Antero-Lateral System Tracts

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Questions and Answers

Which of the following is NOT a destination for second-order neurons in the anterolateral system, unlike the dorsal column medial lemniscus (DCML) pathway?

  • Colliculi
  • Reticular formation
  • Thalamus
  • Hypothalamus
  • Cerebellum (correct)

The spinothalamic tract (STT) is primarily responsible for the transmission of which type of pain?

  • Chronic pain
  • Neuropathic pain
  • Visceral pain
  • Acute (fast) pain (correct)
  • Emotional pain

What type of receptor is predominantly associated with the anterolateral system pathways for pain and temperature?

  • Free nerve endings (correct)
  • Merkel's disks
  • Pacinian corpuscles
  • Ruffini's endings
  • Meissner's corpuscles

Which component of the spinothalamic tract is considered the 'clinically important pathway' and is tested using the pinprick test?

<p>Lateral spinothalamic tract (B)</p> Signup and view all the answers

Besides pain, what other primary sensation is transmitted by the lateral spinothalamic tract?

<p>Temperature (C)</p> Signup and view all the answers

In the spinal cord, where is the lateral spinothalamic tract located?

<p>Lateral white column (B)</p> Signup and view all the answers

Where are the cell bodies of the first-order neurons of the lateral spinothalamic pathway located?

<p>Dorsal root ganglia (C)</p> Signup and view all the answers

At what anatomical structure does the decussation of the second-order neurons occur in the lateral spinothalamic tract pathway?

<p>Anterior white commissure of the spinal cord (C)</p> Signup and view all the answers

Which tract in the brainstem do the second-order neurons of the lateral spinothalamic pathway ascend in?

<p>Spinal lemniscus (E)</p> Signup and view all the answers

In which thalamic nucleus do the second-order neurons of the lateral spinothalamic tract synapse with third-order neurons?

<p>Ventral posterolateral (VPL) nucleus (D)</p> Signup and view all the answers

Through which part of the internal capsule do the third-order neurons of the lateral spinothalamic pathway pass?

<p>Posterior limb (B)</p> Signup and view all the answers

To which area of the cerebral cortex do the third-order neurons of the lateral spinothalamic pathway project?

<p>Primary somatosensory cortex (A)</p> Signup and view all the answers

What type of nerve fibers primarily constitute the lateral spinothalamic pathway, enabling fast pain transmission?

<p>A-delta fibers (A)</p> Signup and view all the answers

Where are the cell bodies of the first-order neurons for pain and temperature sensation from the face located?

<p>Trigeminal ganglion (A)</p> Signup and view all the answers

The ventral trigeminothalamic tract (VTT) decussates in which part of the brainstem?

<p>Medulla (B)</p> Signup and view all the answers

In the ventral trigeminothalamic tract pathway, where do second-order neurons synapse with third-order neurons?

<p>Ventral posteromedial (VPM) nucleus of thalamus (E)</p> Signup and view all the answers

Which of the following is a descending pain modulation pathway that contains opioid receptors?

<p>Periaqueductal gray matter (PAG) (D)</p> Signup and view all the answers

The Rostral Ventromedial Medulla (RVM) is a key structure in descending pain modulation. Where is the RVM located?

<p>Medulla (B)</p> Signup and view all the answers

What type of sensory deficit is typically observed with a lesion above the pons affecting the pain and temperature pathways?

<p>Contralateral hemisensory loss (B)</p> Signup and view all the answers

A spinal cord lesion leads to what specific type of sensory deficit regarding pain, temperature and proprioception?

<p>Dissociated sensory deficit (D)</p> Signup and view all the answers

Which factor most significantly increases the conduction velocity of an action potential in a neuron?

<p>Presence of myelin sheath (C)</p> Signup and view all the answers

Which type of nerve fiber is associated with fast pain and has an intermediate diameter and light myelination?

<p>Group A delta fibers (A)</p> Signup and view all the answers

What type of nerve fiber is associated with slow, chronic pain and is unmyelinated with the smallest diameter?

<p>Group C fibers (B)</p> Signup and view all the answers

A lesion in the left lateral medulla could cause facial anesthesia on which side of the face, based on the ventral trigeminothalamic tract pathway?

<p>Right side (A)</p> Signup and view all the answers

If a medullary hemisection affects the ventral trigeminothalamic tract, what is the expected outcome regarding facial anesthesia?

<p>Anesthesia of the whole face (A)</p> Signup and view all the answers

Which of the following tests is used to assess the function of the lateral spinothalamic tract?

<p>Pinprick test (D)</p> Signup and view all the answers

What type of sensation is assessed using cotton wool to lightly touch the skin?

<p>Crude touch (E)</p> Signup and view all the answers

Which sensory pathway from the face is responsible for transmitting proprioception, vibration, and discriminative touch?

