Nervous Pathways

The nervous pathways are the routes formed by chains of neurons, through which sensory
awareness reaches the cerebral cortex and a motor response is initiated. As we have learned, a
receptor converts a stimulus into a nerve impulse, and only after that impulse has been conducted
to a region of the spinal cord or brain can it be translated into a sensation. After receiving and
interpreting sensations, the central nervous system generates nerve impulses to direct responses
to that sensory input. The nature of the sensation and type of reaction generated vary with the
level of the central nervous system at which the sensation is translated. When sensory impulses
reach the spinal cord, lower brain stem or cerebellum, they cause subconscious sensations and
subconscious motor reactions; when sensory information reach the cerebral cortex where
conscious sensations result, we can experience precise localization. It is at this level that
memories of previous sensory information are stored and the perception of sensation occurs on
the basis of past experience, which may bring about conscious motor reaction. Only if every
sensory or motor impulse has been transmitted by the corresponding nervous pathway can it
reach the destination. For convenience of study, the nervous pathways are commonly classified
into sensory (ascending) pathways and motor (descending) pathways.

Section 1 Sensory Pathways

In most sensory pathways there are three orders of neurons involved: the first-order
neurons (lower sensory neurons), located in the ganglia, and their peripheral and central
processes; the second-order neurons (intermediate neurons) in the spinal cord or brain stem
and their processes; the third-order neurons (upper sensory neurons), which are the nerve cells
of the thalamus and the fibers passing from them to cerebral cortex. The sensory pathways
mainly include the superficial and deep sensory, visual and acoustic pathways.
I. Superficial sensory pathways
They include three orders of neurons and convey the sensory impulses of pain, temperature,
rude tactile and pressure from the skin and mucosa to the cerebral cortex.

1. Superficial sensory pathway of trunk and limbs (Fig. VI-3-1)

(1) Pathway concerned with pain and thermal sensations The first-order neurons of the
route are pseudounipolar located in the spinal ganglia whose peripheral processes join the spinal
nerve to the in cutaneous exteroceptor of the trunk and limbs, the central processes enter the
spinal cord as a lateral bundle (thin unmyelinated fiber) through the dorsal roots of the spinal
nerve and join the dorsolateral fascicules, and synapse with the second-order neurons in the
lamina I, IV, V of the posterior horn. The axons of the second-order neurons run upward
within one or two segments and cross through the anterior white commissure to the opposite
lateral funiculus to form the lateral spinothalamic tract which runs up to the third-order
neurons in the ventral posterolateral nucleus(VPL) of the thalamus. The third-order neurons
send out axons to join the thalamocortical tract and pass through the posterior limb of the
internal capsule to the upper and middle parts of the postcentra1 gyrus, and the posterior
part of the paracentral lobule.

Fig. VI-3-1.The superficial sensory pathways

(2) Rude tactile and pressure sensation pathway The route is almost same as the pain and
thermal pathway except that the thick fibers of the first-order neurons enter the spinal cord

through medial part of the dorsal roots of spinal nerve and the axons of the second-order neurons
form the bilateral anterior spinothalamic tracts.
The arrangement of the ascending fibers in both tracts is upon a somatotopic basis. Fibers
crossing at any particular level join the medial aspect of those already ascending on the
contralateral side of the spinal cord. Both tracts are segmentally laminated, with fibers
originating in lower segments, and therefore of greater total length, being more superficial (Fig.
VI-2-11). In addition, as light spiral twist is evident, the more superficial fibers run progressively
more dorsal in position as the tracts ascend in the cord. This arrangement is continued through
the medulla and pons to the thalamus.
2. Superficial sensory pathway of head and face The cell bodies of the first-order neurons
are situated in the trigeminal ganglion whose periphera1 processes join the sensory branches of
the trigeminal nerve and terminate in the superficial receptors in the skin and mucosa of the head
and face. Their central processes enter the pons via the sensory root of the trigeminal nerve to
join the spinal tract of trigeminal nerve(Fig. VI-3-1). Descending fibers in this tract conducts the
impulses associated with pain and thermal sensations, and terminate in the spinal nucleus of
trigeminal nerve. Ascending fibers in this tract are concerned with tactile and pressure
sensations and terminate in the pontine nucleus of trigeminal nerve. The second-order neurons,
situated in the spinal and pontine nuclei of the trigeminal nerve, give rise to axons to opposite
side to join the trigeminal lemniscus running through the pons and the midbrain to the thirdorder neurons of the ventral posteromedial nucleus (VPM) of the thalamus. The neurons of
the ventral posteromedial nucleus give rise to axons to form the thalamocortical tract ascending
through the posterior limb of the internal capsule to the inferior part of the postcentra1 gyrus.
II. Deep sensory (or the proprioceptive) pathways
The pathways mediate the deep sensations (including the sensations of the body posture,
movement, vibration and pressure )and fine touch sensation (discriminatory sensation.
1. Conscious deep sensory pathways
(1) Deep sensory and fine touch pathway of trunk and limbs It consists of three orders of
neurons (Fig. VI-3-2). The first-order neurons (pseudounipolar) are located in the spinal ganglia

