Cranial Nerve V: Trigeminal Nerve

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Questions and Answers

The trigeminal nerve divides into three branches before exiting the cranial cavity. Which of the following is correct?

  • CN V2 - Maxillary branch exits via the superior orbital fissure.
  • CN V1 - Ophthalmic branch exits via the foramen ovale.
  • CN V3 - Mandibular branch exits via the foramen ovale. (correct)
  • CN V1 - Ophthalmic branch exits via the foramen rotundum.

Which statement accurately describes the sensory innervation of the trigeminal nerve divisions?

  • The ophthalmic division (V1) provides sensation to the lower face and jaw.
  • The mandibular division (V3) provides sensation to the mid-face and upper jaw.
  • The ophthalmic division (V1) provides sensation to the cornea of the eye. (correct)
  • The maxillary division (V2) provides sensation to the forehead and upper eyelid.

In a clinical exam, which action is appropriate and directly evaluates the motor function of the trigeminal nerve (CN V)?

  • Asking the patient to clench their teeth while palpating the masseter muscle. (correct)
  • Having the patient follow a moving finger with their eyes.
  • Testing light touch sensation on the cheek.
  • Touching the forehead with a cotton swab to test corneal reflex.

Which of the following statements accurately describes the sensory component of the corneal reflex?

<p>The ophthalmic branch of the trigeminal nerve (CN V1) detects the stimulus. (A)</p> Signup and view all the answers

Which nerve is primarily affected in trigeminal neuralgia?

<p>Trigeminal nerve (CN V) (D)</p> Signup and view all the answers

What symptoms would you expect with damage in the right side of the brainstem, specifically affecting the trigeminal nerve's nuclei?

<p>Sensory loss and muscle weakness both on the ipsilateral (right) side of the face. (A)</p> Signup and view all the answers

Regarding the muscles of mastication, which of the following statements is most accurate?

<p>The mandibular branch of the trigeminal nerve (CN V3) innervates all the muscles of mastication. (C)</p> Signup and view all the answers

If asked to test temporalis muscle function, what action is most appropriate to test?

<p>Ask the patient to clench their teeth. (A)</p> Signup and view all the answers

Damage to the facial nerve as it exits the stylomastoid foramen is most likely to result in:

<p>Paralysis of the muscles of facial expression on the ipsilateral side. (D)</p> Signup and view all the answers

Which of the following components of the facial nerve is responsible for innervating the stapedius muscle?

<p>Motor component. (C)</p> Signup and view all the answers

Which of the following is most likely affected by problems with the superior salivatory nucleus?

<p>Salivary and lacrimal glands. (C)</p> Signup and view all the answers

What part of the face is affected if there is damage to the facial nerve (CN VII) at the cerebellopontine angle?

<p>The entire half of the face on the same side. (C)</p> Signup and view all the answers

A patient presents with the inability to wrinkle their forehead on the right side, but can still move the lower parts of their face normally. Where is the most likely location of the lesion?

<p>Left motor cortex. (B)</p> Signup and view all the answers

A patient has the inability to wrinkle their forehead, close their eye, and move their mouth on the left side of their face. Where is the most likely location of the lesion?

<p>Facial nerve near the parotid gland. (A)</p> Signup and view all the answers

A tumor located at the cerebellopontine angle is most likely what?

<p>Schwannoma of CN VIII. (C)</p> Signup and view all the answers

During parotid surgery, what is the most significant risk?

<p>Damage to the facial nerve branches. (A)</p> Signup and view all the answers

Which of the following muscles is responsible for closing the eyes tightly?

<p>Orbicularis oculi. (C)</p> Signup and view all the answers

Which of the following muscles is responsible for closing, or pursing the lips?

<p>Orbicularis oris. (B)</p> Signup and view all the answers

Which statement accurately describes key differences between upper motor neuron (UMN) and lower motor neuron (LMN) facial nerve palsy?

<p>UMN lesions spare the forehead, while LMN lesions cause paralysis of the entire ipsilateral face. (D)</p> Signup and view all the answers

Which of the following is a primary function of the vestibulocochlear nerve (CN VIII)?