<p>Ventral trigeminothalamic tract (E)</p> Signup and view all the answers

Where does the decussation of second-order neurons occur in the ventral trigeminothalamic tract pathway?

<p>Pons (A)</p> Signup and view all the answers

Sensory information from the face related to pain and temperature is initially processed in which nucleus of the trigeminal nerve?

<p>Spinal nucleus (B)</p> Signup and view all the answers

Which of the following describes spinocerebellar tracts?

<p>Transmit unconscious proprioceptive information (D)</p> Signup and view all the answers

To which part of the cerebellum do spinocerebellar tracts primarily project?

<p>Ipsilateral cerebellar hemisphere (B)</p> Signup and view all the answers

Perception of basic sensations like pain and touch, without discrimination or localization, occurs at which level?

<p>Thalamus (B)</p> Signup and view all the answers

More detailed sensory processing, including localization and quality of sensation, occurs at which level?

<p>Primary sensory cortex (D)</p> Signup and view all the answers

Stereognosis and graphesthesia are examples of which type of sensory function?

<p>Secondary or cortical sensations (A)</p> Signup and view all the answers

Deficits in visuospatial awareness and awareness of the body are most commonly associated with lesions in which cerebral lobe?

<p>Parietal lobe (A)</p> Signup and view all the answers

Right parietal lobe lesions are more likely to cause hemineglect and inattention to which side of space?

<p>Left side (B)</p> Signup and view all the answers

Cortical sensations can only be reliably tested if which type of sensory modalities are intact?

<p>Primary modalities (D)</p> Signup and view all the answers

In the somatotopic organization of the sensory pathway in the spinal cord, where are lower limb neurons typically located compared to upper limb neurons?

<p>More peripherally (C)</p> Signup and view all the answers

What is 'sacral sparing' in the context of spinal cord lesions?

<p>Preservation of sensory function in sacral dermatomes despite cervical cord lesions (B)</p> Signup and view all the answers

A lesion affecting a spinal nerve root will typically result in sensory loss in which distribution?

<p>Dermatomal distribution (E)</p> Signup and view all the answers

If a patient presents with complete sensory loss in a specific dermatome, possible locations of the lesion include:

<p>Spinal nerve root or dorsal horn of spinal cord (D)</p> Signup and view all the answers

In a clinical scenario of subacute combined degeneration of the cord due to Vitamin B12 deficiency, which part of the spinal cord is primarily affected, leading to sensory ataxia?

<p>Dorsal columns (D)</p> Signup and view all the answers

What type of sensory loss would be expected with a lesion confined to the dorsal gray horn of the spinal cord?

<p>Loss of all sensations in the dermatome (A)</p> Signup and view all the answers

If a patient has pain and temperature loss below a specific dermatome level on the contralateral side, and no proprioceptive loss, where is the most likely location of the lesion within the spinal cord?

<p>Lateral spinothalamic tract (C)</p> Signup and view all the answers

Which of the following is the primary type of receptor associated with the anterolateral system for detecting pain and temperature?

<p>Free nerve endings (E)</p> Signup and view all the answers

What is the primary function of the lateral spinothalamic tract?

<p>Transmitting fast pain and temperature sensations (A)</p> Signup and view all the answers

Where do second-order neurons in the lateral spinothalamic tract decussate?

<p>Spinal cord (C)</p> Signup and view all the answers

What type of nerve fibers are predominantly found in the lateral spinothalamic pathway?

<p>A-delta fibers (B)</p> Signup and view all the answers

Where do first-order neurons of the ventral trigeminothalamic tract synapse with second-order neurons?

<p>Spinal trigeminal nucleus (A)</p> Signup and view all the answers

What is the primary function of the ventral trigeminothalamic tract?

<p>Proprioception, vibration, and discriminative touch from the face (D)</p> Signup and view all the answers

A patient has a lesion in the posterior limb of the internal capsule. Which sensory deficits would MOST likely be observed?

<p>Contralateral loss of all somatic sensation (C)</p> Signup and view all the answers

What is the expected sensory deficit from a lesion affecting the entire dorsal horn of the spinal cord at a specific level?

<p>Complete loss of all sensation in the dermatome corresponding to that level (E)</p> Signup and view all the answers

A patient presents with loss of pain and temperature sensation starting two segments below the level of the lesion on the contralateral side. Where is the MOST likely location of the lesion?

<p>Lateral spinothalamic tract (A)</p> Signup and view all the answers

What type of sensory loss is expected with damage limited to a single spinal nerve root?

<p>Complete sensory loss involving all sensory modalities in the corresponding dermatome (C)</p> Signup and view all the answers

Which of the following best describes the function of spinocerebellar tracts?

<p>Unconscious proprioception to the cerebellum (E)</p> Signup and view all the answers

Which of the following is a key characteristic of cortical sensations?

