Podcast
Questions and Answers
What type of sensory information is primarily carried by the DCML pathway?
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?
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?
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?
What is the sequence of brain structures that the DCML pathway synapses with after decussation?
Which pathway runs on the ipsilateral side of the spinal cord before decussation?
Which pathway runs on the ipsilateral side of the spinal cord before decussation?
Which type of sensation requires the integrity of the contralateral cerebral sensory cortex for correct perception?
Which type of sensation requires the integrity of the contralateral cerebral sensory cortex for correct perception?
What is the primary role of the posterior roots of spinal nerves?
What is the primary role of the posterior roots of spinal nerves?
Which pathway is responsible for carrying information about pain and temperature?
Which pathway is responsible for carrying information about pain and temperature?
What does the term 'decussate' refer to in the context of sensory pathways?
What does the term 'decussate' refer to in the context of sensory pathways?
Which of the following is not a cortical sensation?
Which of the following is not a cortical sensation?
How are sensations of itching and tickling processed in the nervous system?
How are sensations of itching and tickling processed in the nervous system?
What ability is assessed when a patient can recognize a key placed in their hand without seeing it?
What ability is assessed when a patient can recognize a key placed in their hand without seeing it?
Which of the following sensations is processed primarily at the contralateral thalamus?
Which of the following sensations is processed primarily at the contralateral thalamus?
What is a common cause of dorsal radiculopathy?
What is a common cause of dorsal radiculopathy?
Which neurological syndrome is characterized by impaired vibration and proprioception below the level of the lesion?
Which neurological syndrome is characterized by impaired vibration and proprioception below the level of the lesion?
Which condition is described by damage to multiple peripheral nerves in a symmetrical manner?
Which condition is described by damage to multiple peripheral nerves in a symmetrical manner?
What symptom would NOT typically be associated with an impairment in the dorsal root?
What symptom would NOT typically be associated with an impairment in the dorsal root?
Which of the following conditions is NOT a cause of Posterior Cord Syndrome?
Which of the following conditions is NOT a cause of Posterior Cord Syndrome?
Which symptom is typically spared in Posterior Cord Syndrome unless the lesion progresses?
Which symptom is typically spared in Posterior Cord Syndrome unless the lesion progresses?
What type of nerve damage involves only a single nerve?
What type of nerve damage involves only a single nerve?
Which of the following is a characteristic symptom of dorsal radiculopathy?
Which of the following is a characteristic symptom of dorsal radiculopathy?
What causes Anterolateral Cord Syndrome?
What causes Anterolateral Cord Syndrome?
Which sensory modalities are preserved in Central Cord Syndrome?
Which sensory modalities are preserved in Central Cord Syndrome?
Which tract is least affected by lesions of the Medulla Oblongata?
Which tract is least affected by lesions of the Medulla Oblongata?
What is a clinical feature of Anterolateral Cord Syndrome?
What is a clinical feature of Anterolateral Cord Syndrome?
Which syndrome features dissociated sensory loss?
Which syndrome features dissociated sensory loss?
Who is most likely to be affected by the consequences of lateral medullary infarction?
Who is most likely to be affected by the consequences of lateral medullary infarction?
What effect does Anterolateral Cord Syndrome have on the corticospinal tract?
What effect does Anterolateral Cord Syndrome have on the corticospinal tract?
Which clinical sign is typical of Central Cord Syndrome as it expands?
Which clinical sign is typical of Central Cord Syndrome as it expands?
What is the primary function of the trigeminal nerve (CN V)?
What is the primary function of the trigeminal nerve (CN V)?
What is the clinical feature associated with lesions of the Medulla Oblongata?
What is the clinical feature associated with lesions of the Medulla Oblongata?
Where does sensation from the trigeminal nerve's nuclei decussate before ascending to the thalamus?
Where does sensation from the trigeminal nerve's nuclei decussate before ascending to the thalamus?
Where is sensory impairment localized with a unilateral lesion of the pons or midbrain?
Where is sensory impairment localized with a unilateral lesion of the pons or midbrain?
Which part of the body does the somatosensory cortex primarily receive sensations from?
Which part of the body does the somatosensory cortex primarily receive sensations from?
Which sensory pathway is primarily responsible for transmitting fine touch and proprioception?
Which sensory pathway is primarily responsible for transmitting fine touch and proprioception?
