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Neuroanatomy Outlined

Amy Dodds

Created on December 19, 2023

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Transcript

Created by Amy Dodds

Click on each bullet point below to reveal the learning outcomes:
Apply your knowledge to explain the effects of lesions
Draw and label each of the 3 main spinal pathways
Describe the function(s) of the 3 main spinal pathways
Apply your knowledge to explain the effects of lesions
Draw and label each of the 3 main spinal pathways
Describe the function(s) of the 3 main spinal pathways
Hover over each button to learn about its function:

SPINOTHALAMIC PATHWAYS

Lateral spinothalamic pathway: carries pain & temperature
Anterior spinothalamic pathway: carries crude touch & pressure
Ascending pathways from the body to the cerebrum. Consists of two pathways, each carrying a different modality of sensation:

Sensation of crude touch & pressure

Sensation of pain & temperature

Sensation of fine touch & vibration

Sensation of pressure & pain

Sensation of proprioception

Q1: What is the function of the anterior spinothalamic tract?

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The anterior spinothalamic tract carries sensory (afferent) information about crude touch & pressure from the body to the cerebrum.

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Cuneate nucleus

Cuneate nucleus

Ventral posterolateral nucleus

Substantia gelatinosa

Ventral posterolateral nucleus

Gracile nucleus

Ventral horn of grey matter

Ventral horn of grey matter

Substantia gelatinosa

Gracile nucleus

Q2: Where do primary neurons of the spinothalamic tract synapse?

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Primary neurons of the spinothalamic tract enter the spinal cord via the dorsal root and synapse with their secondary neuron at the substantia gelatinosa of the dorsal horn of grey matter.

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Q3: Briefly describe the clinical effects of a total spinal cord transection at the T10 level

A total cord transection affects the descending and ascending pathways on both sides, but the cranial nerves remain intact. Here, this will present with complete loss of sensory and motor functions below the T10 level, but intact function above this level.

Cuneate nucleus

Cuneate nucleus

Ventral posterolateral nucleus

Substantia gelatinosa

Ventral posterolateral nucleus

Gracile nucleus

Ventral horn of grey matter

Ventral horn of grey matter

Substantia gelatinosa

Gracile nucleus

Q4: Where do secondary neurons of the spinothalamic tract synapse?

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Secondary neurons of the spinothalamic tract ascend via the spinal lemniscus to the thalamus, where they synapse with tertiary neurons at the ventral posterolateral nucleus.

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Cuneate nucleus

Anterior corticospinal

Anterior spinothalamic

Substantia gelatinosa

Ventral posterolateral nucleus

Dorsal columns-medial lemniscus

Lateral spinothalamic

Ventral horn of grey matter

Lateral corticospinal

Gracile nucleus

Q5: Which spinal pathway is most likely to be affected by occlusion of the posterior spinal arteries?

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The DCML pathways run along the dorsal aspect of the spinal cord and, therefore, are most at risk.
The posterior spinal arteries, which arise from the posterior inferior cerebellar artery (PICA), supply the posterior 1/3rd of the spinal cord.

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CORTICOSPINAL PATHWAYS

Lateral corticospinal pathway: carries motor information to limbs
Anterior corticospinal pathway: carries motor information to trunk
Descending pathways from the cerebrum to the body. Consists of two pathways, each carrying motor signals to different regions:

Somatic afferents from limbs

Somatic afferents from trunk

Somatic efferent to trunk

Somatic efferent to limbs

Somatic efferent to face

Q1: What is the function of the lateral corticospinal tract?

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The lateral corticospinal tract carries voluntary motor (somatic efferent) information to the muscles of the upper and lower limbs.

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Cuneate nucleus

Anterior white commissure

Cerebral peduncle

Substantia gelatinosa

Ventral posterolateral nucleus

Internal capsule

Substantia gelatinosa

Ventral horn of grey matter

Medulla oblongata

Gracile nucleus

Q2: Where do 90% of the corticospinal tract fibres decussate?

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90% of the descending motor fibres decussate at the pyramidal decussation of the medulla oblongata, where they enter the lateral corticospinal tract.

