ivana pavlinac dodig, m.d., ph.d.neuron.mefst.hr/docs/katedre/neuroznanost/katedra... · spinal...
TRANSCRIPT
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Ivana Pavlinac Dodig, M.D., Ph.D.
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1. Organization of the CNS2. Spinal cord3. Pathways of the spinal cord1. Long ascending tracts2. Long descending tracts
4. Spinal cord in cross sections
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Grey Matter = Cell Body
White Matter = Myelinated axon
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CortexNucleus (CNS)Ganglion (PNS); exception: Basal Ganglia
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Nerve (PNS)Tract (CNS)Fasciculus/Funiculus = group of fibers with common origin and destinationLemniscus = ribbon‐like fiber tractPeduncle = massive group of fibers (usually several tracts)
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Tracts are named with origin first, then destinationCorticobulbar tractCorticospinal tractSpinocerebellar tractMammilothalamic tract
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Spinal cord is SMALL!40‐45 cm long1 cmwide at widest pointDoes not extend all the way to the bottom of the spinal columnFrom foramenmagnum to intervertebral disc (L1‐L2); continues as filum terminale (to sacral canal)
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Parscervicalis
Parsthoracica
Parslumbalis
Conus medullaris& filum terminale
Upper 2/3 of thevertebral column
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Pattern of grey/white matter is reversed in the cordWhite matter tracts on outsideGrey matter on the insideStaining reverses this!!!
White matter (tracts of axons)
Grey matter(cell bodies)
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White matter ‐ funiculi:Dorsal (posterior)LateralVentral (anterior)
Gray matter – buterfly shaped – horns:AnteriorPosteriorIntermediolateral cell column (IML)
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Posterior (dorsal) hornIntermediate greyAnterior (ventral) horn
Laminar organisationRexed laminae
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Spinal cord is segmented anatomicallyInput and output occurs in groups of rootlets arranged in a series longitudinally along the cord
Dorsal rootlets = Input (carry sensory information)Ventral rootlets =Output (motor neurons)
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Dorsal and ventral roots
Common spinal nerve trunk (1‐2 mm)
Dorsal and ventral ramus
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31 pair of spinal nerves8 cervical (C1 ‐C8)12 Thoracic (T1 ‐T12)5 Lumbar (L1 ‐ L5)5 Sacral (S1 ‐ S5)1 Coccygeal
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The spinal cord is housed within the vertebral columnEach cord segment has a corresponding vertebra of the same name (e.g., C3)Spinal nerves enter/exit underneath their corresponding vertebral segment
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But wait! Something doesn’t add up!How can spinal nerves exit below their corresponding vertebral segment if the cord is only 40cm‐45cm long?Answer: Spinal nerves extend down to the appropriate vertebral segment forming the caudaequina
This means cord segments and vertebral segments don’t line up
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Each set of rootlets forms a spinal nerve that innervates a corresponding segment of
the body
Area of the skin supplied by theright and left dorsal roots of a single spinal segment.
Overlapping areas!
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Cord is not of uniform thickness throughout its length. Why not?
Answer: Segments of the cord innervate parts of the body that differ in complexityThere are fewer white matter tracts lower in the cord.
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2 enlargements:▪ Cervical (C5‐T1)▪ Lumbar (L1‐S2)
o C1‐C4 = plexus cervicaliso C5‐T1 = plexus brachialiso L1‐L4 = plexus lumbaliso L4‐S2 = plexus sacralis
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Cervical enlargementC5 - T1
Lumbar enlargementL1 – S2
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Association
Projection
Commissural
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Exteroceptive (from surface): touch, vibration, pain, temperature, localization
Proprioceptive (deep, protopathic): locomotorsystem (periost, tendon and muscle spindles, joints); mostly nonconscious!