<p>Hearing and balance. (A)</p> Signup and view all the answers

Which anatomical structures does the vestibulocochlear nerve (CN VIII) pass through to exit the skull?

<p>Internal acoustic meatus. (C)</p> Signup and view all the answers

The vestibular nuclei, which receive input from the vestibulocochlear nerve, are primarily located in the:

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

What inner ear structure is most directly responsible for transducing sound vibrations into electrical signals?

<p>Organ of Corti. (A)</p> Signup and view all the answers

Which of the following structures is primarily responsible for detecting angular acceleration of the head?

<p>Semicircular canals. (A)</p> Signup and view all the answers

Which is a symptom associated with vestibular neuritis?

<p>Vertigo. (D)</p> Signup and view all the answers

After the vestibulocochlear nerve transmits auditory information, which area receives sound?

<p>Ventral and Dorsal cochlear nuclei. (B)</p> Signup and view all the answers

Which of the following is most likely associated with sensorineural hearing loss?

<p>Damage to hair cells in the cochlea. (D)</p> Signup and view all the answers

Which nerve damage is most likely when there is a base of skull fracture?

<p>Damage to the facial or vestibulocochlear. (A)</p> Signup and view all the answers

Following a traumatic injury, a patient reports hearing loss and dizziness together. A fracture to which cranial fossa is most likely?

<p>Posterior Cranial Fossa. (B)</p> Signup and view all the answers

The chorda tympani is a branch of which cranial nerve?

<p>Facial nerve (CN VII) (C)</p> Signup and view all the answers

In the auditory pathway, what is the first structure to receive bilateral input?

<p>Superior olivary complex. (C)</p> Signup and view all the answers

A lesion to the right internal acoustic meatus would most likely affect which combination of functions?

<p>Hearing and balance. (B)</p> Signup and view all the answers

Unlike the Dorsal Column-Medial Lemniscus (DCML) pathway, the Antero-Lateral System (ALS) has multiple destinations for its second-order neurons. Which of the following is a destination of the ALS?

<p>The thalamus (D)</p> Signup and view all the answers

The spinothalamic tract is responsible for carrying sensory information related to pain and temperature. What is the primary type of receptor associated with this system?

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

The lateral spinothalamic tract is crucial for sensing specific types of somatosensory information. Which of the following sensations is primarily transmitted by the lateral spinothalamic tract?

<p>Immediate, localized pain (D)</p> Signup and view all the answers

What is the primary role of the anterior spinothalamic tract?

<p>Mediating crude touch sensations. (A)</p> Signup and view all the answers

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

<p>In the anterior white commissure of the spinal cord (A)</p> Signup and view all the answers

In the lateral spinothalamic tract, where do the third-order neurons synapse?

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

Which type of nerve fiber is primarily associated with the fast pain pathway mediated by the lateral spinothalamic tract?

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

What type of sensory information is carried by the ventral trigeminothalamic tract?

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

Where are the cell bodies of the first-order neurons located in the ventral trigeminothalamic tract?

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

Where do second-order neurons of the ventral trigeminothalamic tract decussate?

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

Which brain structure serves as the location for the third-order neuron cell bodies in both the lateral spinothalamic tract and the ventral trigeminothalamic tract?

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

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

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

Which of the following is true regarding the inputs to the cerebellum from the spinocerebellar tracts?

<p>Inputs are primarily ipsilateral. (D)</p> Signup and view all the answers

Why are the unconscious proprioceptive inputs from the spinocerebellar tracts important for cerebellar function?

<p>To supervise and coordinate executed movements (B)</p> Signup and view all the answers

What is the main difference between primary and secondary (cortical) somatosensory sensations?

<p>Primary sensations are perceived at the level of the thalamus, while secondary sensations require cortical processing. (D)</p> Signup and view all the answers

Which of the following best describes the key characteristics of primary sensory inputs?

<p>They include proprioception, vibration, pressure, crude touch, and discriminative touch. (A)</p> Signup and view all the answers

Which of the following sensory functions relies most heavily on cortical inputs compared to other primary sensations?

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

A lesion in the primary sensory cortex would most likely result in:

<p>Inability to discriminate the qualities of a sensation (e.g., sharpness) on the contralateral side (C)</p> Signup and view all the answers

A patient has difficulty recognizing objects by touch (astereognosis) and identifying letters traced on their palm (graphaesthesia). Where is the most likely location of a lesion causing these deficits?

