Theoretical background to the
study of the sense organs and
pathways of the central nervous
system. Ascending projection
pathways of the brain and spinal
cord. Descending projection
pathways (pyramidal and
extrapyramidal).
Composed by
Natalia Leonidovna Svintsitskaya,
Associate professor
of the Chair of Human Anatomy,
Candidate of Medicine
environment
animal
organismNervous system
sensory
neuron
stimulus reaction
effectorInter-
neuronreceptor
Motor
neuron
Nervous System stimulus and reaction
Sensory System
Modality of Sensation
Receptor
Sensory Tract
Primary Neuron
Secondary Neuron
Tertiary Neuron
Termination
Modality of Sensation
General Sensation, Special Sensation
vision, hearing, equilibrium, smell, taste
Exteroception, Interoception, Proprioception
conscious vs. unconscious proprioception
position sensation, kinesthesia
Touch, Pain, Temperature Sensation
discriminative vs. light touch sensation
fast vs. slow pain
Receptors
Peripheral Nerve Ending
Receptor Neuron
Olfactory Neuron of Olfactory Epithelium
Specialized Receptor Cell
Merkel cell of Epdermis
Taste (Gustatory, Clear) Cell of Taste Bud
Photoreceptor cells of Retina
Hair cells of Inner Ear
Receptor: Peripheral Nerve Endings
Receptor Neurons of Craniospinal Ganglion
Pseudounipolar neurons of dorsal root ganglia
Trigeminal (semilunar, Gasserian ganglion),
geniculate (VII), superior IX, superior X ganglia (GSA)
Geniculate (VII), inferior IX, inferior X ganglia (VA)
Morphological Classification
Free nerve endings
Expanded tip endings
Encapsulated endings ----- CT envestment
Receptors
Free Nerve Endings
- Nerve endings without special structural
organization
- pain and temperature receptor
Expanded Tip Endings
- Merkel’s Touch Corpuscle
Merkel cells in basal layer of epidermis
- Type I Hair cells of Vestibular Labyrinth
Pathways for General Sensation
Touch & Proprioception from body
Posterior White Colum-Medial Lemniscal Pathway
Pain & Temperature from body
Spinothalamic Tract
cf. Spinoreticular or Spinoreticulothalamic Tract
General Sensation from Face
Trigeminothalamic Tracts
Sensory System General Sensation
Pain Pathway
Spinothalamic Tract
Anteromedial System
Modality: Pain & Temperature Sensation,
Light Touch from body
Receptor: Free Nerve Ending
1st Neuron: Dorsal Root Ganglion
2nd Neuron: Dorsal Horn
Anterior White Commissure
Spinothalamic Tract (Spinal Lemniscus)
3rd Neuron: Thalamus
Internal Capsule ----- Corona Radiata
Termination: Primary Somesthetic Area (S I)
Spinothalamic Tract
Spinothalamic Tract
Modality: Pain & Temperature Sensation,
Light Touch from body
Receptor: Free Nerve Ending
1st Neuron: Dorsal Root Ganglion
2nd Neuron: Dorsal Horn
Anterior White Commissure
Spinothalamic Tract (Spinal Lemniscus)
3rd Neuron: Reticular Formation
4rd Neuron: Thalamus
Internal Capsule ----- Corona Radiata
Termination: Diffuse Cerebral Cotex
Spinoreticulothalamic Tract (Paleospinothalamic Tract)
Spinothalamic Tract
spinothalamic
tract
anterior white
commissure
posterior root
decussation
- contralateral loss of pain and temperature
sensation below the level of lesion
Modality: General Sensation from face
Receptor: Most receptors in the face
1st Neuron: Trigeminal (Semilunar) Ganglia
2nd Neuron: Trigeminal Sensory Nucleus
pain & temperature ---- pars caudalis of
spinal tract nucleus of V
Ventral and Dorsal Trigeminothalamic Tract
3rd Neuron: Thalamus
Internal Capsule ----- Corona Radiata
Termination: Primary Somesthetic Area (S I)
Trigeminothalamic Tract
Trigeminothalamic
Tract
A. trigeminal ganglion
B. trigeminal sensory
nucleus
C. thalamus
D. cerebral cortex
1. spinal tract of
trigeminal nerve
2. ventral
trigeminothalamic tract
3. dorsal
trigeminothalamic tract
4. corona radiata
V. trigeminal nerve
Spinocerebellar Tract
Posterior SCbllT
Inferior
cerebellar
peduncle
Post. SCbllT and
cuneocerebellar
tract
posterior
white column
posterior root
Anterior SCbllT
superior
cerebellar
peduncle
anterior
spinocerebellar
tract
anterior white
commissure
posterior root
Predominant Sensory Syndromes
• Herpes Zoster- inflammatory reactions of dorsal root ganglion
- severe pain on the dermatomes of affected ganglion
followed by rashes and vesicle
• Tabes Dorsalis
- common variety of neurosyphilis
- posterior colum and spinal posterior root lesion
- loss of discriminative touch sensation and consciousproprioception below the level of lesion
- posterior column ataxia
- lancinating pain
- loss of deep tendon reflex (DTR)
Herpes Zoster (Shingles)
• varicella-zoster virus
reactivation from the dorsal root ganglia
• unilateral vesicular
eruption within
a dermatome
• T3 to L3 dermatome
lesions are frequent
• zoster ophtahalmicus
(ophthalmic division
of trigeminal n., V1)
• Ramsey-Hunt syndrome
(sensory br. of VII)
• acyclovir, antiviral agent
Herpes Zoster
(Shingles) Zoster ophthalmicus
Tabes Dorsalis (Neurosyphilis)
posterior column lesion - sensory symptoms, posterior column ataxia
Tabes Dorsalis
Subacute Combined
Degeneration
Ataxic Gait and Position:
- Watches the ground
in walking
- Positive Romberg Test
- Stick and Stamp Sign
Posterior Column
Ataxia
Friedreich’s Ataxia
posterior spinocerebellar tract lesion - cerebellar ataxia
Muscle Status - Balance and Posture
alcohol and cerebellar dysfunction
Syringomyelia
initial symptom - bilateral loss of pain and temperature sensation
Syringomyelia
initial symptom - bilateral loss of pain and temperature sensation
Trigeminal Neuralgia
(tic douloureux)
- excruciating episodic pain
in the area supplied by
trigeminal nerve, especially
second and third division
- trigger point
- intense pain makes the
patient grimace (tic)
- antiepileptic drug (phenytoin,
carbamazepine) is effective
- surgical treatment