CNS 7

The ascending tracts of the spinal cord

 Conduct afferent information
o May or may not reach consciousness
o Divided into 2 main groups
 Exteroceptive information
 Originate from outside the body
 Pain, temperature and touch
 Proprioceptive information
 Originate from inside the body
 From muscle and joints

Anatomical organization
 Ascending pathway consist of 3 neurons
o First-order neuron
 Has its cell body in the posterior root ganglion of the spinal nerve
 Has a peripheral process that connects with a sensory receptor ending
 Has a central process that enters the spinal cord through the posterior root to
synapse on the second order neuron.
o Second-order neuron
 Has an axon that decussates and ascend to a higher level of the central nervous
system where it synapse with the
o Third-order neuron
 Usually in the thalamus
 Give rise to a projection fiber that pass to a sensory region of the cerebral cortex

Function of the ascending tracts

 Lateral spinothalamic tract
o Pain
o Thermal sensation
 Anterior spinothalamic tract
o Light (crude) touch
o Pressure
 Posterior white columns
o Discriminative touch
 The ability to localize accurately the area of the body touched and also to be aware
that 2 points are touched simultaneously
o Information from muscle and joints
o Vibratory sensations
 Anterior spinocerebellar tract + posterior spinocerebellar tract + cuneocerebellar tract
o Unconscious information from muscles, joints, the skin and subcutaneous tissue
 To the cerebellum
 Spinotectal tract
o Pain, thermal and tactile information
 To the superior colliculus
 For spinovisual reflexes
 Spinoreticular tract
o Pathway from the muscles, joints and skin to reticular formation
  Spino-olivary tract
o Indirect pathway for further afferent information to reach the cerebellum

Pain and temperature pathways

Lateral spinothalamic tract
 Pain and thermal receptors in the skin and other tissues are free nerve endings.
 Pain impulses are transmitted to the spinal cord in fast-conducting delta type A and slow-
conducting C-type fibers
 First-order neuron
o Axon from posterior root ganglion enter the spinal cord to the tip of posterior gray
column
o Divide into ascending and descending branches
 Travel for 1 or 2 segments of spinal cord, posterolateral tract of Lissauer
o Terminate by synapsing with cells in posterior gray column (including cells in substantia
gelatinosa)
 Substance P is the neurotransmitter
 Second-order neuron
o Axons cross obliquely to the opposite side in the anterior gray and white commissures
within one spinal segment
o Ascend in the contralateral white column
o Lies medial to anterior spinocerebellar tract
o New fibers are added to the anteromedial aspect of the tract
o Sacral fibers are lateral and cervical segments are medial in the upper cervical segments
o Fibers carrying pain lies anterior to those conducting temperature
o Lie near lateral surface in the medulla
 Between the inferior olivary nucleus and nucleus of spinal tract of CN V
o Spinal lemniscus: lateral spinothalamic + anterior spinothalamic and spinotectal tracts
in the medulla oblongata
 Ascend in the posterior part of pons
 Lies in the tegmentum in the midbrain
 Lateral to medial lemniscus
 Third-order neuron
o Located in ventral posterolateral nucleus of the thalamus
o Axon pass through posterior limb of internal capsule and corona radiata to the
somesthetic area in postcentral gyrus
o Contralateral half of the body is represented inverted
 Mouth and hand inferiorly
 Leg superiorly
 Foot and anogenital region medially

Pain reception
 Two types of pain
o Fast pain
 Felt 0,1 second after the stimulation
 Experienced by mechanical or thermal stimuli
o Slow pain
 Felt 1 second or later after the stimulation
 Experienced by mechanical, thermal or chemical stimuli
 Chemical substance that will excite free nerve endings
o Serotonin
o Histamine
o Bradykinin
o Acids (lactic acid)
 o K ions
 Threshold for pain ending can be lowered by prostaglandins and substance P

Conduction of pain to the central nervous system

 Fast pain travels in large diameter A delta axon at velocities 6-30 m/sec
 Slow pain travels in small diameter C fibers at velocities 0,5-2 m/sec

Other terminations of the lateral spinothalamic tract

 Fast pain impulses travel directly to ventral posterolateral nucleus of the thalamus
 Majority of slow pain fibers in the lateral spinothalamic tract terminate in the reticular
formation.
 Concerned with nociceptor information
o Postcentral gyrus
 Responsible for interpretation of pain in relation to past experiences
o Cingulate gyrus of the limbic system
 Involved with interpretation of emotional aspect of pain
o Insular gyrus
 Concerned with interpretation of pain stimuli from internal organs of the body
 Bring about an autonomic response

