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Bassett Collection of Stereoscopic Ima
Lab 2: Spinal Cord
Cordelia Erickson-Davis
January 21 2016
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Case studyA more detailed neurological exam revealed:
Ipsilateral to the lesion:
Contralateral to the lesion:
Loss of motor function
joint position
vibration sense below thelesion
fine touch
Loss of pain sensation
temperature and
crude touch below the level of the lesion.
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Case study:
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Bassett Collection of Stereoscopic Ima
Functions of the Spinal Cord
1. Conduit between brain andperiphery
2. Final common pathway for motor
output3. Basic sensorimotor processing
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Bassett Collection of Stereoscopic Images of Human Anatomy.
Overvie
1. External an
2.
Internal an3. Circuitry/P
4.
Lesions &
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Bassett Collection of Stereoscopic Images of Human Anatomy.
Overvie
1.
External an
2. Internal ana
3.
Circuitry/Pa4.
Lesions & D
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The Spinal Cord is
SMALL
42-45 cm
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31 pairs of
spinal ne
Brachial
plexus
30,000 miles of periphera
some neuron
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The Spinal Cord is Divided Into Functional Units
Vertebral body
Spinal
nerve
Pedicle
Spinous process
Spinal cord
A
P
8 cervic
12 thorac
5 lumba
5 sacr
1 coccygeNolte, J. & Angevine Jr., JB. (2007) The Human Brain in Photographs and D
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Each segment specifies dermatome or myoto
Thieme Atlas of Anatomy: Head and Neuroanatomy. (2010) Schuenke, Schulte & Schumacher.
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Review: The Cranial Meninges
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Bassett Collection of Stereoscopic Images of Human Anatomy.
pia mater
arachnoid
dura mater
Spinal Meninges are Continuous with the Cranial M
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VERTEBRA
..BUT Spinal Meninges are Different than Cranial M
spinal cord
pia mater
arachnoid
dura mater
fat/venous plexus
only a single layer of dura(continuous with meningeal layer)
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Venous plexus is within the epidura
Upper thoracic spLumbar spinal cordBassett Collection of Ste
venous
plexus
Thieme Atlas of Anatomy: Head and Neuroanatomy. (2010) Schuenke, Schulte & Schumacher.
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C4
C3
C5
C6
C7
Hendelman, WJ.Atlas of Functional Neuroanatomy, 2nd
A look inside the
pial sp
d
arach
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A closer look at the infe
conus
medullaris
cauda
equina
cauda equina
Hendelman, WJ.Atlas of Functional Neuroanatomy, 2nd
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L5 L4 L3
L5
L4
L3
L2
MRI from mr-tip.com
conus
medullaris
lumbar
cistern
Lumbar pu
Video at http://www.nejm.org/doi/full/
L1
L2
L3
L4
L5
S1S2
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C4
C3
C5
C6
C7
Pial specializations stabilize the spina
denticulate
ligaments
caud
equin
fi
Hendelman, WJ.Atlas of Functional Neuroanatomy, 2ndedition (2007). CRC Press.
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Lets Synthesize All This Anatomy In Situ
meninge
(dura mate
spinal venous
plexus
denticulateligament
meninges
(arachnoid layer)
Bassett Collection of Ste
M i t th A i
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C4
C3
C5
C6
C7
Moving on to the
vasculature
d
arachn
Anterio
anterior spina
denticul
Hendelman, WJ.Atlas of Functional Neuroanatomy, 2nd
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Review: The dorso-ventral axDorsal
Ventralbelly
Dorsbac
Rostral
Caudal
Anterior
Ceph
V l t S l i th S i l C d
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vertebral arteries
anterior spinal artery
Vasculature Supplying the Spinal Cord
V l t S l i th S i l C d
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anterior spinal artery
anterior 2/3 of spinal cord
anterior spinal artery
posterior spinal arteries
Vasculature Supplying the Spinal Cordposterior spinal art
Thieme Atlas of Anatomy: Head and Neuroanatomy. (201
V l t S l i th S i l C d
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radicular arteries
Skandalakis JE, Colborn GL, Weidman TA et al. Skandalaskis Surgical Anatomy (2009). McGraw-Hill Companies.
Vasculature Supplying the Spinal Cord
anterior spinal artery
anterior 2/3 of spinal cord
posterior spinal art
Lets Synthesize All This Anatomy In Situ
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Let s Synthesize All This Anatomy In Situ
meninge
(dura mate
spinal venous
plexus
denticulateligament
meninges
(arachnoid layer)
Bassett Collection of Ste
anterior spinal artery
vertebral arte
radicular artery
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Bassett Collection of Stereoscopic Images of Human Anatomy.
Overvie
1.
External an
2. Internal ana
3.
Circuitry/Pa
4.
