Conus Medullaris (L1-2)

Cauda Equina

Anterior median fissure

Anterolateral fissure
Spinal segment
C8, T12, L5, S5, Cx1

Anterior (Ventral) Root

Posterior (Dorsal) Root
Dorsal Root (Spinal) Ganglion
Root - Rootlets
Spinal Cord
- Comparable to
Input-Output (IO) System of the Computer

- Spinal Nerve (C8, T12, L5, S5, Cx1)

Segmental Structure of Neural Tube Origin

The Spinal Cord-part of the CNS found within the spinal column
The spinal cord communicates with the sense organs and muscles below the level
of the head

Bell-Magendie Law-the entering dorsal roots carry sensory information and the
exiting ventral roots carry motor information to the muscles and glands

Dorsal Root Ganglia-clusters of neurons outside the spinal cord

 Spinal Cord Anatomy
 Central canal filled with cerebrospinal
fluid

Figure 7.19

Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings Slide

 CROSS SECTION OF SPINAL CORD

• White matter: • Gray matter:

• Myelinated axons forming nerve tracts • Neuron cell cell bodies,
• Fissure and sulcus dendrites, axons
• Three columns: • ‘Horns’:
• Ventral • Posterior (dorsal)
• Dorsal • Anterior (ventral)
• Lateral • Lateral

• Commissures:
(see later for white matter • Gray: Central canal
pathways) • White
CROSS SECTION OF SPINAL CORD
 Spinal Cord External Figure

Conus Medullaris (L1-2)

Spinomedullary Junction
- Foramen Magnum, Pyramidal decussation, C1 ventral root
Enlargements
- cervical (C5-T1) & lumbosacral (L1-L4)
Longitudinal Fissures
- anterior median fissure
- anterolateral fissure
- posterior median sulcus
- posterolateral sulcus
Conus Medullaris (L1-2)
Cauda Equina

Anterior median fissure

Anterolateral fissure
 Posterior
median sulcus
Posterolateral
sulcus
Posterior
intermediate
sulcus
Fasciculus
cuneatus
Fasciculus
gracilis

Posterior surface of the spinal cord

See ANS
lecture
‘Plexus’:
intermingling /
merging of nerves
and subsequent re-
organisation
--> distribution of
peripheral nerves
is different from
that of spinal
nerves
 DERMATOMAL MAP

• Skin area supplied with sensory innervation by spinal nerves

Equivalent
for motor
output to
muscle
groups:
Myotome
 Spinal Cord Meninges

Periosteum of Vertebra
- Epidural Space ----------------- epidural anesthesia
(fat, vein, epidural plexus)
Dura Mater Spinalis
Arachnoid Membrane
- Subarachnoid Space -------- Lumbar Puncture
Spinal Anesthesia
Pia Mater Spinalis
- Denticulate Ligament --------- Cordotomy
- Filum Terminale
 Meninges of
the spinal cord
• Dura mater
• Arachnoid membrane
• Pia mater

Denticulate ligament
- specilization of the pia mater
- landmark for cordotomy
Meninges of the spinal cord
Meninges of the spinal cord
Lumbar Puncture – lumbar (terminal) cistern
 Spinal Cord Vascular Supply

Arterial Supply
- Spinal Arteries
Anterior (1) & Posterior (2) Spinal Artery
from Vertebral artery
- Radicular Arteries ----- Segmental arteries
from Vertebral, Ascending Cervical, Intercostal and
Lumbar Artery
Venous Drainage
- Longitudinal & Radicular Veins
to Intervertebral veins ---- to Internal Vertebral Venous Plexus
to external vertebral venous plexus ---- to segmental veins
 5. Adamkiwicz artery

anterior spinal artery segmental arteries

Spinal Cord Internal Structure

White Matter
Anterior Funiculus (Anterior White Column)
Posterior Funiculus (Posterior White Column)
Fasciculus Gracilis & Fasciculus Cuneatus
Lateral Funiculus (Lateral White Column)
Gray Matter
Anterior Horn ------------ --- motor
Posterior Horn -------------- sensory
Lateral Horn ----------------- autonomic (sympathetic)
Gray Commissure -------- anterior and posterior
1. posterior horn
9. anterior median
2. anterior horn fissure