<p>Sensory association cortex (C)</p> Signup and view all the answers

What type of deficits are most likely associated with lesions commonly occurring in the right parietal lobe?

<p>Deficits in contralateral visuospatial awareness and awareness of the body. (B)</p> Signup and view all the answers

What clinical sign is most indicative of visuospatial neglect following a right hemisphere lesion?

<p>Neglecting to shave the left side of their face (D)</p> Signup and view all the answers

What is the likely sensory deficit in a patient with visuospatial neglect following a right parietal lobe stroke?

<p>Attention to left-sided stimuli is diminished (B)</p> Signup and view all the answers

After a stroke, a patient is unable to feel a pinprick on the left side of their body but retains the ability to feel light touch. Where is the most likely location of the lesion?

<p>Right spinothalamic tract (D)</p> Signup and view all the answers

What is the expected sensory deficit from a lesion that involves only the dorsal horn of the spinal cord?

<p>Loss of pain, temperature, and touch sensation in the ipsilateral dermatome (C)</p> Signup and view all the answers

Sensory deficits from damage to a single spinal nerve root will:

<p>affect all sensory modalities in the dermatome associated with that nerve root (A)</p> Signup and view all the answers

Why does a spinal cord lesion often result in sacral sparing?

<p>Sacral sensory fibers in the spinal cord are located more peripherally within the spinal cord. (A)</p> Signup and view all the answers

Lesions above the pons typically result in what type of sensory deficit?

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

What sensory finding is characteristically associated with a spinal cord lesion?

<p>Dissociated sensory loss (e.g., loss of pain/temperature on one side, loss of proprioception on the other) (C)</p> Signup and view all the answers

If a patient has a dissociated sensory deficit, such as losing pain on the left side of the body and proprioception on the right, the lesion is likely located in the:

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

Which of the following best describes the reason that night time makes sensory ataxia more obvious for patients?

<p>The lack of visual input exacerbates the reliance on proprioceptive information, making deficits more pronounced (B)</p> Signup and view all the answers

A patient displays clumsiness and gait issues that worsen significantly at night. Muscle power is normal, and pain/temp are intact. Proprioception and vibration are diminished in both arms and legs. Which vitamin deficiency is most likely associated with these findings?

<p>Vitamin B12 (C)</p> Signup and view all the answers

A patient reports numbness and tingling throughout the entire C8 dermatome on their left side. Examination reveals decreased sensation to light touch, pinprick, and temperature in this area. The most likely location of the lesion is:

<p>Spinal nerve root at C8 (B)</p> Signup and view all the answers

A patient presents with loss of pain and temperature sensation starting 2 segments below a spinal cord lesion. What is the most likely explanation for this phenomenon?

<p>Second order neurons of the spinothalamic tract ascend approximately 2 segments before crossing in the anterior white commissure (B)</p> Signup and view all the answers

Which of the following best explains the somatotopic organization of the sensory pathways in the spinal cord?

<p>Upper limb fibers are centrally located, while lower limb fibers are peripherally located. (B)</p> Signup and view all the answers

A patient has right sided loss of lower extremity fine touch sensation, and left sided loss of leg pain / temperature. Where is the lesion most likely located?

<p>The right spinal cord (B)</p> Signup and view all the answers

Which of the following fiber types has the slowest conduction velocity?

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

A patient exhibits loss of pain and temperature sensation on the left side of the face. Where is the MOST likely location of the lesion?

<p>Right spinal trigeminal nucleus (C)</p> Signup and view all the answers

A patient has an injury near the spinal cord that affects both the dorsal column and spinothalamic tract on the same side. What are the most likely sensory deficits they will experience?

<p>Ipsilateral loss of light touch and proprioception, contralateral loss of pain and temperature (C)</p> Signup and view all the answers

Which statement is most accurate regarding the destinations of second-order neurons in the Antero-Lateral System (ALS)?

<p>They have multiple destinations, including the thalamus, colliculi, reticular formation, and hypothalamus. (A)</p> Signup and view all the answers

A patient reports a burning, poorly localized pain. Based on the provided information, which pathway is most likely involved in transmitting this type of pain?

