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■ Posterior Column–Medial Lemniscus System in Clinical Orientation: Representative

Lesions and Deficits ■

Postcentral gyrus (middle

third is upper extremity area Posterior paracentral gyrus
of somatosensory cortex) (lower extremity area of
somatosensory cortex)

Thalamocortical fibers
in posterior limb of
internal capsule

Ventral posterolateral • Diminution/loss proprioception, dis-

nucleus criminative touch, vibratory sense, pain,
and thermal sense on right UE and LE
plus face and oral cavity if VPM involved
• Paresthesias
• Transient right hemiplegia

ML in midbrain

• Loss of proprioception, discriminative

ALS in midbrain touch, and vibratory sense on right LE
(plus UE if medial part of ML involved)
Red nucleus • Loss of pain and thermal sensation
on right UE and LE

Mid-to-rostral pons
• Loss of proprioception; discriminative
touch; and vibratory, pain, and thermal
senses on right UE and LE
• Loss of discriminative touch, pain, and
thermal sense on left side of face;
ML in pons paralysis of masticatory muscles
(trigeminal nuclei involved)
ALS in pons Caudal pons
• Proprioception and pain/thermal loss
as in mid-to-rostral pons
• Left-sided facial and lateral rectus
paralysis (facial/abducens nucleus/nerve)
• Loss pain/thermal sense on left face
• Left ptosis, miosis, and anhidrosis
(Horner)
ML in medulla
Anterolateral system • Loss of proprioception, discriminative
(ALS) in medulla touch, and vibratory sense of right UE/LE
• Tongue weakness: Deviates to left on
attempted protrusion
Spinal trigeminal • Hemiplegia of right UE and LE
tract and nucleus

Medial lemniscus (ML)

Sensory decussation
Internal arcuate fibers Cuneate nucleus
Gracile nucleus
Spinal cord hemisection
• Right-sided loss of proprioception,
discriminative touch, and vibratory sense
below lesion
• Left-sided loss of pain/thermal sensation
beginning about two levels below lesion
• Right-sided paralysis below lesion
• Right Horner, if lesion at cervical levels
Posterior root
Posterior column lesion ganglia above T6
• Right-sided loss of proprioception,
discriminative touch, and vibratory sense
below lesion
Gracile fasciculus Posterior root
Posterior columns
Cuneate fasciculus ganglia below T6

Representative lesions within the CNS that involve the the deficits is determined by whether the lesion is on the left or right
8-5B PC–ML system and the deficits that correlate with the side of the MRI/CT; this reinforces important clinical concepts.
level and laterality of each lesion. Note that the laterality (R/L) of