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Gray Matter –Buterfly Shaped –Horns: ƒ Anterior ƒ Posterior ƒ Intermediolateral Cell Column (IML)

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Gray Matter –Buterfly Shaped –Horns: ƒ Anterior ƒ Posterior ƒ Intermediolateral Cell Column (IML) Ivana Pavlinac Dodig, M.D., Ph.D. 1. Organization of the CNS 2. Spinal cord 3. Pathways of the spinal cord 1. Long ascending tracts 2. Long descending tracts 4. Spinal cord in cross sections 2 Grey Matter = Cell Body White Matter = Myelinated axon 3 Cortex Nucleus (CNS) Ganglion (PNS); exception: Basal Ganglia 4 Nerve (PNS) Tract (CNS) Fasciculus/Funiculus = group of fibers with common origin and destination Lemniscus = ribbon‐like fiber tract Peduncle = massive group of fibers (usually several tracts) 5 Tracts are named with origin first, then destination ¾Corticobulbar tract ¾Corticospinal tract ¾Spinocerebellar tract ¾Mammilothalamic tract 6 Pars cervicalis Spinal cord is SMALL! 40‐45 cm long Pars thoracica 1 cm wide at widest point Does not extend all the way to the bottom of the spinal column From foramen magnum to intervertebral disc (L1‐L2); Pars lumbalis continues as filum terminale (to sacral canal) Conus medullaris Upper 2/3 of the & filum terminale vertebral column 7 Pattern of grey/white matter is reversed in the cord White matter tracts on outside Grey matter on the inside Staining reverses this!!! White matter (tracts of axons) Grey matter (cell bodies) 8 White matter ‐ funiculi: Dorsal (posterior) Lateral Ventral (anterior) Gray matter –buterfly shaped –horns: Anterior Posterior Intermediolateral cell column (IML) 9 Posterior (dorsal) horn Intermediate grey Anterior (ventral) horn Laminar organisation Rexed laminae 10 Spinal cord is segmented anatomically Input 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) 11 Dorsal and ventral roots Common spinal nerve trunk (1‐2 mm) Dorsal and ventral ramus 12 13 31 pair of spinal nerves 8 cervical (C1 ‐ C8) 12 Thoracic (T1 ‐ T12) 5 Lumbar (L1 ‐ L5) 5 Sacral (S1 ‐ S5) 1 Coccygeal 14 The spinal cord is housed within the vertebral column Each cord segment has a corresponding vertebra of the same name (e.g., C3) Spinal nerves enter/exit underneath their corresponding vertebral segment 15 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 cauda equina This means cord segments and vertebral segments don’t line up 16 Each set of rootlets forms a spinal nerve that innervates a corresponding segment of the body Area of the skin supplied by the right and left dorsal roots of a single spinal segment. Overlapping areas! 17 Cord is not of uniform thickness throughout its length. Why not? Answer: Segments of the cord innervate parts of the body that differ in complexity There are fewer white matter tracts lower in the cord. 18 2 enlargements: ▪ Cervical (C5‐T1) Cervical enlargement C5 - T1 ▪ Lumbar (L1‐S2) o C1‐C4 = plexus cervicalis o C5‐T1 = plexus brachialis o L1‐L4 = plexus lumbalis Lumbar enlargement L1 – S2 o L4‐S2 = plexus sacralis 19 Association Projection Commissural 20 Exteroceptive (from surface): touch, vibration, pain, temperature, localization Proprioceptive (deep, protopathic): locomotor system (periost, tendon and muscle spindles, joints); mostly nonconscious! Interoceptive: from visceral system; mostly nonconscious! Base for proper function of the autonomic reflexes, homeostasis, neuroendocrine system 21 Tractus spinothalamicus Tractus spinocerebelaris Fasciculus gracilis and cuneatus 22 1. Direct pathway (pain, temperature, simple tactile sensations) ▪ Neospinothalamic tract 2. Indirect pathways (affective, autonomic, endocrine, motor, and arousal components of pain, and simple tactile sensations) ▪ Paleospinothalamic ▪ Spinoreticular ▪ Spinomesencephalic tracts 23 Neuron I Neuron II Receptors in Dorsal root Dorsal horn (nucleus Dorsal root skin ganglion proprius) Anterior white commissure Ventral Postcentral Lateral white Capsula interna posterolateral gyrus (area 3,1,2) column nucleus of thalamus Neuron III Tractus neospinothalamicus 24 Neurons located in the dorsal horn and intermediate gray matter Ascend contralaterally and ipsilaterally Synapses in reticular formation Project in midline and intralaminar thalamic nuclei – diffuse projections to the cortex and limbic regions (cingulate gyrus) 25 Neurons located in the dorsal horn and intermediate gray matter Ascend contralaterally and ipsilaterally Synapses in medullary and pontine reticular formation Project in midline and intralaminar thalamic nuclei – diffuse projections to the cerebral cortex 26 Neurons located in the dorsal horn and intermediate gray matter Ascend to the midbrain (PAG) Descending projections to the spinal cord to inhibit pain sensations Transmission to the amygdala via parabrachial nuclei? 