Somatosensory System (Peripheral & Central Pathways) Flashcards
What is the sensory map sharper for?
- Nociception
- Light Discriminative Touch
Nociceptive Pain Inputs –> SHARPER –> than Light Discriminative Touch
After childhood chickenpox infections, where does the herpes zoster virus lie?
- Dormant in the Primary Sensory Neurone
- In the Dorsal Root Ganglia
What sensation can the reactivated virus cause?
- Severe Burning Pain
What happens in shingles?
Reactivated virus –> travels down the afferent axons –> causing blistering of the skin
How are the effects of shingles presented?
- Often restricted to a single dorsal root –> therefore a single defined dermatome (e.g. T2)
What virus causes shingles?
Herpes-Zoster Virus
What can cause reactivation?
- Stress
- Immunosupression
- Fatigue
- Other States of Poor Health
What are the effects of shingles?
How does it cause its symptoms?
- Produces inflammation in all the nerve fibres (starting at dorsal root ganglia itself)
- Virus travels down the axons to the periphery –> producing skin blisters where there are cutaneous somatosensory endings
(too late to treat with anti-virals at this stage)
What can be a strong indicator of Herpes-Zoster Virus?
- Severe Pain
- Unilateral
- Highly Regional Dermatomal Pattern
- (Even if you do not see the blisters)
When can HZV be very dangerous?
Why?
- In the Trigeminal System
- Can affect vision quite badly
What are the laminae of Rexed?
Vertical Laminations of the Dorsal & Ventral Horns of the Grey Matter
What is found in Lamina II?
Substantia Gelatinosa
What is found in lamina III & IV?
Sensory Neurons
What is found in laminas V-VIII?
Interneurones
What is found in lamina IX?
Motor Neurones
What are the dorsal columns?
- Direct & Uncrossed in the Spinal Cord
- Carry discriminated touch & propioception
What is the passage for afferents which send fibres up the dorsal column?
- Afferent fibres pass through the dorsal column –> before turning towards laminae (V-VIII) to synapse onto interneurones
- One Branch –> runs up the dorsal column
- One Branch –> synapses with interneurones at the same level
(it is one afferent fibre that does this - it does not synapse –> the same afferent fibre runs from receptor up)
What are the two divisons of the dorsal column?
- Cuneate Tract
- Gracile Tract
Where is the gracile tract found?
- Starts at the Lowest Levels of the cord
- Fibres run forward to the brain (from lower limb & lower trunk)
Where is the cuneate found?
- Fibres are added into the dorsal column as you ascend the spinal cord
- This builds up and forms the cuneate tract
What is the spinothalamic tract?
- Indirect Tract
- Crosses the spinal cord
- Conveys pain & temperature
Where do afferents involved in the spinothalamic tract route terminate?
- Substantia Gelatinosa (lamina II)
What first order afferent types convery nociception, temperature & light touch?
- C-Fibres
- A-delta fibres
Describe the route of the first & second order neurons in the spinothalamic tract route.
- First order neuron comes in from receptor
- Synapses with the second order neuron at the substantia gelatinosa
- Neurone projects across the spinal cord
- Crosses anterior to the central canal to the antero-lateral pathway (spinothalamic tract)
- Second order neuron ascends to the thalamus
What is the difference between dorsal columns & spinothalamic tracts in terms of crossing?
- Dorsal Column –> first order neurone itself goes up on the ipsilateral side to receptor
- Spinothalamic Tract –> second order neurone crosses over then ascends
Where does the second order neurone of the spinothalamic tract cross?
In front of the central canal (anterior to it)
What condition can affect these crossing spinothalamic fibres?
- Syrinx
What branches off the first order neurone and where does it go?
- Branch from the first order neurone –> comes off to ascend a local tract
- This tract is called Lissauer’s Tract (run up a few segments)
What is the spinocerebellar tract?
- Indirect
- Mainly propioception
Describe how muscle spindle afferents from the legs & lower trunk join spinocerebellar tracts.
- Muscle spindle afferents ascending the gracile tract –> exit at the thoracic level
- They synapse with neurons of the nucleus dorsalis (Clarke’s column, T1-L3)
- Axons from Clarke’s column form the dorsal spinocerebellar tract (DSCT) ending in the cerebellum ipsilaterally
Name 2 other spinocerebellar tracts.
- Ventral Spinocerebellar Tracts
- Cuneocerebellar Tract
What does the ventral spinocerebellar tract do?
- Supplies Golgi Tendon Organ information
What does the cuneocerebellar tract do?
- Similar to the DSCT
- Equivalent of DSCT but for the upper body
Why are muscle spindle afferents important?
- Supply cerebellum with vital movement control information
What is the Dorsal Spinal Cerebellar Tract (DSCT)?
- This receives afferents which go through the Dorsal Column
- They then come out to the nuclei in Clark’s Column
- They then run up to the cerebellum
Describe the route of the first order neuron in the dorsal column tract.
- Enters the dorsal column
- Branch turns up & ascends to the brain (ipsilateral side)
- Arrives at the dorsal column nuclei where the tract terminates (in the medulla)
Where do the first order neurons of the fasciculus gracilis tract terminate?
What level is this?
- Nucleus Gracilis
- Medial Nucleus in the Medulla
What takes place in the nucleus gracilis & nucleus cuneatus?
- First order neurone synapses with the second order neurone
Where does the dorsal column decussate?
- Level of the Dorsal Column Nuclei in the Medulla
- Synapses with the second order neurone
- Projects down & ventrally (diagram) –> goes to other side via central decussation
What is the central decussation of the dorsal column called?
- Decussation of the Medial Lemniscus
Describe the pathway of the second order neurons of the medial lemniscus.
Where do they terminate?
- They run up the medial lemnsicus (ascending tract)
- They terminate in the ventral-posterior nucleus (thalamus)
Where in the thalamus are neurons associated with the motor system found?
- Ventral-Lateral Thalamus
Where in the thalamus are neurons associated with the somatosensory system found?
Lateral Ventral-Posterior Thalamus (also medial division)
Where does the third order neurone go from and to in the medial lemniscal pathway?
- From the thalamus to the somatosensory cortex (S1)
Describe briefly the overall dorsal column - medial lemniscal pathway.
Include modalities
- Discriminative touch & propioception –> enter the dorsal column and ascend on ipsilateral side
- They synapse at the dorsal column nucleus –> then the projection decussates (second order)
- This goes to the lateral ventral-posterior thalamus
- This synapses onto the third order neuron which projects to the somatosensory cortex (S1)
What is the trigeminal touch pathway the equivalent of?
- Dorsal Column for the Face
Where does touch information from the face go to in terms of nucleus?
- Principal Sensory Nucleus of the Trigeminal Nerve
Where does touch information project to in the thalamus?
- Medial Ventral-Posterior Nucleus
(this projects S1)
Describe the pathway of a touch/sensory fibre in the face.
- Sensory Fibres (first order neurones) in the trigeminal nerve –> going to the principal sensory trigeminal nucleus
- Second order nucleus –> goes from the principal nucleus –> where it crosses then ascends –> with the medial lemniscal fibres –> targetting the medial ventral-posterior nucleus of the thalamus
- This then projects to S1
Roughly where is the face respresented in terms of the somatotopic map in S1?
- Lateral on the Hemisphere
What is the Ventral-Posterior Nucleus of the Thalamus responsible for?
- Somatosensation
What are the two parts of the Ventral-Posterior Nucleus of the Thalamus and what are they responsible for?
- Medial Division –> somatosensation from the face
- Lateral Division –> somatosensation from the upper body & lower body