<p>They involve detailed sensory processing such as localization and quality of sensation. (E)</p> Signup and view all the answers

A patient is unable to recognize objects by touch (astereognosis) in their left hand, but can feel basic sensations such as pain and light touch. Which area of the brain is likely affected?

<p>Right parietal lobe (B)</p> Signup and view all the answers

A patient shows symptoms of visuospatial neglect, predominantly ignoring the left side of their body and visual field. Lesions in which area of the brain are most likely?

<p>Right parietal lobe (C)</p> Signup and view all the answers

A patient demonstrates loss of proprioception and vibration sense bilaterally, along with clumsiness that worsens at night. MRI imaging shows increased signal intensity in the dorsal columns of the spinal cord. Which vitamin deficiency is MOST likely responsible for these findings?

<p>Cobalamin (B12) (A)</p> Signup and view all the answers

Flashcards

Antero-Lateral System

An ascending sensory pathway carrying pain and temperature information to higher brain centers.

Lateral Spinothalamic Tract

A sensory tract responsible for fast pain, temperature and intensity.

Anterior Spinothalamic Tract

Sensory tract responsible for crude touch.

Anterior White Commissure

Point where second-order neurons cross over to the opposite side of the spinal cord.

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Ventral Trigeminothalamic Tract

A sensory pathway carrying pain and temperature sensation from the face.

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Spinocerebellar Tracts

Carry proprioceptive (unconscious) information to the cerebellum for motor coordination.

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Thalamus (Sensory)

Primary sensory inputs are perceived at this level

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Cortical Sensations

Complex aspects of sensation that requires inputs from primary sensory areas regarding fine touch pressure and proprioception

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Somatotopic Organization

A map of the body within the spinal cord.

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Dermatome

Area of skin innervated by a single spinal segment or nerve.

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Contralateral Hemisensory Loss

Loss of sensory modalities on opposite sides of the body.

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Dissociated Sensory Loss

Pain/temp loss on one side, proprioception loss on the other.

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Study Notes

Antero-Lateral System Destinations

  • The antero-lateral system has multiple destinations for the second-order neurons, unlike the dorsal column-medial lemniscus pathway
  • The thalamus is one destination, via the spinothalamic tract (STT)
  • Other destinations include:
    • Colliculi, via spinotectal tracts (STCT)
    • Reticular formation, via spinoreticular tract (SRT)
    • Hypothalamus, via spinohypothalamic tract (SHT)

Function of Antero-Lateral System Tracts

  • The antero-lateral system tracts serve different functions related to pain such as acute pain, chronic pain, emotional aspects of pain, pain-related reflexes, and pain modulation
  • Acute (fast) pain is transmitted via the spinothalamic tract
  • Chronic (slow) pain involves conduction and has differing aspects
  • Receptors for antero-lateral system are mostly free nerve endings

Lateral Spinothalamic Tract

  • The lateral spinothalamic tract is a component of the spinothalamic tracts and carries a fast pain pathway
  • Functions of the lateral spinothalamic tract are immediate awareness, localization, and intensity of pain
  • The lateral spinothalamic tract transmits temperature sensations and is clinically important for the pinprick test
    • Carried in the lateral spine segment with awareness and localisation, intensity

Lateral Spino-Thalamic Pathway (LST)

  • The 1st-order neurons start from free nerve endings, and cell bodies are in the dorsal root ganglia
    • Central processes of the neurons enter into the dorsal horn spinal cord
  • The 2nd order neurons synapse directly with the first-order neurons in the dorsal horn
    • These neurons take an oblique, upward course, crossing anterior to the central canal via the anterior white commissure
    • Pathway ascends about two segments before entering the LST
  • The 2nd order neurons continue into the brainstem, ascending as the spinal lemniscus to the thalamus
  • The 3rd order neurons synapse with the 2nd order neurons in the ventral posterolateral (VPL) nucleus
    • These then pass through the posterior limb of the internal capsule, corona radiata and reach the somatosensory cortex
  • The pathway mostly consists of fast-conducting A delta-type neurons

Pain/Temp Conduction - Ventral Trigeminothalamic Tract

  • This pathway traces pain/temperature sensations from the face
  • 1st order neurons originate from receptors and have cell bodies located in the trigeminal ganglion
    • Their processes enter the pons, then descend into the medulla as the spinal trigeminal tract
  • 2nd order neurons synapse with the 1st in the spinal nucleus of trigeminal
    • These neurons decussate and enter the VTT before synapsing with 3rd order
  • The 3rd order neurons are located in the ventral posteromedial nucleus (VPM) of the thalamus, and then enter the posterior limb of the internal capsule
    • Following this they will pass through the corona radiata and reach the head representation of the primary somatosensory cortex

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