<p>The slow pain pathway involving C fibers, which may project to multiple areas of the brain. (A)</p> Signup and view all the answers

After a spinal cord injury, a patient has an immediate loss of pain and temperature sensation. Which of the following tracts is most likely affected?

<p>Lateral Spinothalamic Tract (A)</p> Signup and view all the answers

During a neurological exam, which tract is being primarily assessed when a pin prick test is administered?

<p>Lateral Spinothalamic Tract (A)</p> Signup and view all the answers

Why might a lesion affecting the anterior white commissure impact pain and temperature sensation?

<p>It prevents the decussation of second-order neurons in the spinothalamic tract, disrupting pain and temperature pathways. (D)</p> Signup and view all the answers

Following a stroke, a patient exhibits loss of pain and temperature sensation on one side of their body, originating approximately two spinal segments below the level of the lesion. What is the most likely explanation for this specific sensory deficit?

<p>The second-order neurons of the spinothalamic tract ascend two segments before decussating in the anterior white commissure. (B)</p> Signup and view all the answers

Which of the following best describes the somatotopic organization within the spinal cord influencing how lesions may present?

<p>Sacral sensory neurons are located more peripherally within the spinal cord, while upper limb neurons are located more centrally. (B)</p> Signup and view all the answers

A patient has a spinal cord lesion that results in loss of pain and temperature sensation on the left side of the body and loss of proprioception on the right side. Where is the lesion most likely located?

<p>Hemi-section of the spinal cord (B)</p> Signup and view all the answers

In a patient with known B12 deficiency presenting with sensory ataxia that is worse at night, what is the most likely underlying mechanism?

<p>Reduced visual input at night exacerbates reliance on already impaired proprioceptive and vibratory senses. (A)</p> Signup and view all the answers

Which of the following scenarios would you most likely suspect damage to the trigeminal nerve?

<p>Loss of pain and temperature sensation on the left half of the face. (D)</p> Signup and view all the answers

Which of the following is the most accurate description of how the trigeminal pathway carries pain and temperature information?

<p>First-order neurons in the trigeminal ganglion synapse in the pons, then descend to the medulla to synapse with second-order neurons which decussate and ascend in the VTT. (B)</p> Signup and view all the answers

A patient presents with clumsiness when handling small objects, especially at night. Examination reveals intact motor strength, but impaired proprioception and vibration sense in both arms and legs. Where do the responsible pathways travel?

<p>Dorsal column-medial lemniscus pathway. (C)</p> Signup and view all the answers

A patient exhibits a loss of crude touch sensation. Which of the following pathways is likely affected?

<p>Anterior Spinothalamic Tract (A)</p> Signup and view all the answers

What is the key characteristic of primary sensory inputs compared to secondary (cortical) sensations?

<p>Primary sensory inputs are processed at the level of the thalamus, while secondary sensations require suprathalamic processing. (C)</p> Signup and view all the answers

A patient with a right parietal lobe lesion is asked to draw a clock. Which of the following is the most likely presentation given this information?

<p>The patient draws a clock with numbers only on the right side. (B)</p> Signup and view all the answers

Flashcards

CN V

Cranial Nerve V, responsible for sensory and motor functions in the face.

Gasserian Ganglion

The sensory root expands into this ganglion, located in the middle cranial fossa.

CN V Branches

CN V divides into three branches before exiting the cranial cavity: Ophthalmic (V1), Maxillary (V2), and Mandibular (V3).

Superior Orbital Fissure

CN V1 enters through this opening, progressing distally to supply the forehead, scalp, and upper eyelid.

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Foramen Rotundum

CN V2 exits through this opening to supply the cheek, upper lip, and cheek.

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Foramen Ovale

CN V3 exits through this foramen to supply the lower jaw, lower teeth, and muscles of mastication.

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Main sensory nucleus

Primary sensory nucleus for touch, vibration, and conscious proprioception.

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Mesencephalic nucleus

Nucleus responsible for unconscious proprioception from muscles of mastication.

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Spinal nucleus of V

Receives pain and temperature sensations from the head and neck via the trigeminal nerve.

