Anatomy Neuroendocrine 4

Somatosensor dan Motor Pathway

dr. Justinus Putranto Agung Nugroho

Sensory system
Main Somatosensory Pathways
Bodily sensations of touch, pain, temperature, vibration, and proprioception (limb or
joint position sense).
1. The posterior columnmedial lemniscal (DCML) pathway conveys
proprioception, vibration sense, and fine, discriminative touch
2. The anterolateral (ALS) pathways include the spinothalamic tract and other
associated tracts that convey pain, temperature sense, and crude touch
Posterior ColumnMedial Lemniscal Pathway
Large-diameter, myelinated axons carrying information about proprioception, vibration sense,
and fine touch enter the spinal cord via the medial portion of the dorsal root entry zone.
Many of these axons then enter the ipsilateral posterior columns to ascend all the way
to the posterior column nucleiin the medulla. In addition, some axon collaterals enter the
spinal cord central gray matter to synapse onto interneurons and motor neurons. It is easier to
remember the somatotopic organizationof the posterior columns (Figure 7.3) if you picture fibers
adding on laterally from higher levels as the posterior columns ascend.
The medial portion, called the gracile fasciculus (gracile means thin) carries information
from the legs and lower trunk. The more lateral cuneate fasciculus(cuneate means wedge
shaped) carries information from the upper trunk above about T6, and from the arms and neck.
The first-order sensory neurons that have axons in the gracile and cuneate fasciculi (also called
fasciculus gracilis and fasciculus cuneatus) synapse onto second-order neurons in the
nucleus gracilis and nucleus cuneatus, respectively.
Axons of these second-order neurons decussate as internal arcuate fibers and
then form the medial lemniscus on the other side of the medulla.The medial
lemniscus initially has a vertical orientation and then comes to occupy a progressively
more lateral and inclined position as it ascends in the brainstem.
The next major synapse occurs when the medial lemniscus axons terminate
in the ventral posterior lateral nucleus (VPL) of the thalamus.
The neurons of the VPL then project through the posterior limb of the internal
capsule in the thalamic somatosensory radiations to reach the primary
somatosensory cortex in the postcentral gyrus.
An analogous pathway called the trigeminal lemniscus conveys touch sensation
for the face via the ventral posterior medial nucleus of the thalamus (VPM) to the
somatosensory cortex.
Smaller-diameter and unmyelinated axons carrying information about pain
Spinothalamic Tract and Other Anterolateral Pathways
and temperature sense also enter the spinal cord via the dorsal root
entry zone.
However, these axons make their first synapses immediately in the gray
matter of the spinal cord, mainly in the dorsal horn marginal zone(lamina
I) and deeper in the dorsal horn, in lamina V.
Some axon collaterals ascend or descend for a few segments in Lissauers
tractbefore entering the central gray.
Axons from the second-order sensory neurons in the central gray cross over
in the spinal cord anterior (ventral) commissure to ascend in the
anterolateral white matter.
It should be noted that it takes two to three spinal segments for the
decussating fibers to reach the opposite side, so a lateral cord lesion
will affect contralateral pain and temperature sensation beginning a
few segments below the level of the lesion.
The anterolateral pathways in the spinal cord have a somatotopic organization in which the feet are
most laterally represented. To help you remember this organization, picture fibers from the
anterior commissure adding on medially as the anterolateral pathways ascend in the spinal cord.
This somatotopic organization, with arms more medial and legs more lateral, is preserved as the
anterolateral pathways pass through the brainstem. When they reach the medulla, the anterolateral
pathways are located laterally, running in the groove between the inferior olives and the inferior
cerebellar peduncles.
They then enter the pontine tegmentum to lie just lateral to the medial lemniscus in the
pons and midbrain.
The anterolateral pathways consist of three tracts: the spinothalamic, spinoreticular, and
spinomesencephalic tracts. The spinothalamic tract is the best known and mediates
discriminative aspects of pain and temperature sensation, such as location and intensity of the
stimulus. Like the posterior columnmedial lemniscal pathway, a major relay for the
spinothalamic tract is in the ventral posteriorlateral nucleus(VPL) of the thalamus.
However, the terminations of the spinothalamic tract and the posterior column
medial lemniscal pathway reach separate neurons within the VPL.
From the VPL, information travelling in the spinothalamic tract is again
conveyed via the thalamic somatosensory radiations to the primary
somatosensory cortex in the postcentral gyrus.
There are also spinothalamic projections to other thalamic nuclei, including
intralaminar thalamic nuclei (central lateral nucleus) and medial
thalamic nuclei such as the mediodorsal nuclei. These projections probably
participate together with the spinoreticular tract in a phylogenetically older pain
pathway responsible for conveying the emotional and arousal aspects of pain.
The spinomesencephalic tract projects to the midbrain periaqueductal gray matter
and the superior colliculi. The periaqueductal gray participates in central
modulation of pain.
The spinothalamic and spinomesencephalic tracts arise mainly from
spinal cord laminae I and V, while the spinoreticular tract arises diffusely from
intermediate zone and ventral horn laminae 6 through 8 In addition to pain and
temperature, the anterolateral pathways can convey some crude touch sensation,
therefore, touch sensation is not lost when the posterior columns are damaged.

