NeuralPathways

Sensory Pathway
MedialLemniscus 1. 2. 3.

Function

Receptors (Peripheral)
1. Meissners, Merkels, Peritrichial Pacinian, Meissners Diffuse Nerve Endings

1st OrderNeuron

2nd Order Neuron

Nucleus Gracilis and Cuneatus Form Internal Arcuate Fibers (course ventromedial) Somatotopic Organization! Superficial spinal cord lamina (I-IV)

3rd Order Neuron

VPL (thalamus) Via Internal Capsule to Area 3,1,2 (Somatosen. Cortex in postcentral gyrus) 1.

Synapses

Decussation

Lesions

Clinical Correlations
Romberg Sign -- test for cons. Proprio Tabes Dorsalis (nerve degeneration) Wide, staggering gait; foot slap Syringomy. cavitation of central canal, ant. white comm damage Thalamic pain sydnrome (VPL damage) Cordotomy to treat pain

Discrim. Touch Vibration Conscious Proprio

2. 3.

DRG to F. Gracilis and Cuneatus Central process = medial root Peripheral process = heavily myelinated DRG and ascend 1 level (posterolat. fasciculus) Central process = lateral Peripheral process = lightly myelinated Trigeminal Ganglion To mid pons via Portio Major and descend to C2 level Trigeminal Ganglion To mid pons via Portio Major

2.

N. Gracilis and Cuneatus VPL

Caudal Medulla

Dorsal Column ipsilateral loss of discrim, vibration, cons. proprio. ML, VPL contralateral loss Lat. Funiculus contralateral loss 1 level below lesion Ant. White Commissure - bilateral 1+ dermatomes below

ALS

1.

Pain, Temp, Crude Touch

1.

Free Nerve Endings Thermo warm and cold Nociceptors detect dangeros stimuli

VPL (thalamus) Via internal capsule to area 3,1,2 (somatosen. cortex in postcentral gyrus)

1.

2.

Superficical lamina (IIV) of dorsal horn VPL

1 level above in anterior white commissure

TrigeminalSpinalNucleus

1. 2. 3.

Pain Temp Light Touch

Free Nerve Endings

Spinal Nucleus of V

VPM (thalamus) Via POSTERIOR limb of IC to postcentral gyrus VPM (thalamus) Via POSTERIOR limb of IC to postcentral gyrus -1-

1.

2.

Spinal Nucleus of V VPM

C2 - medulla Cross after leaving Spinal Nucleus of V to form VTTT

Ipsilateral loss of pain and temp to face

Trigeminal- Chief Nucleus

1. 2.

Fine Touch Vibration

1.

2.

Meissners, Merkel, Petrichial Pacinian

Chief Sensory Nucleus of V

1.

2.

Chief Sensory Nucleus of V VPM

Uncrossed form DTTT, synapse in ipsilateral VPM Pons to VTTT

NeuralPathways
Sensory Pathway
TrigeminalMesencephalic Nucleus 1.

Function

Receptors (Peripheral)
1. Diffuse Endings in joint capsule

1st OrderNeuron

2nd Order Neuron

Mesencephal Nucleus of V IN CNS (rostral and mid pons!)

3rd Order Neuron

VPM To 3,1,2 (ventral of lateral surface) Cerebellum Via ipsilateral cerebellar peduncle 1.

Synapses

Decussation

Lesions

Clinical Correlations

Conscious Proprio

Mesencephal Nucleus of V IN CNS (rostral and mid pons!)

2.

Mesenceh Nucleus of V VPM

Cross midpons to rostral midbrain Form VTTT NONE

1.

Uncons. Proprio

1.

Spindle and GTO

1.

2. 1.

Mesenceph Nucleus of V Cerebellum a.Dorsal and ventral cochlear nuclei b.Superior olivary nucleus, trapezoid (Nucleus of LL to) Inf. Colliculus Medial Geniculate Nucleus

AuditorySystem

1.

Hearing (duh)

1.

Hair cells in organ of corti

Spiral Ganglion Enter at cerebellar pontine angle

Dorsalcochlear Superior Olivary nucleusNucleus -cross midline cross midline as DORSAL to join LL ACOUSTIC STRIA to join 3rd,4th order -inferior lateral colliculus lemniscus receive from Ventral LL; send via cochlear brachium of nucleusinf. Coll. to intermediate MGN acoustic stria MGN to to lateral Transverse lemniscus -Temporal ventral Gyri of some to Heschl superior (primary - 41, olivary associated nucleus and 42) trapezoid

At level of cochlear and trapezoid nuclei (cerebellopon angle) Commissure of inf. Coll.

2.

Lateral Lemniscus bilateral loss, worse in contralateral Cochlea, CN VIII, Cochlear nuclei ipsilateral

3.

Conduction impairment of soundwave passage Perception degeneration of hair cells, tumor, damage to nerve Central interference of pathway

-2-

NeuralPathways
Sensory Pathway
Vestibular (see pg 170-3 in BRS) 2. 1.

Function

Receptors (Peripheral)
1. 2. Macula Ampulla

1st OrderNeuron

2nd Order Neuron

Vestibular nuclear complex semi circ (superior and rostral medial), u/s (lateral); also an inferior fastigial nucleus - ipsi, flocculonodul ar lobe (excitatory) vestibulocere bellum -- ipsi input from flocculus, nodulus, post. Vermis (inhibitory) Spinocerebell - ipsi input from ant. Vermis (inhibitory)

3rd Order Neuron

LVST - from lat nucleus to ipsi spinal cord alpha motorneurons (medial ventral horn axial and proximal muscles) oppose the force of gravity MVST through MLF, caudal of vestibular complex (medial nucleus), reflex head and neck mvt Eye Mvt from rostral bilaterally to abducens, trochlear, and oculomotor nuclei horizontal rotation of head 1.

Synapses

Decussation

Lesions

Clinical Correlations
Nystagmus slow phase is vestibular Thermal Test - normal = nystagmus is CO, WS

Utricle/ Saccula linear accel. Semicirc Canals balance

Scarpas Ganglion Hair cells in macula/ ampulla (deviation causes release of NTs onto Scarpas Ganglion

2.

Vestibular Nuclear Complex/ Fastigial Nucleus LVST, MVST, Eye muscle nuclei (III, IV, VI)

Some fibers cross to contralateral motor nuclei (6 from there some cross back to ipsi lateral 3)

-3-

NeuralPathways
Sensory Pathway
CentralVisual Pathway 1.

Function

Receptors (Peripheral)
1. Photorecep tors in retina

1st OrderNeuron

2nd Order Neuron

LGN - Optic radiations - to area 17; Cuneas (lower visual field, upper radiations); Lingula (upper visual field, lower radiations) Suprachiasm atic circadian rhythms Pretectal pupil diameter Superior Collic - rapid eye mvt

3rd Order Neuron

To area 18 and area 19 (parietal pathway hand-eye coordination; temporal pathway face/form analysis) 1. 2.

Synapses

Decussation

Lesions

Clinical Correlations
Occlusion of post. Cerebral artery macular sparing Injury to back of head macular blindness

Vision

Ganglion cells (receives impulse from bipolar cells) - forms optic nerve Nasal fibers cross in optic chiasma Optic Tract fibers from same visual fields

LGN Area 17

Optic Chiasma (rostral midbrain, caudal dienceph)

Optic Nerve blindness in 1 eye Optic Chiasma bitemporal heteonymous hemianopsia Optic Tract contralateral homonymous hemianopsia Meyers Loop - contralateral superior homonymous quadranopsia

-4-