Somatosensory Systems

Vito Masagus Junaidy

Departemen Bedah Saraf

Facultas Kedokteran Universitas Padjadjaran
Bandung
2022
 Overview
Input from the somatosensory systems informs the organism about
events impinging on it.

Sensation can be divided into Superficial, Deep, Visceral,

and Special Senses
four types

Reference: Clinical Neuroanatomy Stephen G. Waxman 28th edition

 Overview

Superficial sensation  touch, pain, temperature, two-point discrimination.

Deep sensation  muscle and joint position sense (proprioception), deep muscle pain,
and vibration sense.

Visceral  relayed by autonomic afferent fibers include hunger, nausea, and visceral
pain

Special senses  smell, vision, hearing, taste, and equilibrium—conveyed by cranial

nerves

Reference: Clinical Neuroanatomy Stephen G. Waxman 28th edition

 Receptors

Receptors are specialized cells for detecting particular changes in the environment

Exteroceptors
• Affected mainly by the external
environment:
• Meissner’s & Merkel’s corpuscles,
• Hair cells (touch)
• Krause’s end-bulbs (cold)
• Ruffini’s corpuscles (warmth)
• and free nerve endings (pain)
Proprioceptors
• Receive impulses mainly from
pacinian corpuscles, joint receptors,
muscle spindles, and Golgi tendon
organs.
• Painful stimuli are detected at the free
endings of nerve fibers.

Reference: Clinical Neuroanatomy Stephen G. Waxman 28th edition

 Receptors

The greater the intensity of a stimulus


• the more end-organs that stimulated,
• the longer the duration of effect

Reference: Clinical Neuroanatomy Stephen G. Waxman 28th edition

 Connections
A chain of three long neurons and a number of interneurons conducts stimuli from the receptor
or free ending to the somatosensory cortex

Third-Order Neuron
First-Order Neuron Second-Order Neuron Cell body lies in the thalamus,
Cell body lies in a dorsal root Cell body lies within the neuraxis projects rostrally to the sensory
ganglion or a somatic afferent (spinal cord or brain stem; cortex.
ganglion (eg, trigeminal ganglion) examples are provided by the They interpret its location, quality,
of cranial nerves. dorsal column nuclei). and intensity and make
appropriate responses.

Reference: Clinical Neuroanatomy Stephen G. Waxman 28th edition

 Sensory Pathways

Multiple neurons from the same type of receptor often form a bundle (tract),
creating a sensory pathway

Characterized by somatotopic distribution, with convergence in the thalamus

(ventroposterior complex) and cerebral cortex where there is a map-like
representation of the body surface.

The sensory trigeminal fibers contribute to lemniscal and ventrolateral systems 

provide input from the face and mucosal membranes

Reference: Clinical Neuroanatomy Stephen G. Waxman 28th edition

 Sensory Pathways

The lemniscal (dorsal column) system

Carries touch, joint sensation, two-point
discrimination, and vibratory sense from receptors
to the cortex.

Reference: Clinical Neuroanatomy Stephen G. Waxman 28th edition

 Sensory Pathways

The ventrolateral system

Relays impulses concerning nociceptive stimuli
(pain, crude touch) or changes in skin temperature

Reference: Clinical Neuroanatomy Stephen G. Waxman 28th edition

 Sensory Pathways

Single case of priapism in an adult that

leads to a diagnosis of muscle invasive
bladder cancer (MIBC)

Reference: Clinical Neuroanatomy Stephen G. Waxman 28th edition

 Clinical Correlations
Interruption in the course of first- and second-order neurons produces
characteristic sensory deficits, which can be especially apparent when they involve
sensitive areas such as the face or fingertips.

Example is provided by sensory loss in the territory innervated by a particular

nerve or spinal root when this nerve or root is injured.

Thalamic lesions may be characterized by loss of the ability to discriminate or

localize simple crude sensations or by severe, poorly localized pain (thalamic
pain).

