Exam #2 Notes Flashcards
What type of information does the Anterolateral System (STT) covey?
Pain, Temperature and crude touch
Are sensory pathways ascending or descending?
Ascending.
Motor pathways are descending
In the STT and DCML the primary neurons are all located in the:
DRG
Neuron #1 synapses in:
The spinal cord
The STT and DCML pathways will synapse on:
The cortical sensory strip
What are the two parts of the anterolateral (STT) tract:
Anterior spinothalamic tract: Crude touch
Neospinothalamic tract (classic LST): Pain (fast) and temp
What type of fibers can be found in the ALS/STT?
Mostly Ad (myelinated) Some C fibers (unmyelinated)
Describe the 3 neuron system in the ALS/STT:
- 1* neuron in DRG (is pseudonunipolar): Central process transmits into CNS
Peripheral process picks up Information from receptor - 2* neuron (Multipolar) in I (marginal zone; Rex laminal) and II (Substantial gelatinosa; Rex lamina 2)– Dorsal horn
- 3* neuron (Multipolar) in VPL of THALAMUS (central posterior lateral nucleus): The third neuron projects to sensory strip
What types of receptors does the STT have?
Free nerve endings: Sense pain, temp touch
Grey matter contains
Cell bodies
White matter contains:
Nerve fibers
What forms Lissauer’s tract?
Central process going into the spinal cord trying to get to grey matter forms the lissauer’s tract
What is the central process?
Terminates in brainstem or spinal cord
What is the peripheral process?
Receptive end (Muscle, join, skin, eat)
Function of mechanoreceptors?
Touch, Pressure, Stretch
Function of thermoreceptors
Temperature
Function of Nociceptors
Noxious stimuli (pain)
Function of Chemoreceptors:
Smell, Taste, pH ion concentration
List and describe the Non-encapsulated receptors:
Hair Follicle receptor: Located in the follicle. Senses touch
Merkel Complex: Located on hairy and glabrous skin. Senses touch
Free Nerve Ending: Located on skin, muscle, tendons, joints. Senses pain (nociceptors)
List and describe the Encapsulated receptors:
Meissner’s receptor: Senses light touch. Is made up of horizontal lamellae. Created by stacks of epithelial cells. 1* afferent goes into structure indigestion between the stacks of epithelial cells
Pacinian Receptos: Sense vibration and pressure. Concentric lamellae: Rings of CT lined by single layer of epithelial cells. 1* afferent in center
Ruffini Receptors: (look like free nerve endings) Sense stretch and proprioception. Ct capsule and 1* afferent
What are the types of pain?
Skin (Cutaneous; dermis and epidermis)- somatic
Joint
Visceral
What receptors are found in Gingiva?
Meissner’s Ruffini, Free nerve endings
What receptors are found in Teeth?
Pulp, Dentin: Free nerve endings
PDL: Ruffini, Free nerve endings
What are the types of fibers in the muscle spends that help to detect changes in length?
- Extrafusal fibers: Skeletal muscle fibers
- Intrafusal fibers: Nuclear bag fiber, Nuclear chain fiber
- Sensory fibers: Annulospiral and flower spray endings
Nuclear bag is associated with both annulospiral and flower spray endings.
Nuclear chain is only associated with flower spray endings.
wrap around nuclear chain and bag fibers
What does the Golgi Tendon Apparatus do?
Detects tension. It’s found at the junction of tendon and muscle
Which nerve fibers is the fastest, slowest, smallest and largest?
Fastest: Aalpha (Ia/b): Largest and faster found in annulospiral endings and golgi tendons— Myelinated
Slowest: C (IV): the smaller and slowest nerve fiber. Functions in pain and temp. Is the only unmyelinated fiber
The slowest myelinated fiber is the Alphadelta (III) It functions in crude touch, temp and pain
Describe the pathway of STT:
Neuron #1: Peripheral process picks up sensory information to dorsal horn. The cell body is located in DRG
Neuron #2: Will decussate in anterior white commissure. Will either travel to RL I (Marginal zone) or RL II (Substantial gelatinous)
It will ascend in contralateral lateral functions. The same pattern occurs in cervical, thoracic, and lumbar regions. Pathway gets larger as it ascends.
Neuron #3 is located in the VPL in the Thalamus. Axons of neuron #3 will ascend to the cortex, from thalamus out to the posterior limb of the internal capsule then make way up to the post central gyrus.
What is the internal capsule?
Structure composed of lots of different types of fibers
How does the neurons from #3 in the STT get to the post central gyrus
Through the posterior limb of the internal capsule
Sensation to the face will exit the somatosensory cortex near the:
Lateral sulcus
The central process creates sewers tract from:
Cell body #1 the pseudonunipolar neuron
What are the descending pathways?