Pain control in the central nervous system

The analgesia system
 Stimulation of the following areas of the brainstem can reduce or block sensations of pain
o Periventricular area of the diencephalon
o Periaqueductal gray matter of the midbrain
o Midline nuclei of the brainstem
 Neurotransmitter substance in the analgesic system
o Enkephalins
o Endorphins
o Serotonin

Light (crude) touch and pressure pathways

Anterior spinothalamic tract
 First-order neuron (posterior root ganglion)
o Axons enter the spinal cord to the tip of the posterior gray column
o Divide into ascending and descending branches
 Travel for a distance of 1 or 2 segments, Posterolateral tract of Lissauer
o Terminate by synapsing with cells in the substantia gelatinosa in the posterior gray
column
 Second-order neuron
o Axon cross obliquely to the opposite side in the anterior gray and white commissures
within several spinal segments
o Ascend in the opposite anterolateral white column
 Third-order neuron
o Lies in the ventral posterolateral nucleus of thalamus
o Axon pass through posterior limb of internal capsule and the corona radiata to reach the
somesthetic area in the postcentral gyrus
Discriminative touch, vibratory sense and conscious muscle joint sense
Posterior white column: fasiculus gracilis and fasiculus cuneatus
 First-order neuron (posterior root ganglion)
o Axons pass to posterior white column and divide into
 Long ascending branch
 May end by synapsing with cells in posterior gray horn
 Involved with intersegmental reflexes
 Travel upward as the
o Fasiculus gracilis
 Present throughout the length of spinal cord
 Contain long ascending fibers from sacral, lumbar and lower
6 thoracic spinal nerves
o Fasiculus cuneatus
 Lies laterally in the upper thoracic and cervical segments of
spinal cord
 Separated from fasiculus gracilis by a septum
 Contain long ascending fibers from the upper 6 thoracic and
all cervical spinal nerves
 Fibers of nucleus gracilis and cuneatus run ipsilaterally
o Terminate in second order neurons in nuclei gracilis and cuneatus of
the medulla oblongata
 Short descending branch
 Give off collateral branches
o Synapse with cells in the posterior gray horn
 Involved with intersegmental reflexes
o Second-order neurons
 Lie in the nuclei gracilis and cuneatus of medulla oblongata
 Internal arcuate fibers: axons sweep anteromedially around the central gray
matter and cross the median plane
 Decussate with fibers of opposite site in the sensory decussation
 Ascend as a single compact bundle, medial lemniscus through medulla,
pons and midbrain
 Terminate by synapsing with third-order neurons
 Many axons (posterior external arcuate fibers) from nucleus cuneatus of
medulla pass through inferior cerebellar peduncle to the cerebellum of the
same side, cuneocerebellar tract
o Convey information of muscle joint sense to the cerebellum
o Third-order neurons
 Ventral posterolateral nucleus of thalamus
 Axons pass through posterior limb of internal capsule and corona radiata to
postcentral gyrus
Muscle joint sense pathways to the cerebellum
Posterior spinocerebellar tract
 First-order neuron
o Located in the posterior root ganglion
o Axons enter the posterior gray column and terminate by synapsing with second order-
neuron
 Second-order neurons
o Located at the base of the posterior gray column
o Known as nucleus dorsalis (Clarke’s column)
 Extend from C8 – L3 or L4
o Axons enter the posterolateral part of the lateral white column of the same side and
ascend as the posterior spinocerebellar tract to the medulla oblongata
o Axons entering from the lower lumbar and sacral segments ascend in the posterior white
column until they reach L3 or L4 where they enter nucleus dorsalis
o The tact join the inferior cerebellar peduncle and terminates in the cerebellar cortex
 Receive muscle joint information from the muscle spindles, tendon organs and joint receptors of
the trunk and lower limbs
o Concern tension of muscle tendons and the movements of muscle and joints

Anterior spinocerebellar tract

 First-order neuron
o Located in the posterior root ganglion
 Second order neurons
o Nucleus dorsalis, at the base of the posterior gray column
o The majority of the axons cross to the opposite side and ascend in the contralateral white
column
o The minority of axons ascend in the lateral white column of the same side
o Axons ascend through medulla and pons, enter superior cerebellar peduncle and
terminate in the cerebellar cortex
o Crossed fibers in the spinal cord cross back in the cerebellum
 Convey muscle joint information from the muscle spindles tendon organs and joint receptor of
the trunk and limbs
 Cerebellum receive information from skin and superficial fascia by this tract

