NUEROANATOMY

ZND
WEEK FILE
2 LECTURES

BY : HEMMEH ASNAN

E a >»
Herniated (something come out of its natural position) Disc/ ruptured
bas disc/ slipped 4. disc
lides content
protrusion (leakage) of the gelatinous nucleus lecture notes
pulposus through the anulus fibrosus of IV disc

fibrocartilage >reinforced
(A le
I
bad forty bas
b collagen fibers
398 Jaoud allay 5” body
Verabrat
a
| ii Nucleuf
Yi FE

ral
oh

vo—r
Intervertebral Anulus
(about 70% of the body weight) (W “isedisc)
. fe 2

_ |
fibrosis _f
— -

Po st er ol at er al di re ct io n: (w ee ke st poi nt)
Thinner annulus fibrosus
95% in L4/L5orL5/S1 |...

r Spinal nerve
intervertebral foramen :
Herniation) pressure on the spinal nerve
Nucleus pulposus
more elastic (gelatinous), central part of the disc
Annulus fibrosus
fibrocartilage
ANTERIOR Superior view

omatic
sensory
nerve

posterior root

somatic
motor
nerve
(GSE)
anterior root

muscle muscle tissue that is supplied by

(myotome) single spinal nerve

when asking about the sensory innervation of the lateral aspect of the forearm
The answer could be the lateral cutaneous nerve of forearm (a branch from the
musculocutaneous nerve)
OR C6 because the musculocutaneous nerve is a branch from the lateral cord(brachial
plexus) that is formed by the anterior division of the upper and middle trunk (C5+C6))
Common lumbar disc problems

Percentage | Motor weakness Sensory Reflex affected

changes
L3-L4 L4 3-10% Knee, extension Anteriomedial Knee jerk
moral nerve
(Quadriceps emoris leg (saphenous)
L4-L5 L5 40-45% Big toe dorsifelxion Big toe, Hamstring jerk
(EHL) and TA anteriolateral posterior compartment of the thigh
leg (Common P)
L5-S1 S1 45-50% Foot planter flextion Lateral border Ankle jerk
(Gastrocnemius) of foot (sural)

Important myotomes of lower limb

-Test L5: by asking the patient to stand on his heels
-Test $1: by asking the patient to stand on his
tiptoes

Major symptoms of disc herniation Articular branch Spinal extensors

* Low back pain: radiating to

Posterior ramus:

the gluteal region, the back

of the thigh and back of the
leg
* spinal nerve gives a
meningeal branch bring
sensation from the dura
matter
- Dura matter is sensitive to
stretch
* Pain is diffused due to
overlapping dermatomes
* Straight Leg Raise Test (SLR)
raising the leg that way will tight the sciatic nerve

MRI is commonly used to aid in making the diagnosis

of a herniated disc
 Cross Section of Spinal Cord
- Anterior median fissure:
wide groove on the Anterior aspect
- posterior median sulcus: ee tigate
Narrow groove on the posterior root gangion Posto rootls
aspect Spinal nerve me gray hom
Posterior
* Gray matter: neuron cell seen aa een
bodies, dendrites, axons soi ent oot hit column
Postror
- Divided into horns “<a Gray commissure
- Posterior (dorsal) horn Arr ry han be Axon of sensory neuron

(cell body of sensory N) a Lateral gray hom

Not in All eginents

- Anterior (ventral) horn a Cell body of

sensory neuron

(cell body of motor N to wien ue @. <4

___——_
Cell body
of motor neuron -
skeletal M) ; h Anterior rootlets Nerve impulses
- for sensations
ate ra orm Axon of motor neuron Nerve impulses to
effector tissues
(cell body of motor N to (a) Transverse section
of thoracic spinal cord (muscles and glands)

cardiac M, smooth M,
glands)
Posterior median sulcus Dura mater
Posterior median septum /
Posterior intermediate sulcus Posterolateral sulcus
Posterior intermediate septum

Posterolateral tract Posterior Arachnoid mater

Laminae funiculus
Posterolateral
tract

Lateral
IV funiculus Denticulate
ligament

, l | Fasciculus proprius

. Pia mater
Anterior
\ funiculus Subarachnoid
Anterior white commissure space
Anterior median fissure Anterolateral sulcus

central canal
CSF 'g.3 35
Posterior ‘column:

Gracile fasciculus
Central canal Cuneate fasciculus

ae Lateral corticospinal 4 "

: Ss N on spinocerebellar
tract
- Rubrospinal tract — »~ \ i
. spinocerebellar
tract
white matter has processes and Lateral reticulospinal
no cell bodeis. tact l y . spinothalamic
tract ——]
i
gray matter has cell bodies Vestibulospinal
Vosfocloagn ” ‘ . ALS
(anterolateral system)
Medial
reticulospinal tract
Tectospinal tract Anterior median fissure [i Sensory (ascending) tracts

et ie [BB Motor (descending)

tracts
cortcospinal White matter is divided into two types of tracts "depending on the direction of
the signals"
-ascending (sensory)
-descending (motor)
Posterior White Column-Medial Lemniscal Pathway
* Modality
ype of sensation): Discriminative (localized) Touch
Sensation (include Vibration) and Conscious (aware
of>>go to cortex) (unconscious Proprioception reach the
cerebellum)Proprioception (muscle-joint sense||sense of position)
° Receptor: Most receptors except free nerve
endings :
‘Ist Neuron: Dorsal Root Ganglion Hs: sectiat
close to mide
- 2nd Neuron: Dorsal Column Nuclei (Nucleus es oe Bie —
Gracilis and Cuneatus) rucioun erect fom tele sie
sensation
---Internal Arcuate ..:s Fiber - sce 7 5 pine between
Lemniscal Decussation (sensation from the right go to the left primary am. = in ther part of
and vice versa) dorsal root gan . eS
--Medial Lemniscus gigas
*3rd Neuron: Thalamus (VPL) (ventroposterolateral nucleus of Ww i 5
thalamus) Fi
Internal Capsule fibers from thalamus to cortex 44. dilare 8 Igaans
— Corona Radiata the same fibers \s8s42 a
Termination: Primary
Somesthetic Area (S 1)

Posterior White Column-Medial Lemniscal Pathway

medially
Fasciculus racilis
laterally||u stb rt of the bod Posterior
Fascic e’cuneatu —= ELUM,

Dorsal root
sensory *no functional difference between > and
eatus,the only difference that the fasciculus
transmits information coming from area
Dorsal root —— to T6 (lower part of the body)
ganglion
Posterior spinocerebellar tract

Anterior spinocerebellar tract

apemenenionn Lateral spinothalamic tract

Anterior spinothalamic tract

Discriminative touch, vibratory sense, and conscious muscle-joint sense

*Posterior Column tract consists of:
‘Fasciculus gracilis
‘Transmits information coming from areas inferior to T6
‘Fasciculus cuneatus
*Transmits information coming from areas superior to T6
 Figure 15.1 Anatomical Principles for the Organization of the Sensory Tracts and Lower—Motor Neurons in the
Spinal Cord
MEDIAL — LATERAL
oo >upper
Leg Hip Trunk Arm

Sensory fibers
carrying fine
touch, pressure,
and vibration

Sensory fibers
carrying pain
and temperature

Sensory fibers
carrying crude
touch

Trunk Shoulder Arm Forearm Hand

Discriminative Touch Spinal Pathway

Fasciculus gracilis =
BRAIN
7
Spinal
(dorsal
Cord
view) Nucleus
a
gracilis:
_paMedial
| | EE ee ee

4 Medial
: a | : Cuneate Nuc.
Fasciculus gracilis: Fasciculus cuneatus

Pelvic limb neuron Thoracic limb neuron

howe”

Nucleus gracilis . .
nucleus cuneatus Medial lemniscus
Medulla oblongata
Fasciculus cuneatus
fasciculus gracilis

sel

ELECTROPHYSIOLOGIC CLASSIFICATION OF
CLASSIFICATION OF APFFERENT FIBERS ONLY FIBER DIAMETER CONDUCTION
PERIPHERAL NERVES (CLASS/GROUP) (um) VELOCITY (m,/'s) RECEPTOR SUPPLIED
Sensory Fiber Type
Aa Ja and th 13-20) the biggest SU 120) the fastest Primary muscle spindles, Golgi tendon organ
Afi ll 6-12 5-75 Secondary muscle epindles, skin mechanareveptors
Aa il 1-5 230 fast pain Skin mechunorcceptors, thermal receptors, and
OCigeplors
Cc WV 02-15 O52 slow pain Skin mechunoreceptors, thermal receptors, andl
naciceptors
Motor Fiber Type
Au N/A 12-20 72-120 Extrafusal skeletal muscle fibers
Ay N/A 28 12.48 (ntratusal muscle fibers
R N/A 1a 618 Preganglionic autonomic fibers
¢ NYA 02-2 0.52 Postganglionic autonomic Fibers
 sensory system
otal pl wn Inrvugt
rane
nekds ed yt

