Neuroscience: DCML Pathway Quiz

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Questions and Answers

What type of sensory information is primarily carried by the DCML pathway?

  • Pain and temperature
  • Vibration, proprioception, and fine touch (correct)
  • Visual and auditory stimuli
  • Coarse touch and pressure

Where does the decussation of the DCML pathway occur?

  • At the level of the lumbar region
  • In the spinal cord
  • Within the thalamus
  • In the lower medulla (correct)

Which structures are involved in transmitting information through the DCML pathway?

  • Spinocerebellar tracts
  • Lateral corticospinal tract
  • Cuneate and Gracile Fasciculi (correct)
  • Anterior spinothalamic tract

What is the sequence of brain structures that the DCML pathway synapses with after decussation?

<p>Thalamus, parietal cortex (C)</p> Signup and view all the answers

Which pathway runs on the ipsilateral side of the spinal cord before decussation?

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

Which type of sensation requires the integrity of the contralateral cerebral sensory cortex for correct perception?

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

What is the primary role of the posterior roots of spinal nerves?

<p>Conduct sensory information to the spinal cord (C)</p> Signup and view all the answers

Which pathway is responsible for carrying information about pain and temperature?

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

What does the term 'decussate' refer to in the context of sensory pathways?

<p>The crossing over of nerve fibers to the opposite side (C)</p> Signup and view all the answers

Which of the following is not a cortical sensation?

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

How are sensations of itching and tickling processed in the nervous system?

<p>Via the spinothalamic pathway (C)</p> Signup and view all the answers

What ability is assessed when a patient can recognize a key placed in their hand without seeing it?

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

Which of the following sensations is processed primarily at the contralateral thalamus?

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

What is a common cause of dorsal radiculopathy?

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

Which neurological syndrome is characterized by impaired vibration and proprioception below the level of the lesion?

<p>Posterior Cord Syndrome (A)</p> Signup and view all the answers

Which condition is described by damage to multiple peripheral nerves in a symmetrical manner?

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

What symptom would NOT typically be associated with an impairment in the dorsal root?

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

Which of the following conditions is NOT a cause of Posterior Cord Syndrome?

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

Which symptom is typically spared in Posterior Cord Syndrome unless the lesion progresses?

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

What type of nerve damage involves only a single nerve?

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

Which of the following is a characteristic symptom of dorsal radiculopathy?

<p>Ipsilateral muscle weakness (C)</p> Signup and view all the answers

What causes Anterolateral Cord Syndrome?

<p>Anterior spinal artery occlusion (B)</p> Signup and view all the answers

Which sensory modalities are preserved in Central Cord Syndrome?

<p>Touch, vibration, and proprioception (C)</p> Signup and view all the answers

Which tract is least affected by lesions of the Medulla Oblongata?

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

What is a clinical feature of Anterolateral Cord Syndrome?

<p>Bilateral impairment of pain and temperature perceptions (D)</p> Signup and view all the answers

Which syndrome features dissociated sensory loss?

<p>Central Cord Syndrome (C)</p> Signup and view all the answers

Who is most likely to be affected by the consequences of lateral medullary infarction?

<p>Patients with circulatory system disorders (A)</p> Signup and view all the answers

What effect does Anterolateral Cord Syndrome have on the corticospinal tract?

<p>It is completely affected (B)</p> Signup and view all the answers

Which clinical sign is typical of Central Cord Syndrome as it expands?

<p>Lower motor neuron signs below the lesion (C)</p> Signup and view all the answers

What is the primary function of the trigeminal nerve (CN V)?

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

What is the clinical feature associated with lesions of the Medulla Oblongata?

<p>Impaired pain and temperature perception (B)</p> Signup and view all the answers

Where does sensation from the trigeminal nerve's nuclei decussate before ascending to the thalamus?

<p>Within the trigeminal nucleus in the pons (D)</p> Signup and view all the answers

Where is sensory impairment localized with a unilateral lesion of the pons or midbrain?