3. intermediate zone 10. posterior median

sulcus
(intermediate gray)
11. anterolateral
4. lateral horn
sulcus
5. posterior funiculus
12. posterolateral
6. anterior funiculus sulcus
13. Posterior
7. lateral funiculus
intermediate
8. Lissauer's tract sulcus
cervical enlargement (C8) thoracic cord (T8)

lumbal enlargement (L3) sacral cord (S1)

 Spinal Cord Internal Structure

Principles of Cord Organization

1) Longitudinal Arrangement
Fibers (White Matter) ------------- White Column
Cell Groups (Gray Matter) ------- Gray Column

2) Transverse Arrangement
Afferent & Efferent Fibers
Crossing (Commissural and Decussating) Fibers

3) Somatotopical Arrangement
Columnnar arrangement somatotopical arrangement
Spinal Cord Internal Structure

Lamina of Rexed
Lamina I ---------- posteromarginal nucleus
Lamina II ---------- substantia gelatinosa of Rolando
Lamina III, IV ----- nucleus proprius
Lamina V, VI
Lamina VII --------- intermediate gray
intermediolateral cell column (ILM)
Clarke’s column (Nucleus dorsalis)
intermediomedial cell column (IMM)
Lamina VIII
Lamina IX ---------- anterior horn (motor) cell
Lamina X ----------- gray commissure
Lamina of Rexed
• There is a continuous flow of information between the
brain, spinal cord, and peripheral nerves. This
information is relayed by sensory (ascending) and
motor (descending) ‘pathways’.
• Generally the pathways:
 Consists of a chain of tracts, associated nuclei and
varying number of relays (synapses)
 Consist of two or three neurons
 Exhibit somatotopy (precise spatial relationships)
 Decussate
 Involve both the brain and spinal cord
 Are paired (bilaterally and symmetrically)
SOMATIC SENSORY PATHWAYS
 SENSORY PATHWAYS
 Monitor conditions both inside the body and in the
external environment
 Sensation-stimulated receptor passes information to
the CNS via afferent (sensory) fibers
 Most sensory information is processed in the spinal
cord , thalamus, or brain stem. Only 1% reaches the
cerebral cortex and our conscious awareness
 Processing in the spinal cord can produce a rapid
motor response (stretch reflex)
 Processing within the brain stem may result in
complex motor activities (positional changes in the
eye, head, trunk)
 SENSORY PATHWAYS
 Contain a sequence of THREE
neurons from the receptor to
the cerebral cortex
 First order neuron: Sensory 3
neuron that delivers information
from the receptor to the CNS.
 Cell body located in the dorsal
root ganglion. The Axon
(central process) passes to the 2
spinal cord through the dorsal
root of spinal nerve gives many
collaterals which take part in
spinal cord reflexes runs 1
ipsilaterally and synapses with
second-order neurons in the
cord and medulla oblongata
 Second order neuron:
Has cell body in the
spinal cord or medulla
oblongata
Axon decussate &
Terminate on 3rd order
neuron

 Third order neuron:

Has cell body in
thalamus
Axon terminates on
cerebral cortex
ipsilaterally
SENSORY
PATHWAYS
• The sensory pathways convey
the type and location of the
sensory stimulus

• The type: because of the type

of receptor activated

• The location: because the

brain has a map of the
location of each receptor
 WHITE MATTER: PATHWAY
GENERALIZATIONS
 Ascending and descending fibers are organized in
distinct bundles which occupy particular areas and
regions in the white matter
 Generally long tracts are located peripherally in the
white matter, while shorter tracts are found near the
gray matter
• The TRACT is a bundle of nerve fibers (within CNS) having the same
origin, course, destination & function
• The name of the tract indicates the origin and destination of its fibers
• The axons within each tract are grouped according to the body region
innervated
 TRACTS OF THE SPINAL
CORD
 Tracts that serve to join brain to the spinal
cord
 Ascending
 Descending
 Fibers that interconnect adjacent or distant
segments of the spinal cord
 Intersegmental (propriospinal)
 INTERSEGMENTAL TRACTS
• Extensive fiber connections
between spinal segments
• Fasciculus proprius
• Short ascending &
descending fibers
• Both crossed &
uncrossed
• Begin and end within the
spinal cord
• Participate in
intersegmental spinal
reflexes
• Present in all funiculi
adjacent to gray matter
 INTERSEGMENTAL TRACTS
 Dorsolateral tract of
Lissauer: Primary sensory
fibers carrying pain,
temperature and touch
information bifurcate upon
entering the spinal cord. Their
branches ascend and
descend for several spinal
segments in the dorsolateral
tract, before synapsing in the
dorsal horn

