Sensory Problem Set

Problem 1

Symptoms: Loss of position sense (posture), Affected Pathway:

vibration and highly discriminative touch on Dorsal Column Pathway
the lower right extremity.

Symptoms: Loss of crude mechanosensory, Affected Pathway:

analgesia, thermanesthesia on the lower left Antero Lateral Fasciculus
extremity.

R L
Problem 1

R L

Dorsal Column Pathway

Fasciculus gracilis
R L

Anterolateral fasciculus
Problem 1

First order neuron

Second order neuron

Dorsal column path Anterolateral path

R L R L

RNu RNu

R L

Fasc. gracilis
ALF

Mech. Dorsal horn Pain & temp.

sensations lower limb
lower limb Anterior (ventral)
white commissure
Problem 1

Right (ipsilateral) lower extremity.

The information conveyed in the dorsal column is highly discriminative,
including vibration and two-point discriminative sensibilities.

Left (contralateral) lower extremity.

The information conveyed in the ALF is from all types of general sensory
endings, but the preponderance is from small peripheral fibers
conveying thermal, pain and crude mechanical sensations.

R L
Problem 1

Dorsal column-lemniscal path

a) The lesion of the dorsal columns would result in degenerating
axon terminals in what nucleus (or nuclei) in the brainstem? R L
Right Nucleus gracilis.
Is the nucleus ipsilateral or contralateral to the lesion? Ipsilateral.
Draw the dorsal columns pathway until you reach the nucleus
of termination in the brainstem OK

b) Name the second-order neurons in the dorsal column pathway and

draw them in the diagram. RNu

Cell body in the dorsal column nuclei medial lemniscus path.

Is the projection crossed?
The medial lemniscus projection is crossed. Medial
lemniscus
Fasc. Nucleus
gracilis gracilis
Nucleus
gracilis
Fasc.
Internal gracilis
Arcuate
fibers
Medial
Mech. sensations
lemniscus lower limb
Problem 1

Dorsal column-lemniscal path

Where do the axons of the affected pathway terminate?

R L
The axons terminate in the contralateral VPL nucleus of the thalamus.
Is it possible that the neurons of this tract would degenerate slowly
after the lesion?
The medial lemniscus is not damaged by the lesion, but the normal
spike traffic it conveys would be radically affected. VPL thal.
It is possible that the cells in the right nucleus gracilis would slowly
RNu

degenerate due to denervation.

Medial
lemniscus

Nucleus
gracilis
Fasc.
gracilis

Mech. sensations
lower limb
Problem 1

Anterolateral spino-thalamic path

R L
The lesion of the ALF would result in degenerating axons
terminals in what thalamic nucleus? Target?
The VPL thalamus.
Degeneration in the VPL thalamus would be restricted to the
dorso-lateral aspect due to somato-topic organization within
the nucleus. VPL thal.
RNu
There would also be degeneration in the posterior and
intralaminar nuclei and other thalamic targets.

Would there be degeneration of axon terminals on route to the

thalamus? Which tract?
Spino-thal.
The spinothalamic tract (after medulla). tract
There would be considerable axonal terminal degeneration
along the spino-thalamic tract due to extensive branching of the
fibers of this tract into the reticular formation and other targets. ALF

Draw the ALF pathway until you reach the nucleus termination. OK
Pain & temp.
Is the nucleus ipsilateral or contralateral to the lesion? Ipsilateral. Dorsal lower limb
horn
Problem 1

a) The dorsal column lesion would interrupt information b) The ALF lesion would interrupt information
going to the ________ hemisphere in the
LEFT RIGHT
going to the ________ cerebral hemisphere. _____________ region of the ___________
most medial region of the
Most specifically, the ____________ complementary post-central
gyrus.
post-central gyrus. The paracentral lobule.
___________
Post-central gyrus
Problem 1

The deficit in conscious awareness would be a loss of aspects of the fine discriminative sensibilities
in the right lower extremity and loss of pain and thermal sensation in the left lower extremity.

These deficits would be limited by alternative pathways which carry similar types of information.
It is difficult to detect deficits after pure dorsal column lesions due to redundant information that
is transmitted over the ALF.
R L

R L
The lesion might abolish stretch reflexes if the lesion is space occupying and
destroys the right dorsal root fibers entering the spinal cord at the level of
the lesion.
In this case, all sensory input would be lost for a small region of the skin on
the right pelvic area and from which reflexes cannot be induced.
Problem 2

L R
L R

Lower
open medulla

Area of the spinal tract

of V descending fibers

L R
Open medulla
Problem 2

First order neuron

Putative site of lesion

L R

The deficit would be ipsilateral to the lesion – on the right side.

The information disrupted is more similar to anterior spinothalamic

(ALF) than to dorsal column type of information.
Problem 2

Indeed.

The nucleus of the spinal tract of V.

L R

L R

The degenerating fibers would be found in the right (ipsilateral) side.

Open medulla
Problem 2

The projection of the spinal nucleus of V is crossed.

Its principal target is the VPM thalamus. L R

L R

Other thalamic targets are the intralaminar nuclei

and part of the posterior nuclear group (Po).
Problem 2

The inferior third of the left post-central gyrus is deprived of sensory information.
post-central gyrus

L R

The projection from the principal sensory nucleus to the VPM and the post-central gyrus is an
alternative route for tactile sensitivity. Any part of the spinal nucleus of V that is rostral to the
lesion would be unaffected.

The would be no deficit in tactile sensitivity. There would likely be diminished thermal sensitivity,
and a dramatic decrease in pain sensitivity, since pain is exclusively represented in the pars caudalis
of the spinal nucleus of V.
Problem 2
Som. Sen. Ctx.

R L

VPM
thalamus

spinal tract of
V

n. of spinal tract
of V

The would be no effect on jaw-jerk reflex. It is mediated by stretch receptors in the muscles of mastication
that have cell bodies in the mesencephalic nucleus of V. The central processes synapse on motor neurons in
the motor nucleus of V.
Problem 3
Problem 3

The ALF-spinothalamic pathways, bilaterally.

The anterior white commissure.

R L R L

Anterior (ventral)
white commissure

Anterolateral fasciculi
Problem 3

T2-T9 levels .
The upper and lower limit might be up one or two segmental levels, due to the ALF-
spinothalamic system ascending one or two segmental levels while crossing.
The effect cannot be due to a lesion at one spinal level, unless the lesion is very creative:
perhaps a bilateral ALF lesion at spinal level C5.

Because the ALF-spinothalamic components can cross uninterrupted below T9.

The ALF is spared at lesioned levels of the spinal cord.

T2
T7

T10 and below

R
L
R
L
R Affected ALF
L AWC Spared ALF
Problem 3

In the cervical spinal cord, the “middle”

segment, where T2-T9 is represented, will
be interrupted bilaterally.

The affected region of the thalamus will be,

principally, the middle segments of VPL,
bilaterally.

There will also be regions of the intralaminar

nuclei and the Posterior group, but the
somatotopic representation there is not clear.
Problem 3

Syringomyelia is an elongated cavity, or set of cavities, lined by glia, close to the central canal of the spinal
cord.

A syrinx is a cyst or cavity; frequently in thoracic cord.

Etiology not clear, but could be developmental, a neoplasm,
or due to mechanical stress.
(from: Brain’s Clinical Neurology; 5th ed.)

The diagnosis is consistent with a lesion in the anterior white commissure at thoracic levels.
Usually the lesion is large enough to affect the ventral horn and affect motor function.