as well, their peripheral processes accompany the corresponding spinal nerve to the receptors of
the muscle, tendon, periosteum and joint of the trunk and limbs, their central processes enter the
spinal cord as a medial bundle (thick myelinated fibers)through the dorsal roots of the spinal
nerve and immediately divide into ascending and descending branches, which send numerous
collaterals to synapse directly (or through intermediate neurons ) with the motor cells of the
anterior horn to constitute the spinal reflex arc. The longer ascending fibers run upward in the
ipsilateral posterior funiculus, where they form the fascicules gracilisfibers derived from the
1ower eight thoracic, lumbar, sacral and coccygeal segments and fascicules cuneatus (fibers
derived from the upper four thoracic and cervical segments). Both fasciculi terminate
respectively at the gracile and cuneate nuclei, in where the second-order neurons of the pathway
lie. The majority of the fibers of the second-order neurons sweep ventrally round the central grey
matter as the internal arcuate fibers, cross to opposite side of medulla and take part in the
formation of the decussating of medial lemniscuses. After decussating, as the medial lemnisci
they ascend on each side through the medulla oblongata, pons and midbrain to the ventral
posterolateral nucleus (VPL) of the thalamus which contains the third-order neurons. The
third-order neurons send out axons to form the thalamocortical tract, running through the
posterior limb of the interna1 capsule to the cortex of the superior and middle parts of the
postcentra1 gyrus and the posterior part of the paracentral lobule.

Fig VI-3-2. The deep sensory pathways of trunk and limbs

Interruption of pathways by lesions below the level of the decussation of media lemniscus
causes hemiplegia on the affected side of the body, including the loss of all the sensations
conducted by the path. An interruption above the level of the decussation produces hemiplegia
on the opposite side of the body, including the loss of all the sensations conducted by the path.
(2)Deep sensory pathway of head and face The exact route of this pathway is still not
known.
2. Unconscious deep sensory pathway Fig. VI-3-2 It consists of two orders of
neurons. The cell bodies of the first-order neurons are located in the spinal ganglia. Their
periphera1 fibers end in the receptors of the musc1es, tendon, periosteum and joint of the trunk
and limbs, and their central processes enter the spinal cord and terminate in the thoracic nucleus
and posterior grey horn. The axons of the secondary neurons ascend in the lateral funiculi as
the anterior or posterior spinocerebellar tracts which enter the cerebellum by way of the
superior and inferior cerebellar peduncles respective1y and convey the impulses concerned with
subconscious proprioception. The connections are made with neurons of the cortex of the
cerebellum, where motor impulses are returned to the segmental levels of the spinal cord
through part of the extrapyramida1 tracts to maintain the coordination movement, equilibrium
and appropriate posture of the body.
III. Visual pathways and pupillary reflexes
1. Visual pathwayFig. VI-3-3 The first-order neurons of the route are the bipolar cells
in the middle layer of the retina. Their peripheral processes synapse with the rod and cone cells
in the external layer of the retina, their centra1 processes form synapse with the ganglionic cells
in the innermost layer of the retina, which are the second-order neurons. The axons of the second
neurons aggregate at the optic disc to form the optic nerve, which enters the cranial cavity
through the optic cana1 and unite to form the optic chiasma, beyond which, they continue as the
optic tract. Within the chiasma a partial decussation of the fibers from the nasal halves of the
retina occurs with the fibers from the temporal halves of the retina remaining uncrossed. On each
side, the optic tract courses outward and backward, encircling the cerebral peduncle. Most of the
fibers terminate in the lateral geniculate body, in which the third-order neurons are located. The
third-order neurons then give rise to the optic radiation (or geniculocalcarine tract) which