Intersegmental fibers, establishing connections with neurons in the

opposite half of the spinal cord, cross the midline in the anterior white
commissure
 ASCENDING SPINAL TRACTS
Transmit impulses:
 Concerned with specific sensory modalities:
pain, temperature, touch, proprioception, that
reach a conscious level (cerebral cortex)
Dorsal column funiculi
Spinothalmic tracts
 From tactile and stretch receptors to
subconscious centers (cerebellum)
Spinocerebellar tracts
• Three major pathways carry sensory information
Posterior column pathway (gracile & cuneate
fasciculi)
Anterolateral pathway (spinothalamic)
Spinocerebellar pathway
 ASCENDING SPINAL TRACTS
 Dorsal white column
 Lateral spinothalamic
 Anterior spinothalamic
 Anterior spinocerebellar
 Posterior spinocerebellar
 Cuneocerebellar
 Spinotectal
 Spinoreticulr
 Spino-olivary
 Visceral sensory tracts
 DORSAL COLUMN
• Contains two tracts, Fasciculus
gracilis (FG) & fasciculus
cuneatus (FC)
• Carry impulses concerned with
proprioception and
discriminative touch from
ipsilateral side of body
• Contain the axons of primary
afferent neurons that have
entered cord through dorsal
roots of spinal nerves

FG contains fibers received at sacral, lumbar and lower thoracic levels, FC

contains fibers received at upper thoracic and cervical levels
• Fibers ascend without
interruption where they
terminate upon 2nd order
neurons in nucleus gracilis and
nucleus cuneatus
• The axons of the 2 nd order
neurons decussate in the
medulla as internal arcuate
fibers and ascend through the
brain stem as medial lemniscus.
• The medial lemniscus
terminates in the ventral
posterior nucleus of the
thalamus upon 3rd order
neurons, which project to the
somatosensory cortex
(thalamocortical fibers)

•
 SPINOTHALAMIC TRACTS
 Located lateral and ventral
to the ventral horn
 Carry impulses concerned
with pain and thermal
sensations (lateral tract) and
also non- discriminative
touch and pressure (medial
tract)
 Fibers of the two tracts are
intermingled to some extent
 In brain stem, constitute the
spinal lemniscus
 Fibers are highly somato-
topically arranged, with
those for the lower limb
Information is sent to the
lying most superficially and primary sensory cortex on the
those for the upper limb
lying deeply opposite side of the body
 LATERAL SPINOTHALAMIC TRACT
 Carries impulses concerned
with pain and thermal
sensations.
 Axons of 1st order neurons
terminate in the dorsal horn
 Axons of 2nd order neuron
(mostly in the nucleus
proprius), decussate within
one segment of their origin,
by passing through the
ventral white commissure &
terminate on 3rd order
neurons in ventral posterior
nucleus of the thalamus
 Thalamic neurons project to
the somatosensory cortex
ANTERIOR SPINOTHALAMIC TRACT
 Carries impulses concerned
with non- discriminative touch
and pressure
 Axons of 1st order neurons
enter cord terminate in the
dorsal horn
 Axons of 2nd order neuron
(mostly in the nucleus
proprius) may ascend several
segments before crossing to
opposite side by passing
through the ventral white
commissure & terminate on
3rd order neurons in ventral
posterior nucleus of the
thalamus
 Thalamic neurons project to
the somatosensory cortex
 SPINO-RETICULO-THALAMIC
SYSTEM