Cuneocerebellar tract
Described under posterior white column
Other ascending pathways
Spinotectal tract
 First-order neuron
o Posterior root ganglion
 Second-order neuron
o Unknown
o Axons cross the median plane and ascend in the anterolateral white column close to
lateral spinothalamic tract
o Terminate by synapsing with neuron in the superior colliculus of midbrain
 Provide information for spinovisual reflexes
 Brings about movement of eyes and head toward the source of the stimulation

Spinoreticular tract
 First-order neuron
o Posterior root ganglion
 Second-order neuron
o Unknown
o Axons ascend in the lateral white column mixed with lateral spinothalamic tract.
o Most of axons are uncrossed
o Terminate by synapsing with neurons of reticular formation in the medulla oblongata,
pons and midbrain.
 Provide afferent pathway for the reticular formation
o Play important role in influencing levels of consciousness

Spino-olivary tract
 Axons cross the midline and ascend at the junction of the anterior and lateral white columns.
 Terminate by synapsing in the inferior olivary nuclei in the medulla oblongata
 Axons of 3rd order neuron cross the midline and enter cerebellum through inferior cerebellar
peduncle
 Convey information from cutaneous and proprioceptive organs to the cerebellum.

Visceral sensory tracts

 First order neuron
o Posterior root ganglia
 Second order neuron
o Posterior or lateral gray column
o Axons join spinothalamic tracts
 Third order neuron
o Ventral posterolateral nucleus of thalamus
o Axons to postcentral gyrus
The main somatosensory pathways to consciousness
 Lateral spinothalamic + spinal lemniscus
o Sensations
 Pain + temperature
o First-order neuron
 Posterior root ganglion
o Second-order neuron
 Substantia gelatinosa
o Third-order neuron
 Ventral posterolateral nucleus of thalamus
o Destination
 Postcentral gyrus
 Anterior spinothalamic + spinal lemniscus
o Sensations
 Light touch + pressure
o First-order neuron
 Posterior root ganglion
o Second-order neuron
 Substantia gelatinosa
o Third-order neuron
 Ventral posterolateral nucleus of thalamus
o Destination
 Postcentral gyrus
 Fasiculus gracilis + fasiculus cuneatus + medial lemniscus
o Sensations
 Discriminative touch + vibratory sense + conscious muscle joint sense
o First-order neuron
 Posterior root ganglion
o Second-order neuron
 Nucleus gracilis
 Nucleus cuneatus
o Third-order neuron
 Ventral posterolateral nucleus of thalamus
o Destination
 Postcentral gyrus

Muscle joint sense pathways to the cerebellum

 Anterior spinocerebellar tract + posterior spinocerebellar tract
o Sensations
 Unconscious muscle joint sense
o First-order neuron
 Posterior root ganglion
o Second-order neuron
 Nucleus dorsalis
o Destination
 Cerebellar cortex
The descending tracts of the spinal cord
 Motor neurons lie in the anterior gray columns of the spinal cord
o Referred to as the lower motor neurons

Anatomical organization
 First-order neuron
o Cerebral cortex
o Reflex arc: axon of 1st order-neuron terminates directly on the third-order neuron
 Second-order neuron
o Internucial neuron
o Located in the anterior gray column
 Third-order neuron
o Lower motor neuron in the anterior gray column