passes through the posterior limb of the internal capsule and terminates on both banks of the
calcarine sulcus, i.e, striate cortexor visual area.. A small portion of the optic tract continues
through brachium of superior colliculus to the pretectal area and the superior colliculi, the fibers
of the superior colliculi descend to form the tectospinal tract which is concerned with optic
reflex.
In binocular vision each visual field is projected upon portions of both retinae. Thus the
images of objects in the right field of vision are projected on the nasal half of the right retina and
the temporal half of the 1eft retina. In the chiasma the fibers from these two retina1 portions
combine to form the left optic tract, which represents the complete right field of vision. By this
arrangement the whole right field of vision is projected upon the left hemisphere, and the left
visual field upon the right hemisphere.
Loss of vision for one half of the visual field is known as hemianopia. Complete blindness in
one eye is caused by an interruption of the optic nerve on the same side. Bitempora1 hemianopia,
blindness in the temporal halves of the fields of both eyes, results from interruption of the fibers
crossing in the optic chiasma and is sometimes caused by pituitary tumors. Blindness in the nasal
half of the f1eld of vision can be produced in one eye by damage to the uncrossed fibers of the
corresponding side of the chiasma. Lesions in the left side of the optic tract, optic radiation or
optic center produces blindness in the right halves of both visual field.

Fig. VI-3-3 A diagram of the visual and papillary reflexes pathways

2. Pupillary reflexes Light shone on the retina of one eye causes both pupils to constrict
normally. The response in the eye stimulated is called the direct papillary light reflex, while
that in the opposite eye is known as the indirect (or consensual) pupillary light reflex.
Pathways involved in the pupillary light reflex are not entirely known, but involve: axons of
retinal ganglion cells which pass via the optic nerve, optic tract and brachium of superior
colliculus to the pretectal area, axons of pretectal neurons which partially cross in the posterior
commissure and presumably terminate bilaterally in Edinger-Westphal nucleus E-W
(accessory nucleus of oculomotor nerve), preganglionic fibers from the E-W nucleus course
with fibers of the oculomotor nerve and synapse in the ciliary ganglion, and postganglionic
fibers from the ciliary ganglion innervate to the sphincter of the iris to regulate the contraction of
the pupilFig. VI-3-3.
Light shone on the retina of one eye whose optic nerve is injured, could not cause both
pupils to constrict, but light shone on the healthy one cause both pupils to constrict. The pupil on
the side of which the oculomotor nerve is damaged, does not constrict when light is shone on
either pupil.
IV. Auditory pathway
The first-order neurons are bipolar cells in the cochlear. Their peripheral processes run to
the spiral organ (of Corti) in the internal ear, whose central processes join the cochlear nerve
and pass through the internal acoustic meatus to the cochlear nuclei which are the second-order
neurons (Fig. VI-3-4). Some axons of the second-order neurons course medially along the
ventral border of the pontine tegmentum to form the trapezoid body which passes through or
ventrally to the medial lemniscus. They next cross the raphe to opposite to form a longitudinal
ascending bundle known as the lateral lemniscus. The fibers of the lateral lemniscus terminate
directly or indirectly the media1 geniculate body, whose cells are the third-order
neuronsTheir axons join the acoustic radiation. The fibers of the acoustic radiation course via
the posterior 1imb of the interna1capsule the inferior thalamic radiation to the transverse
temporal gyri. Because the acoustic center on one side receives fibers from the bilateral
cochlear nuclei, damage to the ipsilateral acoustic paths does not cause a hearing defect.

Fig. VI-3-4 The acoustic pathway

V. Equilibratory pathway Fig. VI-3-5 The first-order neurons of this pathway are
bipolar neurons situated in the vestibular ganglion, whose peripheral processes innervate the
cristae ampullares, maculae of the utricle and saccule, and whose central processes join the

vestibular nerve and terminate in the vestibular nucleus of the pons. The vestibular nucleus
contains the second-order neurons whose axons are grouped into five courses joining the
medial longitudinal fasciculus whose fibers end in the oculomotor, abducent and troch1ear
nuclei, and the motor cells of the anterior horn or the upper cervical cord joining the
vestibulospinal tract to the cells of the anterior horn of the spinal cord entering the
cerebellum(the flocculonodular lobe) via the inferior ceredellar peduncle connecting with
the reticular formation of brain stem, vagus and glossopharyngeal nuclei connecting with
the temporalparietal and frontal cortex of the cerebral hemisphere. Using these information
transmitted, the cerebellum monitors and makes corrective adjustments in the motor activities
that originate in the cerebral cortex, causing the motor system to increase or decrease its
impulses to specific skeletal muscles in order to maintain static equilibrium and dynamic
equilibrium.