Lesions & D
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Lets cut into t
cervical
thoracic
lumbar
sacral
Dorsal Ventral
Your Typical Spinal Cord Section Looks Like
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Your Typical Spinal Cord Section Looks Like
white matter
g
The Human Brain in Photographs and Diagrams. Nolte J & Angevine Jr. JB Brain Atlas, 3rd edition (2007).
th t hit tt i t hit
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white matter
gr
The Human Brain in Photographs and Diagrams. Nolte J & Angevine Jr. JB Brain Atlas, 3rd edition (2007).
that white matter is so not white
Thats Because Weve Stained the M
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That s Because We ve Stained the M
white
matter
gray
matter
Thats Because Weve Stained the M
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Luxol Blue/Weil-staine
That s Because We ve Stained the M
Electron micrograph of myelin
Compare/Contrast: Brain to Spin
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white matter
g
Compare/Contrast: Brain to Spin
gray matter
white matter
Lets orient ourselves!D posterolateral sulci
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dorsal/posterior
ventral/anterior
anterior median fissure
dorsal columns
V
anterior sp
posterolateral sulci
Lets Synthesize All This Anatomy In Sit
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Let s Synthesize All This Anatomy In Sit
meninge(dura mat
spinal venous
plexus
denticulateligament
meninges
(arachnoid layer)
Bassett Collection of S
anterior spinal artery
vertebral arte
dorsal columnsposterolateral
sulci
dorsal surface, cervical spinal cord.
Basic Functional Organization of the SpinD
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Basic FunctionalOrganization of the Spin
SEV
Sensory dorsal, motor D
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dorsal root ganglion
y ,V
ventral root
dorsal root
dorsal root
ganglion
spinal nerve spinal motor
Where is the boundary betw
D
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Spinalcord
yV
oligodendrocytesastrocytes
Schwann cells
dorsal or ventral rootlet
RedlichObersteiner zone
The spinal cord is NOT uniform
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T phow do we figure out where we ar
Tips for Success:1. Find a landmark 2. Orient yourself (which way is N
3.Walk around, explore the local neighborhood
How to identify spinal cord segments
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cervical
thoracic
lumbar
sacral
1. Use what weve already learned to orient thesections
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Posterolateral sulci- Anterior median fissure
2.
As you ascend the spinal cord, sections tend tohave increased white matter. Why?
3. Spinal cord is larger at the cervical and lumbar
regions-
Gray to white matter ratio
-
Cervical and lumbar enlargements
Keep these tips in mind for next week
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p pbrainstem!
Brainstem section
Spinal Cord Gray Matter
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p ydorsal
(SENSORY)
ventral
(MOTOR)
marginal zon
nuc
ClaVIIVII
VIIVII
IntermeCell C
substa
gelatin
Review: the Autonomic Nervous System
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HOMEOSTASIS
Sympathetic
Nervous System
fight or flight
The balance between sympa
parasympathetic nervous systems
!blood pressure
!pupil size, focusing the lenthe eyelid
!glandular secretion
!urogenital reflexes: bladder
erection
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IML = preganglionic neurons
of the sympathetic nervous
system
VIIVII
Intermediolateral(IML) Cell Column
(T1-L2)
pre-ganglionic
neuronsin the
interomediolateral
column (IML)
T1-L2
neurotransmitter:
Ach
neurons from
sympathetic ganglia
to effector organs
Superior Cerv
Ganglion
Pa
Sy
Superior Mesen
Ganglion
Inferior MeseGanglion
neurotransmitter:
norepinephrine
Spinal Cord Gray Matter
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motor neurons
dorsal(SENSORY)
ventral
(MOTOR)
marginal zon
nuc
ClaVIIVII
VIIVII
IntermeCell C
substa
gelatin
VIIIVIIIIX
IX IX IXIX
motor inter
X
central gray
Nissl
A closer look at spinal motor neur
D
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Sukiasyan et al., Neuroscience, 2009
medialmotor neurons m
Flexors
Extensors
Axial
muscles
V
Overvie
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Bassett Collection of Stereoscopic Images of Human Anatomy.
Overvie
1.
External an
2. Internal an
3.
Circuitry/P
4.
Lesions &
Important questions to consider
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p qpathways
1.
What information (modality) is carried?2. Where does it start and end?
3. Where does it decussate (cross midline)?
4.
What is the 1st, 2nd, nthorder neuron?