• The system represents an additional route by which dull, aching pain is

transmitted to a conscious level
• Some 2nd order neurons terminate in the reticular formation of the brain stem,
mainly within the medulla
• Reticulothalamic fibers ascend to intralaminar nuclei of thalamus, which in
turn activate the cerebral cortex
 SPINOCEREBELLAR TRACTS
 The spinocerebellar system
consists of a sequence of
only two neurons
 Two tracts: Posterior &
Anterior
 Located near the
dorsolateral and
ventrolateral surfaces of the
cord
 Contain axons of the
second order neurons
 Carry information derived
from muscle spindles, Golgi
tendon organs and tectile
receptors to the cerebellum
for the control of posture
and coordination of
movements
 POSTERIOR SPINOCEREBELLAR
TRACTS
• Present only above level
L3
• The cell bodies of 2 nd
order neuron lie in
Clark’s column
• Axons of 2nd order
neuron terminate
ipsilaterally (uncrossed)
in the cerebellar cortex
by entering through the
inferior cerebellar
peduncle
 VENTRAL SPINOCEREBELLAR
TRACTS
• The cell bodies of 2 nd order
neuron lie in base of the dorsal
horn of the lumbosacral
segments
• Axons of 2nd order neuron cross
to opposite side, ascend as far as
the midbrain, and then make a
sharp turn caudally and enter the
superior cerebellar peduncle
• The fibers cross the midline for a
second time within the
cerebellum before terminating in
the cerebellar cortex
 Both spinocerebellar tracts
convey sensory information to the
same side of the cerebellum
 SPINOTECTAL TRACT
 Ascends in the anterolateral
part in close association with
spinothalamic system
 Primary afferents reach dorsal
horn through dorsal roots and
terminate on 2nd order
neurons
 The cell bodies of 2 nd order
neuron lie in base of the
dorsal horn
 Axons of 2nd order neuron
cross to opposite side, and
project to the periaquiductal
gray matter and superior
colliculus in the midbrain
 SPINO - OLIVARY TRACT
• Indirect spinocerebellar pathway (spino-olivo-cerebellar)
• Impulses from the spinal cord are relayed to the cerebellum via inferior
olivary nucleus
• Conveys sensory information to the cerebellum
• Fibers arise at all level of the spinal cord
 SPINORETICULAR TRACT
• Originates in laminae
IV-VIII
• Contains uncrossed
fibers that end in
medullary reticular
formation & crossed &
uncrossed fibers that
terminate in pontine
reticular formation
• Form part of the
ascending reticular
activating system
SOMATIC MOTOR PATHWAYS
 MOTOR PATHWAYS
• CNS issues motor commands in response to
information provided by sensory systems, sent by
the somatic nervous system (SNS) and the
autonomic nervous system (ANS)
• Conscious and subconscious motor commands
control skeletal muscles by traveling over 3
integrated motor pathways
• The corticospinal pathway – voluntary control of
motor activity
• Corticobulbar tracts
• Corticospinal tracts
• The medial and lateral pathways – modify or direct
skeletal muscle contractions by stimulating,
facilitating, or inhibiting lower motor neurons
 MOTOR PATHWAYS
• Contain a sequence of TWO
neurons from the cerebral UMN
cortex or brain stem to the
muscles
• Upper motor neuron : has cell
body in the cerebral cortex or
brain stem, axon decussates
before terminating on the lower
motor neuron
• Lower motor neuron: has cell
body in the ventral horn of the
spinal cord, axon runs in the
ipsilateral ventral root of the
spinal nerve and supply the
muscle. LMN
DESCENDING SPINAL TRACTS

 Originate from the cerebral cortex & brain

stem
 Concerned with:
 Control of movements
 Muscle tone
 Spinal reflexes & equilibrium
 Modulation of sensory transmission to
higher centers
 Spinal autonomic functions
• The motor pathways are
divided into two groups
• Direct pathways
(voluntary motion
pathways) - the
pyramidal tracts
• Indirect pathways
(postural pathways),
essentially all others -
the extrapyramidal
pathways
 DIRECT (PYRAMIDAL) SYSTEM
• Regulates fast and fine (skilled) movements
• Originate in the pyramidal neurons in the
precentral gyri,
• Impulses are sent through the corticospinal
tracts and synapse in the anterior horn
• Stimulation of anterior horn neurons activates
skeletal muscles
• Part of the direct pathway, called corticobulbar
tracts, innervates cranial nerve nuclei
 INDIRECT (EXTRAPYRAMIDAL)
SYSTEM
 Complex and multisynaptic pathways
 The system includes:
• Rubrospinal tracts: control flexor muscles
• Vestibulospinal tracts: maintain balance and
posture
• Tectospinal tracts: mediate head neck, and
eye movement
• Reticulospinal tracts
 DESCENDING SPINAL TRACTS
• Pyramidal
• Corticospinal
• Extrapyramidal
• Rubrospinal
• Tectospinal
• Vestibulospinal
• Olivospinal
• Reticulospinal
• Descending Autonomic Fibers
 CORTICOSPINAL TRACTS
 Concerned with voluntary,
discrete, skilled
movements, especially
those of distal parts of the
limbs (fractionated
movements)
 Innervate the contralateral
side of the spinal cord
 Provide rapid direct
method for controlling
skeletal muscle
 Origin: motor and sensory
cortices
 Axons pass through corona
radiata, internal capsule,
crus cerebri and pyramid of
medulla oblongata
 In the caudal medulla about
75-90% of the fibers
decussate and form the
lateral corticospinal tract
 Rest of the fibers remain
ipsilateral and form anterior
corticospinal tract. They
also decussate before
termination
• Distribution:
• 55% terminate at cervical region
• 20% at thoracic
• 25% at lumbosacral level