Fig. VI-3-5 The equilibratory pathway

Section 2 Motor Pathways

They are concerned with motor function, and include pyramidal and extrapyramidal
systems.
I. Pyramidal system
It convey the voluntary motor impulses from the motor area of the cerebrum to efferent
somatic neurons (voluntary motor neurons) leading to precise movements of the skeleta1

muscles. The pyramidal system is composed of two orders of neuronsi. e. the upper and lower
motor neuronsFig. VI-3-6. The upper motor neurons are composed of the giant pyramidal
cells Betz cells and other pyramida1cells with various sizes, which are 1ocated in the
precentral gyrus and anterior part of paracentral lobule. Their axons form the descending
pyramidal tract, among which, the fibers ending in the cranial motor nuclei are designated as
the corticonuclear tract or corticobulbar tractand those terminating in the anterior horn of
the spinal cord as the corticospinal tract. The lower motor neurons include the cranial motor
cells of the brain stem and spinal motor cells of the spinal cord.
1. Corticospinal tract It is composed of the axons arising from the giant pyramidal cells
and certain other smaller cells(upper motor neurons) of the superior and middle parts of the
precentral gyrus and anterior part of the paracentral lobule. It traverses the posterior limb of
internal capsule, the intermediate 3/5 of the crus cerebri, the basilar part of the pons, and the
ventral part of the medulla oblongata. In the caudal part of the medulla oblongata the greater part
of the tract crosses to the opposite side to form the pyramidal decussating and continues as the
lateral corticospinal tract in the lateral funiculars of the spinal cord. The smaller part continues
as the anterior corticospinal tract directly into the anterior funiculus of the same side. The
fibers of the anterior tract cross the median plane in the anterior white commissure and synapse,
as do those of the lateral tract, directly or indirectly with the motor neurons of the anterior horn.
The anterior corticospinal tract is generally believed to exist above the level of the mid-thoracic
segments. The large multipolar cells of the anterior grey horn of the spinal cord are the lower
motor neurons of the route. They give rise to the motor fibers that leave the spinal cord through
the anterior roots to be distributed by way of the spinal nerves to the skeletal muscles. Both
lateral and anterior corticospinal tracts contain a few homolateral fibers also. These uncrossed
fibers innervate the trunk muscles by way of the motor cells of the anterior horn, so that the trunk
muscles are controlled by bilateral motor cortex of the hemisphere.
Injuries of the pyramidal tract, at any level, will cause abnormalities of voluntary motion.
Because of the inhibitory functions of the upper motor neurons to the lover ones, there are
different clinical signs in the cases of damage to the upper or lower motor neurons. Injury to the
upper motor neurons leads to a loss of motor functions without the muscles atrophy, but with
increased tendon reflex and tonicity of muscles in the affected side, i. e. to a spastic paralysis
and even with pathological ref1exes, such as Babinski sign, in other words, hard paralysis. If

the lower motor neurons are injured, the associated muscles atrophy and a flaccid paralysis
results with the lose of tendon reflex and tonicity of muscles in the affected side, also called soft
paralysis.