<p>Contralateral to the lesion (C)</p> Signup and view all the answers

Which part of the body does the somatosensory cortex primarily receive sensations from?

<p>The contralateral side of the body (A)</p> Signup and view all the answers

Which sensory pathway is primarily responsible for transmitting fine touch and proprioception?

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

What are common causes of Thalamic Pain Syndrome?

<p>Stroke, multiple sclerosis, tumors, and trauma (B)</p> Signup and view all the answers

What is a clinical consequence of a parietal lobe lesion?

<p>Loss of discriminative sensory function contralateral to the lesion (A)</p> Signup and view all the answers

In a lesion affecting a peripheral nerve, what kind of sensory impairment would you expect?

<p>Impairment of multiple modalities in a corresponding dermatomal distribution (A)</p> Signup and view all the answers

Which of the following distinguishes the sensory effects of a Medulla Oblongata lesion from a Thalamic Pain Syndrome?

<p>Ipsilateral face and contralateral body effects (C)</p> Signup and view all the answers

Which structure directly follows the trigeminal nerve in the ascending sensory pathway?

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

In Thalamic Pain Syndrome, what sensory modality is primarily affected?

<p>All sensory modalities contralateral to the lesion (D)</p> Signup and view all the answers

What is the role of the dorsal ganglion in sensory pathways?

<p>To relay afferent sensory information to the spinal cord (D)</p> Signup and view all the answers

How is pain and temperature perception affected by a lesion in the Medulla Oblongata?

<p>Impaired ipsilaterally on the face (A)</p> Signup and view all the answers

Which of the following best describes the pathway of sensations from the trigeminal nerve to the somatosensory cortex?

<p>CN V → Pons → Thalamus → Somatosensory Cortex (B)</p> Signup and view all the answers

What is typically preserved in a parietal lobe lesion despite sensory loss?

<p>Both pain and temperature (B)</p> Signup and view all the answers

Flashcards

Pain

The feeling of physical discomfort, usually caused by injury or illness.

Touch

The ability to sense pressure, light touch, and texture on the skin.

Temperature

The ability to detect temperature difference with the skin, sensing hot or cold.

Vibration

The ability to sense vibrations applied to the body, usually tested with a tuning fork.

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Proprioception

The sense of body position and movement, including limb position, joint movement, and muscle stretch.

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Joint Motion and Limb Position

The ability to detect the motion and position of your joints, allowing you to understand body movement.

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Cortical Sensations

Sensory functions that are processed in the cerebral cortex, allowing for more complex sensory perception.

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Two-point discrimination

The ability to distinguish two points on the skin that are simultaneously touched, assessed by using two compass points.

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Dorsal Column-Medial Lemniscus (DCML) Pathway

A sensory pathway responsible for transmitting information about vibration, proprioception (awareness of body position), and fine touch.

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Ipsilateral Ascend

The DCML pathway's fibers ascend on the same side of the spinal cord they originated from before crossing over.

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Decussation in the Medulla

The point where the DCML pathway's fibers switch sides, crossing over from one side of the spinal cord to the other.

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Sensory Pathways

The DCML pathway transmits information about fine touch and proprioception, while another pathway, the Lateral Spinothalamic Tract, carries pain and temperature.

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DCML Function

The DCML pathway is responsible for the ability to precisely feel the texture, shape, and movement of objects, allowing for fine motor control.

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Mononeuropathy

Damage to a single peripheral nerve.

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Polyneuropathy

Symmetrical damage to multiple peripheral nerves.

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Dorsal Radiculopathy

Disorder of the dorsal root, often caused by a herniated disc.

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Ipsilateral Radicular Pain

Pain felt along the path of a nerve root, usually described as electric or tingling.

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Posterior Cord Syndrome

A condition affecting the DCML pathway, responsible for vibration and proprioception, caused by factors like Vitamin B12 deficiency or Multiple sclerosis.