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Ophthalmic Nerve

The ophthalmic branch of the trigeminal nerve, supplying the upper face and forehead.

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Maxillary Nerve

The maxillary branch of the trigeminal nerve, supplying the mid face and upper jaw.

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Mandibular Nerve

The mandibular branch of the trigeminal nerve, supplying the lower face and jaw.

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CN V Sensory Testing

Testing using a pin prick or cotton wool to assess the three trigeminal nerve territories.

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Corneal Reflex

Protective reflex against foreign bodies touching the cornea, operating at the level of the pons.

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Sensory Component Of Corneal Reflex

Tactile, pressure, or pain conveyed via V1 to the trigeminal sensory nucleus in the brainstem.

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Motor Component Of Corneal Reflex

The Facial nerve controls the orbicularis oculi muscle, causing the eyes to blink when cornea is touched.

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Herpes Zoster (Shingles)

Characterized by a vesicular rash that doesn't cross the midline and follows a dermatomal pattern.

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Trigeminal Neuralgia

Vascular compression of the trigeminal nerve, leading to intense facial pain.

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Carbamazepine

Anti-convulsant that can be used to treat Trigeminal Neuralgia

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Muscles of Mastication

Muscles innervated by V3, assist with chewing (mastication).

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Pontomedullary junction

Located at the junction between the pons and medulla, involved in various functions including facial movement, taste, and autonomic functions like lacrimation and salivation

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Facial Nerve (CN VII)

Cranial Nerve VII, responsible for facial expression, taste from the anterior 2/3 of the tongue, salivation, and lacrimation.

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Facial Canal Lesion

The upper and lower face are affected; taste is lost from the anterior 2/3 of the tongue.

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Cerebello-Pontine Angle Tumor

Condition where ~80% of masses are a result of schwannoma in CN VIII and may include meningiomas and facial schwannoma

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Facial nerve terminal motor branches

Superior and inferior divisions that divide into temporal, zygomatic, buccal, mandibular and cervical branches.

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Auditory pathway

An ascending pathway of the auditory system connecting the choclea to the auditory cortex

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Vestibulocochlear Nerve

Cranial Nerve VIII, responsible for balance.

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Vestibulocochlear nerve

The vestibulocochlear nerve complex, arise from medulla, balance.

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Vestibular Neuritis

Inner ear infection

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Sensorineural Loss

Loss of hair cells difficulty converting sound electrical signals resulting sound clarity loss

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Antero-Lateral System

Sensory pathway carrying pain and temperature information from the body to the brain.

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ALS destinations

Multiple locations including the thalamus, reticular formation, and hypothalamus.

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Lateral Spinothalamic Tract

Pathway in the ALS for fast pain, immediate awareness, localization, and intensity of pain.

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Anterior Spinothalamic Tract

A smaller, less precise part of the anterolateral system.

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Free Nerve Endings

Unspecialized nerve endings, sensitive to noxious stimuli, temperature and crude touch

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STT Synapse Location

First-order neurons synapse directly with second-order neurons in the dorsal horn.

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STT Decussation

Second-order STT neurons cross the midline via the anterior white commissure

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STT ascent

The second-order neurons ascend in the spinal lemiscus of brainstem to synapse in the VPL nucleus of the thalamus.

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A delta fibers

A fast pain pathway

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Ventral Trigeminothalamic Tract

Pathway carrying pain/temperature sensations from the face.

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VTT-Medulla

The spinal trigeminal tract receives sensory information.

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Descending pain modulation pathways

Pathway that is for pain modulation

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Pain Testing

Testing sharpness

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Temperature Testing

Testing temperature

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Dermatome

A map of dermatomes

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Group A fibers

Contains fine touch sensory neurons in the skin, muscles, and joints

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Group B fibers

Contains preganglionic sympathetic fibers

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Group C fibers

Contains unmyelinated axons

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Somatotopic Organization

In the spinal cord, Lower limb neurons are located more laterally.

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Thalamus

Perception of basic sensation occurs at this level.

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Spatial neglect

Right brain damage causes neglect.