Fig. VI-3-6 The pyramidal system

2. Corticonuclear tract It consists of axons arising from the giant pyramidal and certain
other smaller pyramidal neurons(upper motor neurons) in the inferior part of the precentral
gyrus. In the course of descending through the genu of internal capsule and the brain stem it
gives rise to the collaterals of the bilateral oculomotor nucleus, trochlear nucleus motor
nucleus of trigeminal nerve, nucleus ambiguous, nucleus of accessory nerve and superior part of
the facial nucleus, and to the contralateral hypoglossal nucleus and the inferior part of the
facial nucleus. So, the hypoglossal nucleus and inferior part of the facial nuc1eus receive the
fibers on1y from the contralateral corticonuclear tract. All the above crania1 motor nuclei(lower
motor neurons) give rise to axons joining the corresponding crania1 nerves that control the
movements of the innervated skeletal muscles.
Because the inferior part of the facial nucleus and hypog1ossa1nudeus receive fibers just
from the contralateral corticonuclear tract, the injury of the unilateral corticonuclear tract can
usually cause the paralysis of the contralateral glossal muscles and facial muscles below the
palpebral fissure. This is designated as supranuclear paralysis (Fig. VI-3-7,8), showing that the
nasolabial fold in the unaffected side becomes smooth but the bilateral wrinkles on the forehead
exist; when a smile is attempted the angle of the mouth is drawn up on the affected side; the
protruded tongue deviates to unaffected side but without atrophy of two side of the tongue,
because of the inferior part of the facial nucleus and hypoglossal nucleus in the unaffected side
lost the decussate control of the affected upper motor neurons. Paralysis of the unilateral facial
muscles and glossal muscles caused by an injury of the homolateral facial nerve and hypoglossal
nerve is termed as infranuclear paralysis, showing that the wrinkles on the forehead in the
affected side are smoothed out, the ipsilateral eye can not shut voluntarily, the ipsilateral
nasolabial fold becomes smooth; when a smile is attempted the angle of the mouth is drawn up
on the unaffected side, because of the paralysis of the facial muscles in the affected side; the
protruded tongue deviates to affected side because of the action of the genioglossus in the
unaffected side.

Fig. VI-3-7 Supranuclear infranaclear

parglysis of facial nerve

Fig. VI-3-8 Supranudear, infranuclear

paralysis of facial nerve

II. Extrapyramidal system

It is a common name for the descending pathways except the pyramidal system. The main
functions of the extrapyramidal system in man are to regulate the tonicity of the muscles,
coordinate the muscular activities, maintain the normal body posture and produce habitual and
rhythmic movements. For example, riding and running are initiated in the beginning by the
pyramidal system, but are controlled by the extrapyramidal system when the motions later

become habitual and rhythmic. So, the skeletal movements are controlled by the cortex of the
hemisphere by way of the pyramidal and extrapyramidal systems to produce coordinated, precise
motions, The two systems have the coordinated and dependent functions with each other.

Fig. VI-3-9 The extrapyramidal system

(cortico-neostriated body-dorsothalamus-cortex circuit)

l. Cortico-neostriatum-dorsothalamus-cortex circuit The cortical neurons of the frontal,
parietal, and temporal lobes radiate fibers to the caudate nucleus and putamen whose axons both
terminate in the globus pallidus (Fig. VI-3-9) From the globus pallidus the fibers go to the
ventroanterior nucleus and ventrolateral nucleus of the dorsal thalamus, from where the axons
project through the internal capsule to the somatomotor areas of the cortex. This circuit has the
feedback regulatory inhibition on the motor area of the cortex.
2. Neostriatum-substantia nigra circuit(Fig. VI-3-9) The caudate nucleus and putamen
give rise to the fibers to substantia nigra, and vice versa, substantia nigra send fibers back to the
caudate nucleus and putamen. The content of dopamine is decreased in the corpus striatum,
while substantia nigra is degenerated, as the substantia nigra has the ability of production and
release of dopamine. This is concerned with the occurrence of Parkinson disease.
3. Corticoponto-cerebellar-cortex circuit

It is composed of the frontopontine,

parietopontine occipitopontine and temporopontine tracts arising from the pyramidal cells of the
cortex of such respective lobes. All the above fibers through the internal capsule, the crus cerebri,
end by arborizing around the cells of the pontine nuclei (Fig. VI-3-10). Arising from the cells of
the pontine nuclei, the transverse fibers of the pons cross the median plane and run by way of the
pontine brachium (middle cerebellar peduncle) to the neocortex of the cerebellum. The cerebellar
cortex gives rise to the fibers to the dentate nucleus which sends axons by way of the superior
cerebellar peduncle and crossing to the opposite ventrolateral nucleus of the thalamus and red
nucleus. The ventrolateral nucleus of the thalamus projects fibers to the precentral motor area of
the cerebral cortex and the cortico-pallidal system.

Fig. VI-3-10 The extrapyramidal system (corticoponto-cerebellar-cortex circuit)

The cerebellum plays an important role in the coordination and regulation of large
movement complexes including posture and equilibrium adjustments. Injury of the route, at any
level, will cause the loss of the above functions.