- Periaqueductal gray (PAG) in midbrain
- Rostroventral medulla (RVM)
- Nucleus raphe magnus (NRM)
These are off shoots of STT, Important for pain modulation
Describe the PAG-NRM pathway:
STT sends fibers to PAG: (Some ascending afferent fibers will change course: will leave tract and project to PAG)
PAG fibers project to NRM in RVM
NRM fibers project to DH: Release serotonin and activate interneurons
Interneurons release endogenous opioids (ex. Enkephalins): bind opioid receptors on incoming Adelta and C fibers
Produce analgesia (block some pain)
Describe the Periaquaductal Grey (PAG):
- Ascending fibers branch off to PAG
- From PAG other axons project down to NMR
- Will descend to dorsal horn.
For pain modulation
How do the descending pathways block pain?
Fibers originating from STT activate neurons in NMR. Serotonin is related from NRM neurons which activates interneurons.
Interneurons release endogenous opioids (enkephalins) that bind to opioid receptors on incoming C and A-delta fibers
Blocks activation of 2nd order STT neuron
Produces analgesia
What is affected in Brown squared syndrome?
It’s a hemisection of the spinal cord and will affect pain, temp, touch, proprioception and motor affected.
Specifically it will lead to contralateral loss of pain, temp and crude touch. (STT)
Loss of motor function and vibration, position, and deep touch sensation on same side as the damage. Ipsilateral loss. (DCML)
UMN axons cross at brinastem (medulla) so anything below is ipsilateral
What is a Cordotomy?
Surgical intervention for intractable pain. Cuts ascending tracts. Procedure done on opposite side
Dysesthesia (abnormal sensations) often develops
What types of sensation are carried in the DC-ML pathway?
- Proprioception (conscious)
- Kinesthesia (Perception of motion)
- Fine touch/ 2 point discrimination:
- Stereognosis: Ability to perceive/recognize forms w/o hearing and vision
- Vibration
Which cell bodies are pseudo unipolar and multipolar in DC-ML?
Cell body #1: Pseudounipolar
Cell body #2&3: Mutlipolar
*Same as STT
What types of nerve fibers are in the DC-ML?
ABeta: Flowerspray Myelinated: GTO, annulospiral
Does the DC-ML have few or many synapses?
Few synapses
What are the sensory receptors in the DC-ML?
- Merkel’s Receptors: Light pressure/texture
- Pancinian Corpuscles: Vibration and Pressure
- Meissners corpuscles: Light touch
- Proprioception:
- Neuromuscular: Annulospiral and Flower spray endings
- Neurotendinous: Golgi Tendon
Spinal Primary Affernets enter:
Cell body in DRG Enter post SC via Dorsal rootlets; Rootlets represent efferents.
Delta and C fibers come in leisseurs tract
Larger fibers enter more medially through the large fiber entry zone.
In DC-ML; Sensation from the lower extremities will travel through the:
Fasciculus gracilis
In DC-ML; Sensation from the upper extremities will travel through:
Fasciculus cuneatus
What is the posterior column/funiculus?
Formed by afferent fibers carrying touch and proprioception
Fibers going in the posterior column, part of dorsal column medial leminscus: Efferents carrying fine touch and proprioception go in through the posterolateral sulcus or Posterolateral tract.
This as opposed to STT which is synapsing in dorsal horn.
What is the relationship of F. Cuneatus and F. Gracilis to the vertebral column?
F. cuneatus is rostral to T6 (is T6 and above)
f. Gracilis is caudal to T^ ( is T7 and below)
If there’s a lesion below T6 what will it affect in the DC-ML pathway?
It will only effect info coming from the legs
The somatic organization of the spinal cord fibers will enter?
Medially and be added laterally
Describe the pathway in DC-ML:
Neuron #1: Cell body in DRG. CP enters (medially to STT) spinal cord and ascends
Neuron #2: Cell body is in nucleus gracilis (legs) or cuneatus (trunk, UE). (In the medulla) Axon of CB#2 will decussate as internal arcuate fibers. Forms the medial meniscus and projects to the thalamus.
As fibers are decussating they are called internal arcuate fibers. As they ascend they are called medial meniscus.
Neuron #3: In the VPL of the thalamus. Never fibers from CB#3 (VPL) ascend (exit) thru posterior limb of internal capsule on way to cortex (SAME as STT). Will terminate in post central gyrus
Spinal cord lesion in DC-ML pathway:
Will lead to ipsilateral loss of modalities below lesion:
- Inferior to decussation (decussation occur in medulla
- axons haven’t crossed
Medial meniscus/medulla lesion in DC-ML pathway:
Will lead to contralateral loss of modalities below lesion:
- Superior to decussation
- Axons have crossed
Lesions in the DC-ML will lead to:
Impairment of tactile perception: Because you still have the STT in tract, Still have crude touch but won’t have fine touch
- Loss of proprioception and kinesthesia
- Ataxia
What is Tabes Dorsalis?
Neurosyphilis (posterior column damage)- Stage 4
- Chronic inflammation of dorsal roots and ganglia. Degeneration of posterior column
- Loss of 2 point discrimination
- movement and position impairment
- difficulty walking
- Positive rhomberg’s sign: Identifies sensory ataxia