Interoceptive: from visceral system; mostlynonconscious! Base for proper function of theautonomic reflexes, homeostasis, neuroendocrinesystem
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Tractus spinothalamicus
Tractus spinocerebelaris
Fasciculus gracilis and cuneatus
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1. Direct pathway (pain, temperature, simple tactilesensations)▪ Neospinothalamic tract
2. Indirect pathways (affective, autonomic, endocrine, motor, and arousal components of pain, and simple tactile sensations)▪ Paleospinothalamic▪ Spinoreticular▪ Spinomesencephalic tracts
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Dorsal rootganglion
Dorsal rootDorsal horn (nucleus
proprius)
Lateral whitecolumn
Neuron I Neuron II
Tractusneospinothalamicus
Ventralposterolateral
nucleus of thalamus
Neuron III
Capsula internaPostcentral
gyrus (area 3,1,2)
Receptors in skin
Anterior whitecommissure
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Neurons located in the dorsal horn and intermediate gray matterAscend contralaterally and ipsilaterallySynapses in reticular formationProject in midline and intralaminar thalamicnuclei – diffuse projections to the cortex and limbic regions (cingulate gyrus)
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Neurons located in the dorsal horn and intermediate gray matterAscend contralaterally and ipsilaterallySynapses in medullary and pontine reticularformationProject in midline and intralaminar thalamicnuclei – diffuse projections to the cerebralcortex
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Neurons located in the dorsal horn and intermediate gray matterAscend to themidbrain (PAG)Descending projections to the spinal cord toinhibit pain sensations
Transmission to the amygdala viaparabrachial nuclei?
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Neospinothalamic tract
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Neospinothalamic tract – anesthesia, thermoanesthesia, loss of simple tactile sensations
Neospinothalamic tract – somatotopic organization
Sacral sparing – damage to the neospinothalamictract leaves intact the pain, temperature, and simple tactile sensations in sacral dermatomes(lesion in the gray matter first affects thoracic and cervical fibers due to somatotopic organization of neospinothalamic tract)
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Tactile sense: vibration, deep touch, two‐point discriminationKinesthetic sense: position and movement
Sacral and lumbar part = medial fasciculus gracilis (Goll’s fascicle)
Toracal and cervical part = lateral fasciculus cuneatus (Burdach’s
fascicle)
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Dorsal rootganglion
Dorsal root Dorsal horn
Ipsilateraldorsal columns
Neuron I Neuron II
Fasciculusgracilis and cuneatus
Nucl. gracilisand cuneatus
Neuron III
Postcentralgyrus (area
3,1,2)
Receptors in dermis;
proprioceptors
Mediallemniscus
Ventral posterolateralnucleus of thalamus
Capsulainterna
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Dorsal (posterior) columns
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Tractus spinocerebellaris anterior – informationabout whole limb movement and posturaladjustments (lower limb)
Tractus spinocerebellaris rostralis – upper limb
Tractus spinocerebellaris posterior – status of individual muscles and groups of muscles + tractus cuneocerebellaris
All enter cerebellum ipsilaterally!!!33
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Dorsal rootganglion
Dorsal root Dorsal horn
Lateralfuniculus
Neuron I Neuron II
Tractusspinocerebellaris
anterior
Superior cerebellarpeduncle
Cerebellum(anterior lobe)
Receptors in tendons
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Dorsal rootganglion
Dorsal root Dorsal horn
Lateralfuniculus
Neuron I Neuron II
Tractusspinocerebellaris
rostralis
Inferior cerebellarpeduncle
Cerebellum(anterior lobe)
Receptors in tendons
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Dorsal rootganglion
Dorsal rootDorsal horn
(nucl. dorsalis of Clarke)
Lateralfuniculus
Neuron I Neuron II
Tractusspinocerebellaris
posterior
Inferior cerebellar peduncle(restiform body)
Cerebellum(anterior lobe)
Receptors in joints, tendonsand muscles
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Nonconscious proprioception of upper limb
Rostral to C8 (no nucl. dors. of Clarke)
Ipsilaterally in the fasciculus cuneatus
Neuron II = accessory cuneate nucleus
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Tractusneospinothalamicus
Tractusspinocerebelaris
Fasciculus gracilis et cuneatus
Neuron I Dorsal root ganglion
Neuron IIDorsal horn
(nucleus proprius)
Dorsal horn(nucl. dorsalis
Clarke)
Nucl. gracilis et cuneatus
Neuron III thalamus thalamus
Function Pain and temperatureNonconsciousproprioception
Discriminative touchand kinesthesia
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Corticospinal tractRubrospinal tract
Tectospinal tractVestibulospinal tractReticulospinal tract
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Flexor motor system, fine movements of the limbs