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Study Notes

Pain & Temperature Pathways

  • Unlike the Dorsal Column-Medial Lemniscus (DCML), the Antero-Lateral System has multiple destinations for the 2nd order neurons.
  • Thalamus is a destination via the Spinothalamic tract (STT).
  • The Colliculi is a destination via Spinotectal tracts (STCT)
  • The Reticular formation is a destination via the Spinoreticular tract (SRT)
  • The Hypothalamus is a destination via the Spinohypothalamic tract (SHT)
  • Tracts are likely to have different functions in relation to pain
  • Acute (fast) pain uses the Spinothalamic tract
  • Chronic (slow) pain involves conduction with different aspects
  • Emotional aspects of pain are also processed
  • Pain related reflexes occur
  • Pain modulation occurs through spinotectal and spinoreticular pathways via tectum to control other aspects
  • Receptors for pain and temperature are mostly free nerve endings.

Spinothalamic Tracts

  • There are 2 components - Lateral and Anterior
  • Lateral Spinothalamic Tract
  • It is a fast pain pathway for immediate awareness, localization, and intensity of pain
  • It is clinically important and a substrate for the pin prick test
  • It also transmits temperature sensation
  • Travels in the lateral spine segment and relates to awareness, localisation, and intensity
  • Anterior Spinothalamic Tract
  • Responsible for crude touch
  • Primarily lateral tract, mediates temperature, pain, and discriminative touch

Lateral Spinothalamic Pathway (LST)

  • 1st order neurons originate from free nerve endings with cell bodies in the dorsal root ganglia
  • Central processes enter the dorsal horn of the spinal cord
  • They synapse directly with 2nd order neurons in the dorsal horn
  • 2nd order neurons take an oblique upward course crossing to the opposite side anterior to the central canal via the Anterior White Commissure
  • Enter the LST about two segments above
  • 2nd order neurons ascend in the brainstem as the Spinal Lemniscus to the thalamus
  • They synapse directly with 3rd order neurons in the Ventral Postero-Lateral (VPL) nucleus
  • 3rd order neurons pass into the posterior limb of the internal capsule
  • They pass through the corona radiata and reach the primary somatosensory cortex
  • Pathway mostly consists of fast conducting A delta type neurons, which decussate and takes 2 segments

Pain/Temp Conduction from Head - Ventral Trigeminothalamic Tract

  • 1st order neurons originate from receptors with their cell bodies in the Trigeminal ganglion
  • Central processes enter the Pons.
  • These neurons then descend into the Medulla as the Spinal Trigeminal Tract.
  • They synapse with cell bodies of 2nd order neurons located in the Spinal Nucleus of Trigeminal.
  • The 2nd order neurons decussate in the medulla and enter the VTT (Ventral Trigeminothalamic Tract).
  • 2nd order neurons ascend in the VTT, synapsing with 3rd order neurons in the Ventral Postero-Medial nucleus (VPM) of the thalamus.
  • 3rd order neurons enter the posterior limb of the internal capsule
  • These then passes through the corona radiata and reach the area representing the head the primary somatosensory cortex.

Anterior Tracts of ALS

  • Pathway mostly consists of slow conducting C type (unmyelinated) neurons (very small - type C chronic pain, slow)
    • Anterior Spinothalamic Tract relates to crude touch sensation
  • Spino-mesencephalic pathway
  • Spino-reticular pathway: Type A - fast
  • descending signals from cerebral cortex down to help modulate pain
  • Involved with opioids

Descending Pain Modulation Pathways

  • Projects to the dorsal column, starting with the second neuron
  • Periaqueductal gray matter (PAG - contains opioid receptors)
  • Rostral ventromedial medulla (RVM) projects descending singals
  • Terminates mostly on C fibers, influencing slow pain

Lateral Spinothalamic Pathway (LST)

  • Left medullary lesion could cause left sided facial anesthesia (True or False?)
  • Hemisection could cause anesthesia whole face (True or False?)
  • Affects spinal tract and results in pain and temperature deficits
  • Affects the same (ipsilateral) side
  • Affects Pina, and temperature mostly Lateral Spino-Thalamic-VTT relates to the right side of the face, in hemisection - affect both sides of face Involved neurons from both sides at the level of decussation.