To summarize, if you step on a thumbtack with your left foot,

spinothalamic tract enables you to realize something sharp is puncturing the
sole of my left foot;
spinothalamic intralaminar projections and spinoreticular tract cause you to feel
ouch, that hurts;
spinomesencephalic tract leads to pain modulation, allowing you eventually to
think aah, that feels better.
Corticospinal Tract and Other Motor Pathways
Descending motor pathways can be divided into lateral motor systems and medial
motor systems based on their location in the spinal cord.
Lateral motor systems travel in the lateral columns of the spinal cord and
synapse on the more lateral groups of ventral horn motor neurons and interneurons.
Medial motor systems travel in the anteromedial spinal cord columns to synapse
on medial ventral horn motor neurons and interneurons.
The two lateral motor systems are the lateral corticospinal tract and the
rubrospinal tract. These pathways control the movement of the extremities. The
lateral corticospinal tract in particular is essential for rapid, dextrous movements at
individual digits or joints.
Both of these pathways cross over from their site of origin and descend in the
contralateral lateral spinal cord to control the contralateral extremities.
The four medial motor systems are the anterior corticospinal tract, the
vestibulospinal tracts, the reticulospinal tracts, and the tectospinal tract. These
pathways control the proximal axial and girdle muscles involved in postural tone, balance,
orienting movements of the head and neck, and automatic gait-related movements. The
medial motor systems descend ipsilaterally or bilaterally.
The medial motor systems tend to terminate on interneurons that project to both
sides of the spinal cord, controlling movements that involve multiple bilateral spinal
segments.
Thus, unilateral lesions of the medial motor systems produce no obvious
deficits. In contrast, lesions of the lateral corticospinal tract produce dramatic
deficits.
The rubrospinal tract in humans is small, and its clinical importance is uncertain, but it may
participate in taking over functions after corticospinal injury.
Lateral Corticospinal Tract
The corticospinal tractmore specifically, the lateral corticospinal tractis the most clinically
important descending motor pathway in the nervous system.
This pathway controls movement of the extremities, and lesions along its course produce characteristic deficits
that often enable precise clinical localization.
Over half of the corticospinal tract fibers originate in the primary motor cortex (Brodmanns area
4) of the precentral gyrus. The remainder arise from the premotor and supplementary motor areas (area 6) or
from the parietal lobe (areas 3, 1, 2, 5, and 7). The primary motor cortex neurons contributing to the corticospinal
tract are located mostly in cortical layer 5 (see Figure 2.14B). Layer 5 pyramidal cell projections synapse directly
onto motor neurons in the ventral horn of the spinal cord as well as onto spinal interneurons.
About 3% of corticospinal neurons are giant pyramidal cells called Betz cells, which are the largest neurons in the
human nervous system.
Axons from the cerebral cortex enter the upper portions of the cerebral white matter, or corona
radiata, and descend toward the internal capsule.
In addition to the corticospinal tract, the cerebral white matter conveys bidirectional information
between different cortical areas, and between cortex and deep structures such as the basal
ganglia, thalamus, and brainstem.
The internal capsule is best appreciated in horizontal brain sections, in which the right and
left internal capsules look like arrowheads or two letter Vs, with their points facing inward.
Note that the thalamus and caudate nucleus are always medial to the internal capsule, while
the globus pallidus and putamen are always lateral to the internal capsule.
Three parts to the internal capsule: anterior limb, posterior limb, and genu. Note that the
anterior limb of the internal capsule separates the head of the caudate from the globus
pallidus and putamen, while the posterior limb separates the thalamus from the globus
pallidus and putamen.
The genu (knee in Latin) is at the transition between the anterior and posterior limbs, at
the level of the foramen of Monro.
The corticospinal tract lies in the posterior limb of the internal capsule. The
somatotopic map is preserved in the internal capsule, so motor fibers for the face are most
anterior, and those for the arm and leg are progressively more posterior.
Fibers projecting from the cortex to the brainstem, including motor fibers for
the face, are called corticobulbar instead of corticospinal because they project
from the cortex to the brainstem, or bulb.
The internal capsule continues into the midbrain cerebral peduncles.
The white matter is located in the ventral portion of the cerebral peduncles and is
called the basis pedunculi. The middle one-third of the basis pedunculi contains
corticobulbar and corticospinal fibers with the face, arm, and leg axons arranged
from medial to lateral, respectively. The other portions of the basis pedunculi
contain primarily corticopontine fiber.
The corticospinal tract fibers next descend through the ventral pons,
where they form somewhat scattered fascicles. These collect on the ventral
surface of the medulla to form the medullary pyramids. For this reason the
corticospinal tract is sometimes referred to as the pyramidal tract (this terminology,
though widely used, is somewhat imprecise since the pyramids include
reticulospinal and other brainstem pathways in addition to the corticospinal tract).
 The transition from medulla to spinal cord is called the cervicomedullary junction, which occurs at
the level of the foramen magnum.
At this point about 85% of the pyramidal tract fibers cross over in the pyramidal
decussation to enter the lateral white matter columns of the spinal cord, forming the
lateral corticospinal tract.
A somatotopic representation is present in the lateral corticospinal tract, with fibers that control the
upper extremity located medial to those that control the lower extremity.
The axons of the lateral corticospinal tract enter the spinal cord central gray matter to synapse onto
anterior horn cells.
The remaining ~15% of corticospinal fibers continue into the spinal cord ipsilaterally,
without crossing, and enter the anterior white matter columns to form the anterior
corticospinal tract .
The other lateral and medial descending motor systems include the rubrospinal, anterior
corticospinal, tectospinal, reticulospinal, and vestibulospinal tracts
Reference
Blumenfeld, Hal. (2010). Neuroanatomy Through Clinical Cases 2nd
ed. Massachusetts: Sinauer Associates, Inc. Publishers.