Spinal Cord White MatterD
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lateral ct
fasciculus gracilus
fasciculus cun
spin
antero
system
V
DORSAL COL
Spinal Cord White MatterD
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fasciculus gracilus
fasciculus cun
spin
antero
system
V
DORSAL COLAscending pathwaysDorsal column/Medial
lemniscus
Anterolateral system
Dorsal spinocerebellar
Descending pathway
Lateral corticospinal tract
lateral ct
Dorsal Column/Medial Lemniscus Pathway
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What information does the pathway carry?The BIG FOUR
Fine Touch
Proprioception
Stereognosis
Vibration Sense
What neurons comprise this circuit?1. Peripheral tissue to nucleus gracilis/cuneatus
2. Nucleus gracilis/cuneatus to VPL thalamus
3. VPL thalamus to somatosensory cortex
nucleusgracilis
Dorsal Column/Medial Lemniscus Pathway
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What information does the pathway carry?The BIG FOUR
Fine Touch
Proprioception
Stereognosis
Vibration Sense
What neurons comprise this circuit?1. Peripheral tissue to nucleus gracilis/cuneatus
2. Nucleus gracilis/cuneatus to VPL thalamus
3. VPL thalamus to somatosensory cortex
nucleusgracilis
DC/ML Inputs are Topographically OrganizeD
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from
legs
cervical
thoracic
lumbar
from
trunk
from
armsV
Anterior lateral system:Spinothalamic & Spinoreticular T
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What information does the pathway carry?The little 3
Pain
Temperature
Crude Touch
What neurons comprise this circuit?
1. Peripheral tissue to marginal zone/substantiagelatinosa
2. Marginal zone/substantia gelatinosa to VPL
thalamus (2/3) or reticular formation (1/3)
3. VPL thalamus to somatosensory cortex
Dorsal Spinocerebellar Tract
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What neurons comprise this circuit?
FROM LEGS1. Peripheral tissue to Clarkes column
2. Clarkes column to cerebellum viainferior cerebellar peduncle
FROM ARMS1. Peripheral tissue to accessory cuneate
nucleus
2 Accessory cuneate nucleus to cerebellum
What information does the pathway carry?
Unconscious proprioception
accessorycuneate n.
Clarkescolumn
Corticospinal Tract
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What information does the pathway carry?
Voluntary movement
What neurons comprise this circuit?
1. Neurons in motor and premotor cortex to VIII
interneurons (99%) and motor neurons (1%)
2. Motor neurons to muscle fibers
Upper
MotorNeuron
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Bassett Collection of Stereoscopic Images of Human Anatomy.
Overvie
1.
External an
2. Internal ana
3.
Circuitry/Pa
4.
Lesions & D
Localizing neurological causes for muscle w
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UPPER NEURON DEFICIT LOWER NEURON D
No significant muscle atrophy Significant Atrop
Spastic paralysis (Hypertonia) Flaccid paralysis (Hy
Fasciculations and fibrillations not
present
Fasciculations and fib
present
Hyperreflexia Hyporeflexia
>Babinski reflex may be present > Babinski reflex not
Case Study:Brown-Squard Syndrome (a transverse
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Brainstem
SpinalCord
hemi-section of the spinal cord)
Big 4
Little 3
UnconsciousProprioception
Voluntary MovementWhat functi
below the lIpsilat
- BIG 4
- unconscious
- voluntary moContral
- Little 3
Overv
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Bassett Collection of Stereoscopic Images of Human Anatomy.
1. External an
2.
Internal an
3.
Circuitry/P
4.
Lesions &
Some Administrative Details.
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Lab Rooms:
Go to your lab room f
Review Sessions:
The usual: Wed, 7PM M
Lab Manual:Pre-read it, yo
TEA TIME
Cookies before lab,Tea and cookies after
Canvas Discussion Board
Burning questions? Let us help
Brain Day!Sign-up:https://docs.google.com/spreadsheets/d/18AHwwLpSmRJv4Dwzs8u9yMFCvVHCcMMOvMiWV3RW
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Stay tuned for next week!
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Supplementary Slides
Position of the Spinal Cord Relative to the Ver
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vert
bo
spinal cordspinal nerve
intervertebral
foramenspinous
process
intravertebral
disc
Differential growth of the spinal cord and vertebral column sespinal cord segments from their associated skeletal eleme
(progressively greater mismatch at caudal levels)
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(progressively greater mismatch at caudal levels)
Spinal Cord
SegmentVertebral Body
C8 C6-C7
T6 T5
T12 T10
L3 T11
S1 T12
Vitamin B12 Deficiency
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From Neurology Board Review:
Fig. 20-6. Pathologic features of subacute combined degeneration of vitamin B1A, Note the symmetric loss of myelin staining predominantly involving the postercolumns (Luxol fast blue stain.)B, Histopathologic features of vacuolar myelopathy: spongy white matter vacuolizposterior and lateral columns. (From Okazaki H, Scheithauer BW. Atlas ofneuropathology. New York: Gower Medical Publishing; 1988, p. 255. By permission of Mayo Foundation.)
Spinal Muscular Atrophy
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From Neurology Board Review:
Fig. 20-3. Diffuse, severe atrophy of the lower extremities in a patient with spinal Overviewa. Clinically heterogenous group of disorders characterized by muscle weakness and atrophy without sensory loss or upper motlower motor neuron syndrome) (Fig. above)b. Pathologically due to degeneration of motor neurons (anterior horn cells) in spinal cord and brainstemc. Most common forms of SMA present in childhood with symmetric proximal (more than distal) limb weakness and atrophy; shoinheritance