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Anterolateral Cord Syndrome

A condition affecting the corticospinal tract, responsible for motor control, and spinothalamic tract, responsible for pain and temperature sensation.

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Central Cord Syndrome

A condition affecting the central part of the spinal cord, impacting motor control and sensation.

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Ataxia

Loss of coordination, often seen in conditions affecting the cerebellum or its pathways.

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Trigeminal Nerve Divisions

The three branches of the trigeminal nerve (CN V) responsible for conveying sensations from the head and face. They are the ophthalmic, maxillary, and mandibular divisions.

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Trigeminal Nucleus

The central nucleus in the pons where sensory information from the trigeminal nerve first reaches. It receives pain, temperature, and touch signals.

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Decussation of Trigeminal Nerve

The process where sensory information from the trigeminal nerve crosses over from one side of the brain to the other side of the body. It occurs at the trigeminal nucleus.

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Dorsal Column-Medial Lemniscus Pathway (DCML)

The pathway that carries touch, pressure, and vibration sensations from the body to the brain. This pathway runs alongside the trigeminal nerve pathway.

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Spinothalamic Tract

The pathway that carries pain and temperature sensations from the body to the brain. It works alongside the DCML pathway.

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Somatosensory Cortex

The region in the parietal lobe of the brain where all sensory information is processed and interpreted. It receives signals from the thalamus.

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Peripheral Nerve Lesion

A sensory impairment that affects all modalities (pain, temperature, touch) in a specific area of the body due to damage in the peripheral nerve supplying that area.

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Localisation-Based Classification of Sensory Syndromes

A classification system for sensory syndromes based on the location of the lesion. It considers peripheral nerves, spinal cord, brainstem, thalamus, and the somatosensory cortex.

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Clinical Features of Anterolateral Cord Syndrome

Clinical features include bilateral loss of pain and temperature sensation below the lesion level, along with paraplegia or tetraplegia, characterized by decreased muscle tone (hypotonia) and reflexes (hyporeflexia).

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Clinical Features of Central Cord Syndrome

Clinical features encompass a dissociated sensory loss (bilateral loss of pain and temperature sensation with preserved touch, vibration, and proprioception), and potential LMN signs below the lesion if the lesion expands sufficiently.

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Lateral Medullary Infarction (Wallenberg Syndrome)

A neurological condition affecting the trigeminal nerve and spinothalamic tracts, typically sparing the DCML pathway due to its medial location.

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Lesions of the Medulla Oblongata

A lesion in the medulla oblongata, often due to an occlusion of the posterior inferior cerebellar artery (PICA), which supplies blood to the lateral medulla.

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Spinothalamic and DCML Pathways

The spinothalamic tracts carry pain and temperature information, while the dorsal column-medial lemniscus (DCML) pathway transmits information about fine touch, vibration, and proprioception.

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Decussation

The point at which nerve fibers cross from one side of the nervous system to the other. In the context of the spinothalamic tract, the fibers cross in the spinal cord, while in the DCML pathway, they cross in the medulla oblongata.

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Thalamic Pain Syndrome

A condition caused by damage to the thalamus, resulting in intense, persistent pain on one side of the body, often triggered by even the slightest touch.

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Hyperpathia

A sensory disorder characterized by an exaggerated response to painful stimuli, often experienced with thalamic pain syndrome.

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Harlequin Syndrome

A condition resulting from damage to the medulla oblongata, where pain and temperature sensation are impaired on one side of the face and the opposite side of the body.

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Thalamus

An area of the brain that processes sensory information from the body before sending it to the cortex, essentially acting as a relay station for touch, pain, temperature, and proprioception.

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Medulla Oblongata

A part of the brainstem responsible for vital functions like breathing, heart rate, and blood pressure.

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Pons

A region of the brainstem where sensory pathways from the body converge before being sent to the thalamus.

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Cerebral Cortex

The outermost layer of the brain responsible for higher-level functions, including perception, thought, and language.