• Termination: Ventral horn

neurons (mostly through
interneurons, a few fibers
terminate directly)
• Corticobulbar tracts end
at the motor nuclei of CNs
of the contralateral side
 RUBROSPINAL TRACT
• Controls the tone of limb
flexor muscles, being
excitatory to motor neurons
of these muscles
• Origin: Red nucleus
• Axons course ventro-
medially, cross in ventral
tegmental decussation,
descend in spinal cord
ventral to the lateral
corticospinal tract
• Cortico-rubro-spinal
pathway (Extrapyramidal)
 TECTOSPINAL TRACT
 Mediates reflex movements of
the head and neck in
response to visual stimuli
 Origin: Superior colliculus
 Axons course ventro-medially
around the periaqueductal
gray matter, cross in dorsal
tegmental decussation,
descend in spinal cord near
the ventral median fissure,
terminate mainly in cervical
segments
 Cortico-tecto-spinal pathway
(Extrapyramidal)
 VESTIBULOSPINAL TRACTS
• Lateral Vestibulospinal
Tracts
• Origin: lateral vestibular
(Deiter’s) nucleus
• Axons descend ipsilaterally in
the ventral funiculus
• Terminate on ventral horn
cells throughout the length of
spinal cord
• Has excitatory influences
upon extensor motor
neurons, control extensor
muscle tone in the antigravity
maintenance of posture
 VESTIBULOSPINAL TRACTS
 Medial vestibulospinal
tract
 Origin: medial vestibular
nucleus
 Axons descend bilaterally in
the ventral funiculus, with the
medial longitudinal fasciculus
 Most of the fibers end in the
cervical region, some reaching
upper thoracic segments
 Involved in movements of the
head required for maintaining
equilibrium
WHITE MATTER: PATHWAY GENERALIZATIONS
 SUMMARY: PATHWAYS IN THE SPINAL CORD

Ascending (afferent) pathways (sensation) Descending (efferent) pathways (motor commands)

*
ASCENDING TRACTS:
FASCICULUS
GRACILIS
Function:
• Fine touch
• “Conscious” proprioception
• Below T6
Brain stem tracts @ risk in:
• Medial Medullary
Syndrome (from occlusion
of Vertebral a./lower Basilar
a.)
Cord tracts @ risk in:
• Tabes Dorsalis (from
Neurosyphilis)
• Direct injury: stabbing,
iatrogenic.
• Vascular injury?: 2 x
posterior spinal arteries
supply posterior 1/3 of cord.
@ Thalamus:
• Synapse in Ventral Posterior
Lateral Nucleus + ascends to
contralateral cortex
@ Midbrain:
• Ascends in Medial Lemniscus
@ Pons:
• Ascends in Medial Lemniscus
@ Medulla:
• Synapses in Nucleus Gracilis
• Decussates to ascend
contralateral to stimulus
@ Spinal Level (below T6)
• Via dorsal root ganglia
• Enters + ascends ipsilateral to
stimulus in Fasciculus Gracilis
in Dorsal Columns
ASCENDING TRACTS:
@ Thalamus:
FASCICULUS • Synapse in Ventral Posterior
Lateral Nucleus + ascends to
CUNEATUS contralateral cortex
Function:
• Fine touch @ Midbrain:
• “Conscious” proprioception • Ascends in Medial Lemniscus
• T6 + above

Brain stem tracts @ risk in:
• Medial Medullary
Syndrome
Cord @ Risk in:
• MS
• Tabes Dorsalis
• Iatrogenic injury
• Vascular injury?
@ Pons:
• Ascends in Medial Lemniscus
@ Medulla:
• Synapses in Nucleus
Cuneatus
• Decussates to ascend
contralateral to stimulus
@ Spinal Level (T6 + above)
• Via dorsal root ganglia
• Enters + ascends ipsilateral to
stimulus in Fasciculus
Cuneatus in Dorsal Columns