Function of the descending tracts

 Corticospinal tracts
o Concerned with voluntary, discrete, skilled movements
 Especially those of distal part of limbs
 Reticulospinal tracts
o Facilitate or inhibit the activity of alpha and gamma motor neurons in the anterior gray
columns
 Facilitate or inhibit voluntary movement or reflex activity
 Tectospinal tract
o Concerned with reflex postural movements in response to visual stimuli
o Fibers that are associated with the sympathetic neurons in the lateral gray column are
concerned with pupillodilation reflex in response to darkness
 Rubrospinal tract
o Acts on both alpha and gamma motor neurons in the anterior gray columns
o Facilitate the activity of flexor muscles
o Inhibit the activity of extensor or antigravity muscles
 Vestibulospinal tract
o Act on the motor neurons in the anterior gray columns
o Facilitate the activity of the extensor muscles
o Inhibit the activity of flexor muscles
o Concerned with postural activity associated with balance
 Olivospinal tract
o May play a role in muscular activity
o There is doubt that it exists
 Descending autonomic fibers
o Concerned with control of visceral activity
Corticospinal tract
 Axons arise from pyramidal cells in the 5th layer of the cerebral cortex
o 2/3 originate from the precentral gyrus
o 1/3 originate from postcentral gyrus
 Descending fibers converge in the corona radiata and pass through posterior limb of internal
capsule
o Fibers closest to genu are concerned with cervical portions of the body
o Fibers more posteriorly are concerned with the lower extremity
 The tract descend through cerebral peduncles of midbrain
 Broken into many bundles in the pons by transverse pontocerebellar fibers
 Grouped together in the medulla forming a swelling, pyramid (pyramidal tract)
 Most of fibers cross at the decussation of pyramids
o Enter lateral white column
o Form lateral corticospinal tract
o Terminate in the anterior gray column of all segments
 Remaining fibers do not cross in the decussation
o Descend in the anterior white column
o Form anterior corticospinal tract
o Cross the midline
o Terminate in the anterior gray column in cervical and upper thoracic segments
 Serve voluntary movement
 Branches
o Branches return to the cerebral cortex to inhibit activity in adjacent regions of the cortex
o Branches to:
 Caudate nuclei
 Lentiform nucleus
 Olivary nuclei
 Reticular formation
 Red nuclei

Reticulospinal tracts
 Reticular formation: groups of scattered nerve cells and nerve fibers in the midbrain, pons and
medulla oblongata
 Axons from the pons
o Uncrossed
o Form pontine reticulospinal tract
o Descend in the anterior white column
 Axons from the medulla oblongata
o Crossed and uncrossed
o Form medullary reticulospinal tract
o Descend in the lateral white column
 Include descending autonomic fibers
 Provide a pathway by which the hypothalamus can control the sympathetic outflow and the
sacral parasympathetic outflow.

Tectospinal tract
 Axons arise from the superior colliculus of the midbrain
 Most fibers are crossed
 Descend through the anterior white column close to anterior median fissure
 Majority of fibers terminate in the anterior gray column in the upper cervical segments
 Concerned with reflex postural movements in response to visual stimuli
Rubrospinal tract
 Axons from red nucleus cross and descend through lateral white column
 Facilitate the activity of the flexor muscle
 Inhibits the activity of the extensor muscles

Vestibulospinal tract
 Vestibular nuclei
o Lie in the pons and medulla oblongata, beneath the floor of 4th ventricle
o Receive afferent fibers from the inner ear through vestibular nerve and from cerebellum
 Lateral vestibular nucleus
o Axons form the vestibulospinal tract
o Descend uncrossed through medulla and anterior white column
 Inner ear and cerebellum through this tract facilitate the activity of the extensor muscles
 Inhibit the activity of flexor muscles

Olivospinal tract
 Arise from the inferior olivary nucleus
 Descend in the lateral white column
 There is considerable doubts that it exists

Descending autonomic fibers

 Descend in the lateral white column
 Crossed
 Terminates in the lateral gray columns in the thoracic and upper lumbar and midsacral levels

Reflex arc
 Reflex: involuntary response to a stimulus
 Reflex arc consist of
o Receptor organ
o Afferent neuron
o Effector neuron
o Effector organ
 Monosynaptic reflex arc: reflex arc involving only one synapse
The main descending pathways to the spinal cord
 Corticospinal tract
o Function
 Rapid, skilled voluntary movements, especially distal ends of limbs
o Origin
 Primary motor cortex (area 4)
 Secondary motor cortex (area 6)
 Parietal lobe (area 3,1 and 2)
o Site of crossover
 Most cross at decussation of pyramids as lateral corticospinal tracts
 Some continue as anterior corticospinal tracts and cross over at level of
destination
o Destination
 Internucial neurons or alpha motor neurons
o Branches to
 Cerebral cortex
 Basal nuclei
 Red nucleus
 Reticular formation
 Reticulospinal tracts
o Function
 Inhibit or facilitate voluntary movement
 Hypothalamus controls sympathetic, parasympathetic outflows
o Origin
 Reticular formation
o Site of crossover
 Various levels
o Destination
 Alpha and gamma motor neurons
o Branches to
 Multiple branches
 Tectospinal tract
o Function
 Reflex postural movements concerning sight
o Origin
 Superior colliculus
o Site of crossover
 Soon after origin
o Destination
 Alpha and gamma motor neurons
 Rubrospinal tract
o Function
 Facilitates activity of flexor muscles
 Inhibits activity of extensor muscles
o Origin
 Red nucleus
o Site of crossover
 Immediately
o Destination
 Alpha and gamma motor neurons
 Vestibulospinal tract
o Function
  Facilitates activity of extensor muscle
 Inhibit flexor muscles
o Origin
 Vestibular nuclei
o Site of crossover
 Uncrossed
o Destination
 Alpha and gamma motor neurons
 Descending autonomic fibers
o Function
 Control sympathetic and parasympathetic systems
o Origin
 Cerebral cortex
 Hypothalamus
 Amygdaloid complex
 Reticular formation
o Destination
 Sympathetic and parasympathetic outflows