Antigravity muscles, posture, and balance
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Homunculus – precentral gyrus Primary motor cortex
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Capsulainterna
Cruscerebri
Pyramids
Anterior horn*
Neuron I(upper
motoneuron) Tractuscorticospinalislateralis (90%)
Ventral root
Neuron II(lower
motoneuron)
Spinal nerve
Precentral gyrus(area 4)
Tractuscorticospinalisanterior (10%)
Coronaradiata
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90% fibers cross at pyramidal decussation →lateral funicle (tractus corticospinalis lateralis) → apendicular muscles
10% fibers descend ipsilaterally (tractus corticospinalis anterior) and cross at lower motoneuron → axial muscles
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Lower motor neuron paralysis:
•loss of voluntary movement,
•flaccid paralysis,
•loss of muscle tone,
•atrophy of muscles,
•loss of all reflexes
Upper motor neuron paralysis:
•loss of voluntary movement,
•spasticity,
•increased deep tendon reflexes,
•loss of superficial reflexes,
•Babinski sign
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monoplegia
hemiplegia
diplegia
paraplegia
quadriplegia(tetraplegia)
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Tractus corticospinalis
Neuron I(upper motoneuron)
Precentral gyrus (area 4)
Neuron II(lower motoneuron)
Spinal cord: anterior horn
*Plexus brachialis: C5-Th1Plexus lumbosacralis: L1-S5
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Reflex arc – spinal segment: Aferent neuronInterneuron = Renshaw’s cellEferent neuronEfector (muscle)
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Motor response to afferent stimulation
Automatic reactions – fast response to pain and noxious stimuli
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Tractus rubrospinalis Tractus tectospinalis Tractus vestibulospinalis (medialis and lateralis)Tractus reticulospinalis Fasciculus longitudinalis medialis
Fasciculi proprii – intrinsic reflex mechanisms of the spinal cord
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Nucleusruber
Interneurons
Ventral horn
Ventral tegmentaldecussation
Inferior olive
Sensorimotorcortex
• Facilitation of flexor motor neurons• Inhibition of extensor motor neurons
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Upper cervicalsegments
Colliculussuperior
• Aid in directing head movements in response to auditory and visual stimuli
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InterneuronsMotor neurons
Extensormuscles
Vestibularapparatus
Nucl. vestibularislateralis
Cerebellum
-
+
• Facilitation of ipsilateral extensor muscles• Maintaining upright posture and balance
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• Adjustment of head position in response to changes in posture (i.e. while walking)
Ventral hornNucl. vestibularis
medialis
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Motor functionsMedullary (lateral) reticulospinal tract – supressesextensor spinal reflexesPontine (medial) reticulospinal tract – facilitatesextensor spinal reflexes
Autonomic functions (ventrolateral medulla – IML of thoracolumbar cord)Modulation of pain (enkephalinergic)
Midbrain PAG → nucl. raphe magnus→ dorsal horninterneurons→ spinothalamic system
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MLFIpsilateral upper cervical
motor neurons
Colliculussuperior
Nucl. vestibularismedialis
Reticularformation
-
• Mainly ascending fibers!!!• Head position control in response to excitation by the labyrinth
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Anterior median fissure
Anterior white commisure
Posterior median sulcus
Posterior intermediate sulcus
Tract ofLissauer
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Segments of the spinal cord have a similar organization, but vary in appearance. Always know where you are in the cord (i.e., cervical, thoracic, lumbar, sacral)
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Cervical cord is wide, flat, almost oval in appearance.
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Cervical
Cervical Enlargement
What’s different about the cervical enlargement?
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Less white matter than cervicalRounder appearanceLess prominent ventral horns than cervical enlargement
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Less white matter than thoracicRounder appearanceLarger ventral horns, especially in lumbar enlargement
Lumbar
Lumbar Enlargement
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Not much white matterMostly grey, although not much of that either
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IML = T1‐L2
Clarke’s nucleus = C8‐L3
Fasciculus cuneatus = above T6
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Corticospinal tractVoluntary movement
Dorsal columnsDiscriminative touchConscious proprioception
Spinocerebellar tract (dorsal and ventral)Unconscious proprioception
Spinothalamic tractPain/temperature
Corticospinal tracts
Dorsal Columns
Spinothalamic tracts
Spinocerebellar tracts
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