ASCENDING TRACTS:
SPINOTHALAMIC
Function:
• Pain
• Temperature
• “Deep” touch/pressure
Brain stem tracts @ risk in:
• Lateral Medullary
Syndrome (from occlusion
of Vertebral a./PICA)
Cord @ Risk in:
• Syringomyelia: from
enlargement of central canal
• Vascular injury: 1 x
anterior spinal artery
supplies anterior 2/3 of
cord.
@ Thalamus:
• Synapse in Ventral Posterior
Lateral Nucleus + ascends to
contralateral cortex
@ Midbrain:
• Ascends in Spinal Lemniscus
@ Pons:
• Ascends in Spinal Lemniscus
@ Medulla:
• Ascends in Spinal Lemniscus
@ Spinal Level
• Via dorsal root ganglia
• Synapses
• Decussates (within 2-3 levels)
via Ventral White Commisure
to ascend contralateral to
stimulus
ASCENDING TRACTS:
SPINOCEREBELLAR
Function:
• “Unconscious”
proprioception @ Superior Cerebellar Peduncle:
• Ventral decussate again
• And enter cerebellum
ipsilateral to stimulus
Brain stem tracts @ risk in:
• Lateral Medullary
Syndrome @ Inferior Cerebellar Peduncle:
• Dorsal Medullary
• Dorsal enter cerebellum,
Syndrome (from PICA ipsilateral to stimulus
occlusion)

Cord @ Risk in: @ Spinal Level

• Vascular injury: anterior
spinal a.
• Friedreich’s ataxia
• Via dorsal root ganglia
• Synapses
• Dorsal ascend ipsilateral in
Dorsal Spinocerebellar Tract
• Ventral decussate and ascend
contralateral in Ventral
Spinocerebellar Tract
DESCENDING
@ Cortex:
TRACTS: LATERAL • UMN descends from
CORTICOSPINAL contralateral cortex via Internal
Capsule
Function:
• 75 - 90% of voluntary,
@ Midbrain:
skilled motor
• Descends in Cerebral
Peduncle

Brain stem tracts @ risk in:

• Medial Medullary
@ Pons:
Syndrome
• Locked-in Syndrome • Descends in fascicles
(from Basilar a.
occlusion/trauma) @ Medulla:
• Decussates in Caudal Medulla
Cord tracts @ risk in:
• To descend in Pyramids, then
• Vascular injury: anterior
Lateral Corticospinal Tract,
spinal a.
ipsilateral to effector

@ Spinal Level
• Synapse with LMN in Ventral
Horn
DESCENDING @ Cortex:
TRACTS: VENTRAL • UMN descends from
contralateral cortex via
CORTICOSPINAL Internal Capsule

Function:
• 10 - 25% of voluntary, @ Midbrain:
skilled motor • Descends in Cerebral
Peduncle

Brain stem tracts @ risk in:

• Medial Medullary
Syndrome
• Locked-in Syndrome
Cord tracts @ risk in:
• Vascular injury: anterior
spinal a.
@ Pons:
• Descends in fascicles
@ Medulla:
• Descends in Pyramids, then
Ventral Corticospinal Tract,
contralateral to effector

.
@ Spinal Level
• Decussate
• Synapse with LMN in Ventral
Horn
DESCENDING
TRACTS:
VESTIBULOSPINAL
Function:
• Mediates excitation of
extensor muscles,
maintaining extensor tone +
posture.
@ Pons:
Cord tracts @ risk in:
• Vascular injury: anterior • Arises in Lateral Vestibular
Nuclei
spinal a.
• Receives input from labyrinth (via
cn VIII) + cerebellum (via inf.
. Cerebellar peduncle)

@ Medulla:
• Descends just dorsal to the
Pyramids, then Lateral
Vestibulaospinal Tract,
ipsilateral to effector

@ Spinal Level
• Synapse with LMN in Ventral
Horn
DESCENDING
TRACTS:
@ Midbrain:
RUBROSPINAL • Arises from Red Nucleus
Function:
• Receives input from
• Mediates excitation of
cerebellum (via sup.
flexor muscles. cerebellar peduncle)
• Decussates to descend in
Rubrospinal Tract, ipsilateral
Cord tracts @ risk in: to effector
• Vascular injury: anterior
spinal a.
@ Pons:
• Descends in Rubrospinal Tract

@ Medulla:
• Descends in Rubrospinal Tract

@ Spinal Level
• Synapse with LMN in Ventral
Horn
Spinal Tracts - Summary

• Ascending tracts:
• all rise ipsilateral to the stimulus, except for spinothalamic + ventral part of
spinocerebellar
• Descending tracts:
• All descend ipsilateral to the effector muscle, except for ventral corticospinal
Spinal Tracts - Injury