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Study Notes

Sensory Syndromes

  • This lecture covers sensory pathways and syndromes.
  • Includes classifications based on the location of the lesion affecting the sensory system.

Types of Sensations

  • Pain, touch, temperature, vibration, and proprioception are discussed.
  • Cortical sensations are tested with the patient's eyes closed, including two-point discrimination, tactile recognition, graphesthesia, and localization.

Classification

  • Vibration, proprioception, and cortical sensations require the contralateral cerebral sensory cortex for accurate perception.
  • Pain, temperature, and touch are processed in the contralateral thalamus.

Anatomical Review

  • Spinal Nerves: Each spinal nerve has an anterior and a posterior root. Anterior roots carry motor information, originating from anterior horns and exiting towards muscles. Posterior roots carry sensory information from receptors to the posterior horns, containing a sensory ganglion.
  • Sensory Pathways:
    • The spinothalamic pathway carries pain, temperature, and crude touch, decussating (crossing to the opposite side) in the spinal cord and ascending to the thalamus.
    • The dorsal column-medial lemniscus (DCML) pathway carries vibration, proprioception, and fine touch, ascending ipsilaterally (same side) in the spinal cord, decussating in the medulla, and synapsing in the thalamus and parietal cortex.
  • Cranial Nerves: The trigeminal nerve (CN V) conveys sensory information from the face, with its ophthalmic, maxillary, and mandibular divisions. Afferent signals travel to the trigeminal nucleus in the pons, decussating and ascending to the thalamus and somatosensory cortex.

Sensory Syndromes:

  • Classification by Location: Lesions in peripheral nerves, dorsal roots, spinal cord, brainstem, thalamus, and the somatosensory cortex each result in unique patterns of sensory loss.
  • Peripheral Nerve Lesions: Injury to a peripheral nerve leads to sensory impairment across all modalities in the corresponding dermatome.
    • Mononeuropathy: Damage to a single nerve
    • Polyneuropathy: Symmetrical damage to multiple peripheral nerves
  • Dorsal Root Disorders: Often caused by herniated discs, resulting in ipsilateral (same side) radicular pain (tingling or electrical), hypoesthesia (reduced sensation), and muscle weakness.
  • Spinal Cord Syndromes:
    • Posterior Cord Syndrome: Affects the DCML pathway, sparing spinothalamic and corticospinal fibers. Causes include vitamin B12 deficiency and multiple sclerosis. Clinical features include bilateral loss of vibration and position sense below the level of the lesion.
    • Anterolateral Cord Syndrome: Affects spinothalamic and corticospinal tracts, sparing dorsal columns. Often caused by anterior spinal artery occlusion. Clinical features include bilateral impairment of pain and temperature below the level of the lesion, plus paraplegia or tetraplegia with hypotonia and hyporeflexia.
    • Central Cord Syndrome: Affects spinothalamic fibers at the level of decussation, sparing the DCML pathway. Often due to syringomyelia or spinal tumours. Clinical features include dissociated sensory loss (pain and temperature lost, touch preserved).
  • Brainstem Lesions:
    • Medulla Oblongata Lesions: Commonly due to posterior inferior cerebellar artery occlusion. Affect the trigeminal nerve and spinothalamic tracts (ipsilateral facial and contralateral body pain/temp). Clinical features include impaired pain/temp. ipsilateral on the face and contralateral on the body (Harlequin syndrome).
    • Pons and Midbrain Lesions: Unilateral lesions result in sensory impairment contralateral to the side of the lesion.
  • Thalamic Lesions: Thalamic pain syndrome, causing impairment of all sensory modalities on the opposite side of the body (contralateral). Symptoms may include hyperpathia (excessive sensitivity to pain).
  • Somatosensory Cortex Lesions: Parietal lobe lesions cause loss of discriminative sensory function on the opposite side of the body (contralateral). Pain/temp/touch are relatively preserved.

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