Neuro 8-3-09 Somatosensory/Ascending systems and special systems Picture in the book!

! Fasiculus cuneatus Fasiculus gracilis Posterior spinocerebellar tract Lateral corticospinal tract Bulboreticulospinal tract Rubrospinal tract Anterior spinocerebellar tract - receptors Lateral spinothalamic tract more medial than posteroior and anterior spinothalamic tract Anterior reticulospinal tract Medial reticulospinal tract Anterior spinothalamic tract Anterior corticospinal tract German sounding receptors (Messiner)more superficial then the Italian receptors (pacinian) Face is your benchmark when you are tested for pain. Go on the face and ask if dull or sharp, usually sharp then compare to other areas of the body. Go to the more distal ends of the extremities such as the big toe or dorsum of the thumb. If the pain on the ends are the same then no problem. Pain is a subjective phenomenon. To get the sensory level. Start from the area with no sensation to the area with sensation. To go from area of lower chest to the area of the upper chest. Tuning fork best on the toe in the lower extremities. Spino cerebellar enter from spinal chord to the cerebellum. The 3 functions of the cerebellum are for unconscious prorprioceptor 1. Spinocerebellum enter the vermis truncal ataxia if compromised Review Rexted Lamine. Dorsal horn has X VII is where the intermedial lateral chord in the ventral horn. Posterior spinocerebellar spans from C8 to L2 neurons go into the tract and ascend into the restiform body and inferior cerebellar presynaptic to the vermis. Anterior spinocerebellar has the cuneatus in the medulla into the superior peduncle into the vermis as well. Posterior Column-Medial Lemniscal system Look for the tract in the book goes into the VPL of the thalamus and does 2 point discrimination Dorsal column pathways Anterolateral system goes to dorsal horn and crosses to opposite side at the level of the spinal chord for the lateral spinothalamic tract. Anterior commissure has rexed lamina X. For light touch. Has a catch: for pain and temperature mostly ascend 1-2 levels before join the dorsal horn unlike other sensations that go directly to the dorsal horn. Areas that caps the dorsal horn is the leshower zone that makes the ascending of the levels for pain and temp. The clinical significance causes higher sensation on the right site. The second catch is Topographic localization within the dorsal columns and the spinothalamic tract. A lamination for the pathways, the most medial is the fasciculus gracilis. The cortico spinal tract if there is a cervical lesion then patients has paraparesis Spinocerebellar pathways Both for unconscious proprioception. Difference in the posterior receptors in muscle, tendon, and trunk that enters the cerebellum via the restiform body. The anterior is different because it only uses the

golgi tendon organ and goes through the cuneus cerebellar tract. If a lesion then truncal ataxia. Receptors in the muscle spindles change as reguard to the muscle, the stretch receptors with the flower spray ends. The golgi receptors are in the tendon area. Nociceptive (pain fiver types Acute pain C fiber burning pain unmylinated Classical muscle receptors. Muscle spindles ascend to the proprioceptors Descending noncieptive inhibitory Ascending input. Ascending pathway. Pain is not as simple as an ascending pathway because there are decending modulatory pathways that are opioid receptors. Dermatomes t4 is the most popular. There is no C1 dorsal root ganglion. Stretch receptors. The visceral fibers use the same glanglion and enter about the same ganglion- refererred and visceral pain. Prinicipal dermatimes for referred pain C3-c4 diaphram. Abnormalities Brown Dystal symmetric polyneuropathy usually with diabetes, distal segments of the axons degrade causing stocking and glove abnormalities. Usualy dx tests: - Emg-ncv - Somatosensory evoked potentials* - Nerve biopsy - Skin biopsy *Pitfall: may not reflect entire nerve fiber population as these tests may be sensitive for large diameter nerve fibers only. Epidermal nerve fibers Noncicepitive vs neuropathic pain states Pain from a stimulus from outside of the system Proportional to the stimulation of the receptors Acute serves as a protective Signs and symptoms of neuropathic pain

Dysesthesias Parathesias Spontaneous pain Spimulis evoved allodyna Trigeminal nerve of the face there are 5 lines that delineate them. Primary, secondary, and tertiary trigeminal afferents. Trigeminal neuralgia Lateral medullary syndrome swallowing difficulty. Special sense start with taste in ant 2/3 of tounge facial nerve called the tympany nerve through the gustatory nucleus of the facial nerve. Goes to the 9th cranial nerve Primary gustatory cortex. Smell/olfaction the cribiform plate in the ant skull the olfactory fibers pierce the cribiform then goes to the olfactory tract and nerves to the bulb to the tract that divides into the medial and lateral stria lateral is for the bad smells. Meningoma compressive tumor in the area if the olfactory track so loose smell and have behavioral disturbances. So many olfactory tests for parkinsons because first sense to disappear when the disease occurs Visial optic nerve the temporal fibers go ipsilateral to the lateral geniculate to the 17, 18, 19th area of the cerebral cortex. Temporal fibers for nasal vision? Superior quadratic lobe a lesion of the ? Vestibular cochlear nerve has many pathways which some enter the spinal ganglion from the dorsal coclear nucleus goes to ascend or to the ventral nucleus to go into the inferior colliculus then to the temporal lobe. Some fibers enter ipsilaterally or some ascend. Only time loss of hearing if a lesion outside of the spinal chord such as a ganglion. Vestibular disturbances Vertigo: Illusory disturbance of motion. Nystagmus: Oscillatory eye movements Disequilibrium: postural imbalance Dolls head phenomenon. Brain stem is intact.