Tests

  • Pain testing method involves using a tooth pick or safety pin, asking the patient if they feel sharp or dull, comparing the test on two sides, in order to localize the site of pain or deficit
  • Temperature is evaluated by using test tubes containing warm and cold solutions, asking the patient if they feel warm or cold
  • Crude touch is tested by touching the patient with cotton wool, asking them if they can feel anything, and comparing two sides using the cotton wool ALS for crude touch

Sensory Pathways from the Face

  • All somatic sensations (Pain/temp/Proprioception/Discriminative touch) sensations derived from the head region sent through the 3 main branches of the Trigeminal nerve to the brainstem
  • Ophthalmic
  • Maxillary
  • Mandibular 1st neuron cell bodies are located in Trigeminal ganglion Yellow = pain - BLUE touch or Proprioception .synapse at pons stay stay and synapse 2nd neuron cell bodies are located in Nuclei, MIDBRAIN
  • Mesencephalic nucleus ,Unconscious, Proprioception, PONS
  • Main sensory nucleus pons relates Touch and Conscious Proprioception, Spinal nucleus of V-spinal trigeminal enter pont ,Pain and Temperature

Ventral Trigeminothalamic Tract

  • Ventral Trigeminothalamic tract Proprioception , Vibration, Discriminative-Head Receptors for Ophthalmic ,Maxillary N , Mandibular Proprioception , Vibration , Discriminative touch
    • 1st order neuron ascends upwards to thalamus.

Spinocerebellar Tracts

  • These pathways carry proprioceptive info to the cerebellum (unconscious) via multiple pathways
  • Dorsal spinocerebellar tract (DSCT)- Proprioceptive input to IPSILATERALcerebellum
  • Ventral spinocerebellar tract (VSCT)- Mainly info regarding spinal interneuron activity in relation to stretch reflex to IPSILATERAL cerebellum.

What you need to know

  • The pathways transmit unconscious proprioceptive input ,that are ipsilateral
  • These inputs are important for cerebellum about executed movement
  • Important to supervise (coordinate) the movements.

Primary and Secondary Cortical Sensations

  • Primary sensory inputs include proprioception, vibration, pressure, crude touch and discriminative touch
  • Perception of primary sensation occurs at the level of thalamus
  • Patient is able to to feel pain and crude touch, however the patient will have no discriminating ability or localizing ability
  • Processing of proprioception generally needs cortical inputs, but also
  • Secondary uses multiple primary sensory inputs to process together at supra thalamic levels
  • Primary sensory cortex is Contralateral - localizing, in regards to quality and intensity
  • Cortical sensations
  • Stereognosis, Graphaesthesia is secondary which need primary sesnosory in order for fine touch ,pressure is needed- or 2 point D
  • Contralateral Contralateral Visuo Awareness awareness what happens on to deficits side
  • See why in next slide

Processing of spatial awareness

  • Right Posterior Parietal cortex is responsible for Visuospatial awareness on both left and right

  • Left Posterior Parietal cortex is responsible for Visuospatial awareness on the right side "world"

  • Lesion of the left results in cannot process info process can the right Hemineglect uncommon is where LT hemisphere - RT space

  • Can be the inability to do sterognosis also , inability side to do Sterognosis

Tests for Cortical Sensations

Sensory attention

  • Stereognosis- familiar object close eyes cortical
  • Numbers and letters cortical
  • Double stimulation test - open eyes stimuli if right will- problems this is issue 1ry tested modalities sensations

Somatotopic Organization of Sensory pathway in Spinal Cord

  • Spinal cord tracts-leg medial, face lateral , C - cervical, TG - thoracic, L- lumbar, S - sacral lumbar and sacral periphera
  • Lateral Cortico spinal tract Lateral Lesions . sacral involved
  • Similar to lower
  • Most are located periphery upper limb centrally lesions sacord -Sacral sparing . cord sensory

Patterns of Sensory Deficits – Central & Peripheral Lesions

Spinal - Pink Lateral Dorsal is cord

  • The deficits cord Lateral

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Patterns of Sensory Deficits – Central & Peripheral Lesions

  • VTT is not the Lateral to not the

Dermatome

  • Area of skin innervated by nerve will ,spinal this Spinal dermatome and

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