27 Neospinothalamic tract 28 Neospinothalamic tract – anesthesia, thermoanesthesia, loss of simple tactile sensations Neospinothalamic tract – somatotopic organization Sacral sparing – damage to the neospinothalamic tract 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) 29 Tactile sense: vibration, deep touch, two‐ point discrimination Kinesthetic sense: position and movement Sacral and lumbar part = medial fasciculus gracilis (Goll’s fascicle) Toracal and cervical part = lateral fasciculus cuneatus (Burdach’s fascicle) 30 Neuron I Neuron II Receptors in Dorsal root dermis; Dorsal root Dorsal horn ganglion proprioceptors Ventral posterolateral Medial Nucl. gracilis Ipsilateral nucleus of thalamus lemniscus and cuneatus dorsal columns Postcentral Capsula gyrus (area Neuron III interna Fasciculus 3,1,2) gracilis and cuneatus 31 Dorsal (posterior) columns 32 Tractus spinocerebellaris anterior – information about whole limb movement and postural adjustments (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 Neuron I Neuron II Receptors in Dorsal root Dorsal root Dorsal horn tendons ganglion Cerebellum Superior cerebellar Lateral (anterior lobe) peduncle funiculus Tractus spinocerebellaris anterior 34 Neuron I Neuron II Receptors in Dorsal root Dorsal root Dorsal horn tendons ganglion Cerebellum Inferior cerebellar Lateral (anterior lobe) peduncle funiculus Tractus spinocerebellaris rostralis 35 Neuron I Neuron II Receptors in Dorsal horn Dorsal root joints, tendons Dorsal root (nucl. dorsalis of ganglion and muscles Clarke) Cerebellum Inferior cerebellar peduncle Lateral (anterior lobe) (restiform body) funiculus Tractus spinocerebellaris posterior 36 Nonconscious proprioception of upper limb Rostral to C8 (no nucl. dors. of Clarke) Ipsilaterally in the fasciculus cuneatus Neuron II = accessory cuneate nucleus 37 Tractus Tractus Fasciculus gracilis et neospinothalamicus spinocerebelaris cuneatus Neuron I Dorsal root ganglion Dorsal horn Dorsal horn Nucl. gracilis et Neuron II (nucl. dorsalis (nucleus proprius) cuneatus Clarke) Neuron III thalamus thalamus Nonconscious Discriminative touch Function Pain and temperature proprioception and kinesthesia 38 Corticospinal tract Flexor motor system, fine Rubrospinal tract movements of the limbs Tectospinal tract Antigravity muscles, Vestibulospinal tract posture, and balance Reticulospinal tract 39 Homunculus – precentral gyrus Primary motor cortex 40 Precentral gyrus Corona Capsula Crus (area 4) radiata interna cerebri Neuron I Pyramids (upper motoneuron) Tractus Tractus corticospinalis corticospinalis lateralis (90%) anterior (10%) Anterior horn* Neuron II (lower motoneuron) Ventral root Spinal nerve 41 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 42 Lower motor neuron paralysis: Upper motor neuron paralysis: •loss of voluntary movement, •loss of voluntary movement, •flaccid paralysis, •spasticity, •loss of muscle tone, •increased deep tendon reflexes, •atrophy of muscles, •loss of superficial reflexes, •loss of all reflexes •Babinski sign 43 monoplegia hemiplegia diplegia paraplegia quadriplegia (tetraplegia) 44 Tractus corticospinalis Neuron I Precentral gyrus (area 4) (upper motoneuron) Neuron II Spinal cord: anterior horn (lower motoneuron) *Plexus brachialis: C5-Th1 Plexus lumbosacralis: L1-S5 45 46 Motor response to afferent stimulation Automatic reactions – fast response to pain and noxious stimuli Reflex arc –spinal segment: Aferent neuron Interneuron = Renshaw’s cell Eferent neuron Efector (muscle) 47 Tractus rubrospinalis Tractus tectospinalis Tractus vestibulospinalis (medialis and lateralis) Tractus reticulospinalis Fasciculus longitudinalis medialis Fasciculi proprii – intrinsic reflex mechanisms of the spinal cord 48 Sensorimotor Nucleus Interneurons cortex ruber Ventral tegmental decussation Inferior olive Ventral horn • Facilitation of flexor motor neurons • Inhibition of extensor motor neurons 49 Colliculus Upper cervical superior segments • Aid in directing head movements in response to auditory and visual stimuli 50 Cerebellum - Nucl. vestibularis Motor Extensor Interneurons lateralis neurons muscles + Vestibular apparatus
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