cortex b/c ANS center (reflex ~) ANS hypothalamus . ( : hypo->MO, hypo->spinal cord)

Pg. 309 figure 19-8 ** a) GVE motor neurons of nu. ambiguus & dorsal motor nu. of vagus n. receive input from NTS vagus n. to parasym. ganglia of heart vasodepressor: heart rate blood pressure ** b) rostral areas of anterolat. medulla(medullary reticular formation) NTS input spinal cord projection. intermediolat. cell column preganglionic sym. motor neurons vasopressor: heart rate BP 19-9~

3-3. basal nuclei Direct and Indirect Pathways of Basal Nuclear Activity -basal nuclei consist of parallel circuits -basic circuit (2) Direct pathway Indirect pathway Direct pathway Cerebral cortex (glutaminergic projection) Striatal complex (striatal neurons inhibit cells in GPin. & Sub. Ni. Ret.) *striatopallidal and striatonigral fibers use GABA & substance P. Thalamic neurons