Reference: Clinical Neuroanatomy Stephen G. Waxman 28th edition

 Cortical Areas

The primary somatosensory cortex (areas 3, 1, and 2) is organized in functional

somatotopic columns that represent points in the receptive field.

Within each column are inputs from thalamic, commissural, and associational fibers,
all of which end in layers IV, III, and II.

The output is from cells in layers V and VI

Additional cortical areas—secondary projection areas— also receive input from

receptive fields in the columns.

Reference: Clinical Neuroanatomy Stephen G. Waxman 28th edition

 Pain Pathways
The free nerve endings that emanate from peripheral and cranial nerves are receptors, or
nociceptors, for pain

Nociceptors are sensitive to mechanical, thermal, or chemical stimuli.

The pain fibers in peripheral nerves are of small diameter and are readily affected by
local anesthetic.

The thinly myelinated A-delta fibers convey discrete, sharp, short-lasting pain.

The unmyelinated C fibers transmit chronic, burning pain.

These nociceptive axons arise from small neurons located within the dorsal root ganglia
and trigeminal ganglia.

Reference: Clinical Neuroanatomy Stephen G. Waxman 28th edition

 Pain Pathways

Cells within injured tissue may release

inflammatory molecules such as
prostaglandins or histamine, serotonin 
which lower the threshold of peripheral
nociceptors and thereby increase the sensibility Aspirin and other nonsteroidal anti-

to pain (hyperalgesia) inflammatory drugs inhibit the action of

prostaglandins and act to relieve pain
(hypalgesia or analgesia).

Reference: Clinical Neuroanatomy Stephen G. Waxman 28th edition

 Pain Systems
The central projections of nociceptive primary sensory neurons impinge on second-order neurons
within superficial layers of the dorsal horns of the spinal cord.

Gate theory of pain

The strength of synaptic transmission at these junctions is decreased (by presynaptic
inhibition) when large (non-pain-signaling) axons within the nerve are excited (the gate
“closes”).
Conversely, the strength of synaptic transmission along the pain-signaling pathway is
increased when there is no large-fiber input.

Reference: Clinical Neuroanatomy Stephen G. Waxman 28th edition

 Pain Systems

The central ascending pathway for

sensation consists of two systems:

The spinothalamic tract conducts The spinoreticulothalamic deep,

the sensation of sharp, stabbing pain; poorly localized, burning pain.

Both pathways are interrupted when the ventrolateral quadrant of the spinal
cord is damaged by trauma
These pathways project rostrally to a network of circuits termed as the pain
matrix within the brain.

Reference: Clinical Neuroanatomy Stephen G. Waxman 28th edition

 Pain Matrix

Pain elicits emotional and autononomic responses and is

consciously appreciated as a result of activations of the pain
matrix

Structure of Pain Matrix:

thalamus, primary and secondary somatosensory cortex, insular
cortex, prefrontal cortex, anterior cingulate cortex,
supplementory motor area, posterior parietal cortex,
periaqueductal gray matter, amygdala, and cerebellum

Reference: Clinical Neuroanatomy Stephen G. Waxman 28th edition

 Referred Pain
The cells in lamina V of the posterior column that
receive noxious sensations from afferents in the
skin also receive input from nociceptors in the
viscera.

When visceral afferents receive a strong

stimulus, the cortex may misinterpret the source.

Example:
Referred pain in the shoulder caused by
gallstone colic
Spinal segments that relay pain from the
gallbladder also receive afferents from the
shoulder region (convergence theory

Reference: Clinical Neuroanatomy Stephen G. Waxman 28th edition

 Descending Systems
and Pain
Certain neurons within the brain, particularly within the
periaqueductal gray matter of the midbrain, send
descending axons to the spinal cord.

These descending, inhibitory pathways suppress the

transmission of pain signals and can be activated with
endorphins and opiate drugs.

Reference: Clinical Neuroanatomy Stephen G. Waxman 28th edition

THANK YOU