There are 4 lobes in the cortex

-frontal lobe
-parietal lobe
-temporal lobe
-occipital lobe

Primary Somatosensory (SI) Cortex

_Axons from third-order
thalamic neurons
terminate in the primary
somatosensory
(Sl)cortex
_Subdivided into four
distinct areas; from Postcentral sulcus
Postcentral gyrus
anterior to posterior, these Central sulcus

are Brodmann areas 3a, Precentral gyrus

3b, 1, and 2
‘Area 3a: muscle spindle afferents (mainly)
‘Area 2: Golgi tendon organs, and joint afferents (mainly).
‘Areas 3b and 1: They receive cutaneous afferents from receptors such as
Meissner corpuscles and Merkel cells). also receive input from cutaneous
receptors that transmit pain and temperature

Lateral inhibition r i ar
21 activates y2 2

_The receptor at the site of most intense =| . . : p

stimulation is activated to the greatestextent. | | a ae, “| om El
Surrounding receptors are also stimulated but XT | le “reremven
toa lesser degree ih ilies
_The most intensely activated receptor pathway a . le [—
halts transmission of impulses in the recs | 7 . : a]
less intensely stimulated pathways through =~ lade
lateral inhibition AON ANTON ae
_This process facilitates the localization of the N
site of stimulation Location of stimulus.
tactivation of Y1
lateral spinothalamic tract
* Modality: pain and temperature
- Receptors: free nerve endings

Slaw
; =.
* 1st Neuron: Dorsal root ganglia d * Pee as

* 2nd Neuron: we 5 SN —

a ie
the posterior gray column (substantia Ventral —_ » md

gelatinosa site of synapse between 1st&2nd) lamina 182 (follow the nucleiin |\ S SS =
sytapse bet preamiysd order neuron
thalamus |) | >
The axons of 2nd order neurons cross [uf

obliquely to the opposite side in the anterior

gray and
white commissures , ascending in the
contralateral white column as the lateral
spinothalamic tract Lateral spinothalamic
tract

* 3rd Neuron: Thalamus (VPL) posterior white column le 7934 la ug

Internal Capsule ---- Corona

Radiata
* Termination: Primary Pain and temperature
. tions from right side of =
Somesthetic Area (S 1) and ee ———— |
Widespread Cortical Region

Rexed laminae ; | __Subsanta gn —

- Lamina1 relay information related to @ — Y sain
pain and temperature taminax \_ \/> bse i
* Lamina 2: relay information related to inemedciaer!x — Ly = Coy {sa
pain and temperature owsieain OS O/-\9/ oe
(pain modulation) & @ gy) °x038\@y® e
* Lamina 3 and 4: nucleus Ventrolateral nu & ep
Accessory oe nu
nucleus
Phrenic nu
<P a
Ventromedial nu
Darkly shaded areas
x

proprius; these laminae

in this region form
Lamina IX
Fig. 5.2. Subdivisions of the grey matter of the spinal cord. The left half of the figure shows the cell
have many interneurons groups usually described. The right half shows the newer concept of laminae.

* Lamina 5: relay information related to pain and temperature

* Lamina 6: presents only at the cervical and lumbar enlargements and
receives proprioception
* Lamina 7: Intermedio-lateral nucleus, contains preganglionic fibers of
sympathetic (T1 -L2). Intermedio-medial nucleus ,all over the spinal cord,
receive visceral pain. Dorsal nucleus of Clark's presents at (C8 - L2 or T1-
L4) , relay center for unconscious proprioception

lateral spinothalamic tract

* Lamina 1+ 5: the spinothalamic tract ascend
which transmit pain¢ast pain,temperature and touch. |
(A delta fibers)
* Lamina 1+ 2: the spinothalamic tract ascend (C
fibers).