• Hemi-section of cord:
– Loss of dorsal columns  loss of ipsilat. fine touch + proprioception
– Loss of dorsal spinocerebellar  some ipsilat. intention tremor/ataxia
– Loss of ventral spinocerebellar  some contralat. intention tremor/ataxia
– Loss of spinothalamic  loss of contralat. pain, temperature + pressure
– Loss of lateral corticospinal  loss of ipsilat. 75-90% fine motor
– Loss of vestibulospinal  loss of ipsilat. extensor tone
– Loss of rubrospinal  loss of ipsilat. flexor tone
– Loss of ventral corticospinal  minor loss of contralat. fine motor
Spinal Tracts - Injury

• Anterior Spinal Artery Occlusion (anterior 2/3 of cord):

– Dorsal columns maintained  fine touch intact
– Loss of most spinocerebellar  bilat. intention tremor/ataxia
– Loss of spinothalamic  loss of bilat. pain, temperature + pressure
– Loss of some? lateral corticospinal and all ventral corticospinal  loss of most?
bilat. fine motor
– Loss of vestibulospinal  loss of bilat. extensor tone
– Loss of rubrospinal  loss of bilat. flexor tone
Brain Stem – Upper & Lower Midbrain

Nuceli:
• EPW – Pupil response Edinger-Westphal Nucleus
• CN III – Occulomotor
• CN IV – Trochlear CN III Nucleus
• Medial Lemniscus
• Red Nucleus CN V – Sensory
(Mesencephalic nucleus Spinal Lemniscus
proprioception) – flexor coordination
Substantia Niagra
Benedikt’s syndrome:
• Occlusion of posterior cerebral a. Red Nucleus
• Loss of CNIII  Ipsilat. CNIII Palsy
• Loss of Red Nucl.  ataxia CN V Sensory
• Loss of corticospinal/bulbar  (proprioception)
contralat. hemiparesis
Corticospinal tracts
Weber’s syndrome:
• Tumour in the inter-peduncular
fossa
• Loss of CNIII  Ipsilat. CNIII Palsy Corticobulbar tracts
• Loss of corticobulbar tracts  CN IV Nucleus
contralat. bulbar palsy
Brain Stem – Pons

Nuclei:
• CN V – Sensory part (Chief
nucleus - light touch)
• CN V – Motor part
• CN VI – Abducens
• CN VII - Facial
• CN VIII – Vestibular part

Occlusion of pontine arteries: CN VIII Nucleus

• Loss of CNV  loss of ipsilat.
mastication + facial sensation CN VI Nucleus
• Loss of CNVI loss of lateral CN V Sensory
gaze in ipsilat. eye (light touch)
• Loss of CNVII  ipsilat. facial CN V Motor
palsy
• Loss of CNVIII  N+V, Spinal Lemniscus
nystagmus, vertigo
•Loss of medial lemniscus  loss CN VII Nucleus
of contralat. fine touch Medial Lemniscus
• Loss of spinal lemniscus  loss
of contralat. pain + temp Corticospinal tracts
• Loss of corticospinal tracts 
loss of all contralat. fine motor
Brain Stem – Medulla

Nuclei:
• CN V – Sensory part (pain + temp)
• CN VIII – Cochlear part
• CN X Dorsal Nucleus – Parasymp on CN X
• CN XII – Accessory
• Nucleus Solitarius – Taste + carotid +
CN XII Nucleus
arotic body input (CN VII, IX, X)
• Nucleus Ambiguus – Motor for speech + Nucleus Solitarius
swallowing (CN IX, X)
CN VIII Nucleus
Occlusion of vertebral as./PICA: CN X Dorsal Nucl
• Loss of CNV  loss of ipsilat. pain + temp
• Loss of CNX DN  loss of vagal input?
• Loss of CNXII  tongue protrudes CN V Sensory
towards side of lesion (Pain + temp)
• Loss of CNVIII  N+V, nystagmus, vertigo
• Loss of NS  Loss of taste + Spinal Lemniscus
homeostasis?
Nucleus Ambiguus
• Loss of NA  Loss of speech, swallow +
gag Medial Lemniscus
• Loss of medial lemniscus, spinal
Corticospinal tracts
lemniscus & corticospinal tracts