What are common causes of Thalamic Pain Syndrome?
What are common causes of Thalamic Pain Syndrome?
What is a clinical consequence of a parietal lobe lesion?
What is a clinical consequence of a parietal lobe lesion?
In a lesion affecting a peripheral nerve, what kind of sensory impairment would you expect?
In a lesion affecting a peripheral nerve, what kind of sensory impairment would you expect?
Which of the following distinguishes the sensory effects of a Medulla Oblongata lesion from a Thalamic Pain Syndrome?
Which of the following distinguishes the sensory effects of a Medulla Oblongata lesion from a Thalamic Pain Syndrome?
Which structure directly follows the trigeminal nerve in the ascending sensory pathway?
Which structure directly follows the trigeminal nerve in the ascending sensory pathway?
In Thalamic Pain Syndrome, what sensory modality is primarily affected?
In Thalamic Pain Syndrome, what sensory modality is primarily affected?
What is the role of the dorsal ganglion in sensory pathways?
What is the role of the dorsal ganglion in sensory pathways?
How is pain and temperature perception affected by a lesion in the Medulla Oblongata?
How is pain and temperature perception affected by a lesion in the Medulla Oblongata?
Which of the following best describes the pathway of sensations from the trigeminal nerve to the somatosensory cortex?
Which of the following best describes the pathway of sensations from the trigeminal nerve to the somatosensory cortex?
What is typically preserved in a parietal lobe lesion despite sensory loss?
What is typically preserved in a parietal lobe lesion despite sensory loss?
Flashcards
Pain
Pain
The feeling of physical discomfort, usually caused by injury or illness.
Touch
Touch
The ability to sense pressure, light touch, and texture on the skin.
Temperature
Temperature
The ability to detect temperature difference with the skin, sensing hot or cold.
Vibration
Vibration
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Proprioception
Proprioception
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Joint Motion and Limb Position
Joint Motion and Limb Position
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Cortical Sensations
Cortical Sensations
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Two-point discrimination
Two-point discrimination
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Dorsal Column-Medial Lemniscus (DCML) Pathway
Dorsal Column-Medial Lemniscus (DCML) Pathway
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Ipsilateral Ascend
Ipsilateral Ascend
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Decussation in the Medulla
Decussation in the Medulla
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Sensory Pathways
Sensory Pathways
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DCML Function
DCML Function
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Mononeuropathy
Mononeuropathy
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Polyneuropathy
Polyneuropathy
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Dorsal Radiculopathy
Dorsal Radiculopathy
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Ipsilateral Radicular Pain
Ipsilateral Radicular Pain
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Posterior Cord Syndrome
Posterior Cord Syndrome
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Anterolateral Cord Syndrome
Anterolateral Cord Syndrome
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Central Cord Syndrome
Central Cord Syndrome
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Ataxia
Ataxia
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Trigeminal Nerve Divisions
Trigeminal Nerve Divisions
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Trigeminal Nucleus
Trigeminal Nucleus
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Decussation of Trigeminal Nerve
Decussation of Trigeminal Nerve
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Dorsal Column-Medial Lemniscus Pathway (DCML)
Dorsal Column-Medial Lemniscus Pathway (DCML)
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Spinothalamic Tract
Spinothalamic Tract
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Somatosensory Cortex
Somatosensory Cortex
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Peripheral Nerve Lesion
Peripheral Nerve Lesion
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Localisation-Based Classification of Sensory Syndromes
Localisation-Based Classification of Sensory Syndromes
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Clinical Features of Anterolateral Cord Syndrome
Clinical Features of Anterolateral Cord Syndrome
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Clinical Features of Central Cord Syndrome
Clinical Features of Central Cord Syndrome
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Lateral Medullary Infarction (Wallenberg Syndrome)
Lateral Medullary Infarction (Wallenberg Syndrome)
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Lesions of the Medulla Oblongata
Lesions of the Medulla Oblongata
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Spinothalamic and DCML Pathways
Spinothalamic and DCML Pathways
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Decussation
Decussation
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Thalamic Pain Syndrome
Thalamic Pain Syndrome
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Hyperpathia
Hyperpathia
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Harlequin Syndrome
Harlequin Syndrome
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Thalamus
Thalamus
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Medulla Oblongata
Medulla Oblongata
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Pons
Pons
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Cerebral Cortex
Cerebral Cortex
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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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