Ascending trigeminothalamic tracts

 Ventral trigeminothalamic tract
o Serves as a pain, temperature and light touch pathway from the face and oral cavity
o Ascend to the contralateral sensory cortex via 3 neurons
 First-order neuron
 Located in the trigeminal ganglion
 Mediate pain and temperature sensation
 Give rise to axons that descend in the spinal trigeminal tract
 Mediate light touch sensation
 Give rise to bifurcating axons that ascend and descend in the spinal
trigeminal tract
 Synapse with second order neurons in the spinal trigeminal nucleus
 Second order neuron
 Located in the spinal trigeminal nucleus
 Give rise to decussating axons that terminate in the contralateral VPM
nucleus of thalamus
 Project axons to the reticular formation and motor cranial nerve nuclei to
mediate reflexes (tearing and corneal reflexes)
 Third-order neurons
 Located in the VPM nucleus
 Project via posterior limb of the internal capsule to the area of the
postcentral gyrus
 Dorsal trigeminothalamic tract
o Subserves discriminative tactile and pressure sensation from the face and oral cavity
o Uncrossed
o Rostral equivalent of dorsomedial tract
o Ascend to the sensory cortex via 3 neurons
 First-order neuron
 Located in the trigeminal ganglion
 Second-order neurons
 Located in the principal nucleus of CN V
 Third-order neurons
 Located in the VPM nucleus
 Project to postcentral gyrus
  Somatosensory area
o Postcentral gyrus
o Posterior part of paracentral lobule
 Motor center
o Precentral gyrus
o Anterior part of paracentral gyrus

Visual pathway
 Transmits visual impulses from the retina to the LGB
o From LGB to primary visual cortex of the occipital lobe (area 17)
 Cells of the retina
o Rod and cons
 First order neuron
o Bipolar neurons
 Second-order neurons
o Ganglion cells
 Third-order neurons
o Lateral geniculate nucleus
 Fourth-order neuron
o Visual cortex
 Projection visual area
 Calcarine sulcus
 Adjacent part of cuneus and lingual gyrus
 Association visual area
 Around the visual projection area except anteriorly
 Extend to the temporal and parietal lobes
 Lesion of visual pathway
o Optic nerve
 Blind ness of corresponding eye
o Optic chiasma
 Hemianopia heteronyma (bitemporalis)
o Optic tract
 Hemianopia homonyma (corresponding eye)

Olfactory pathway
 Has 2 neurons only
 Does not pass through thalamus
 Does not cross in the midline
 Olfactory cilia
 Olfactory receptor cells
o First order neurons
o Found in nasal mucosa
 Olfactory nerve
 Olfactory bulb
o Lies on the cribriform plate of the ethmoid bone
o Receive olfactory nerve
o Contain mitral and tufted cells
 Second order neurons
 Olfactory tract
 Primary olfactory cortex
o Overlie the uncus of the parahippocampal gyrus
 o Third order neurons
 Anosmia
o Loss of smell
o Lesion to olfactory nerve

Gustatory pathway
 Mediate taste
 First order neurons
o Pseduounipolar ganglion cells in the geniculate ganglion of CN VII in the petrosal ganglion
 Cortex
o Opercular part of postcentral gyrus

Auditory pathway
 Auditory cortex
o Projection auditory area
 Transverse temporal gyri
 Middle part of superior temporal gyrus
o Association auditory area
 Superior temporal gyrus around the projection auditory area

Vestibular pathway
 Cortex
o Projection vestibular area
 Lower part of postcentral gyrus