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Q3: Briefly describe the clinical effects of spinal cord hemisection (Brown-séquard syndrome)

Brown-Séquard syndrome affects both the descending and ascending pathways. Typical presentation includes:
  • Contralateral loss of pain & temperature sensation (spinothalamic)
  • Ipsilateral loss of fine touch sensation (DCML)
  • Ipsilateral loss of movement (corticospinal)

Cuneate nucleus

Anterior white commissure

Cerebral peduncle

Substantia gelatinosa

Ventral posterolateral nucleus

Internal capsule

Substantia gelatinosa

Ventral horn of grey matter

Medulla oblongata

Gracile nucleus

Q4: Where do 10% of the corticospinal tract fibres decussate?

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10% of the descending motor fibres decussate at the ventral (anterior) white commissure of the spinal cord, where they leave via the ventral root.

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Cuneate nucleus

Bilateral weakness and loss of sensation

Left-sided loss of crude touch and right-sided weakness

Substantia gelatinosa

Ventral posterolateral nucleus

Left-sided weakness and bilateral numbness

Right-sided weakness and right-sided loss of sensation

Ventral horn of grey matter

Right-sided loss of fine touch

Gracile nucleus

Q5: A patient has suffered a stroke in their internal capsule on the left side. How would this patient likely present?

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The internal capsule contains fibres of both the ascending and descending tracts. The patient will present with right-sided weakness and right-sided loss of sensation.

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DCML PATHWAY

Cuneate fasciculus: carries fine touch & proprioception from T6 upwards
Gracile fasciculus: carries fine touch & proprioception from T7 downwards
Ascending pathways from the body to the cerebrum.Two pathways carrying sensory signals about fine touch & proprioception from different regions:

Fine touch & proprioception

Crude touch & pressure

Pain & temperature

Motor control to trunk

Motor control to limbs

Q1: What is the function of the DCML pathway?

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The DCML pathway consists of two pathways, each carrying sensory signals about fine touch & proprioception from different regions.

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Q2: Briefly describe the clinical effects of a lesion in the left gracile fasciculus at the L1 spinal cord level.

The patient will present with loss of fine touch, vibration & proprioception sensation in the left lower limb.

Cuneate nucleus

Lower motor neuron

Primary sensory neuron

Substantia gelatinosa

Ventral posterolateral nucleus

Secondary sensory neuron

Upper motor neuron

Ventral horn of grey matter

Tertiary sensory neuron

Gracile nucleus

Q3: Which neuron synapses at the gracile nucleus?

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The primary sensory neuron enters the spinal cord via the dorsal root and passes into the gracile fasciculus where it ascends. At the medulla oblongata, it forms a synapse with the secondary neuron in the gracile nucleus.

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Cuneate nucleus

Corticospinal & Spinothalamic

Corticospinal & DCML

Substantia gelatinosa

Ventral posterolateral nucleus

Cuneate fasciculus & Corticospinal

Spinothalamic & DCML

Ventral horn of grey matter

Gracile fasciculus & Spinothalamic

Gracile nucleus

Q4: Which spinal pathways are most likely to be affected by occlusion of the anterior spinal artery?

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The anterior spinal artery, which arises from the vertebral arteries, supplies the anterior 2/3rd of the spinal cord. The corticospinal and spinothalamic pathways run in this region of the spinal cord and, therefore, are most at risk.

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Cuneate nucleus

Gracile fasciculus

Cuneate fasciculus

Substantia gelatinosa

Ventral posterolateral nucleus

Internal arcuate fibres

Ventral posterolateral nucleus

Ventral horn of grey matter

Medial lemniscus

Gracile nucleus

Q5: A patient suffers a right-sided midbrain lesion affecting the DCML pathway. Which part of the DCML pathway is most likely to be affected?

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The secondary neurons of the DCML pathway decussate in the medulla oblongata via the internal arcuate fibres and enter the medial lemniscus. They ascend in the medial lemniscus through the pons and midbrain, before synapsing at the thalamus in the cerebrum.

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Damage to the ascending pathways at this point has occurred after their decussation, so the patient presents with loss of sensation on the contralateral side to the lesion – in this case, on the right side.

In this case, the lesion has occurred below the level of the decussation, so symptoms will present on the ipsilateral side to the lesion.
Fibres that decussate in the medulla oblongata will enter the lateral corticospinal tract, so fibres in the anterior corticospinal tract decussate lower down, in the spinal cord white matter!

So the lateral corticospinal tract supplies somatic motor information to the Limbs!

Just remember...

Lateral = Limbs

Damage to the corticospinal tracts at this point has occurred prior to their decussation, so the patient presents with weakness on the contralateral side to the lesion – in this case, on the right side.

Gracile fasciculus Lower body
Cuneate fasciculus Upper body