Nervous System Module

Dr. Gamal Taha

Assistant Professor of Anatomy & Embryology

Tracts
CNS Tractology
 Sensory and Motor Tracts
 Communication to and from the brain
involves different routes according to
function

 Ascending tracts are sensory, delivering

information to the brain

 Descending tracts are motor, delivering

information to the periphery
 Sensory and Motor Tracts
 Naming the tracts

 If the tract name begins with “Spino” (as in

spinocerebellar), the tract is a sensory tract
delivering information from the spinal cord to the
cerebellum (in this case)

 If the tract name ends with “Spinal” (as in

vestibulospinal), the tract is a motor tract that
delivers information from the vestibular apparatus
(in this case) to the spinal cord
 Sensory and Motor Tracts
 There are three major sensory tracts

1. The posterior column tract

2. The spinothalamic tract

3. The spinocerebellar tract

 Sensory and Motor Tracts
The three major sensory tracts involve chains of
neurons

First-order neuron
Delivers sensations to the CNS
The cell body is in the dorsal root ganglion

Second-order neuron
An interneuron with the cell body in the spinal cord or brain

Third-order neuron
Transmits information from the thalamus to the cerebral cortex
1st Order Neuron
 Sensory and Motor Tracts
 Neurons in the sensory tracts are
arranged according to three
anatomical principles

 Sensory modality

 Somatotropic

 Medial-lateral rule
 Sensory and Motor Tracts
Sensory modality

Fine touch sensations are carried in one

sensory tract

Somatotopic

Ascending tracts are arranged according to the

site of origin (Anterior, Lateral & Posterior )
 Sensory and Motor Tracts
Medial-lateral rule

Sensory neurons that enter a low level of

the spinal cord are more medial within the
spinal cord

Sensory neurons that enter at a higher level

of the spinal cord are more lateral within the
spinal cord
 Ascending Tracts
1. Lateral Spinothalamic tract
2. Anterior Spinothalamic tract
3. Gracile tract
4. Cuneate tract
5. Posterior Spinocerebellar tract
6. Anterior Spinocerebellar tract
7. Spino-olivary tract
8. Spino-tectal tract
 Sensory and Motor Tracts
 Based on the perception

For conscious perception:

 Spinothalamic system

For unconscious perception:

1. Spinocerebellar

2. Spino-olivary

3. Spinotectal

4. Spinoreticular
 Sensory and Motor Tracts
 Three major pathways carry sensory
information

 Posterior/Dorsal column pathway (gracile &

cuneate fasciculi)

 Anterolateral pathway (spinothalamic)

 Spinocerebellar pathway
 Spinal Cord Nuclei and
Laminae
 Spinal neurons are organized into nuclei and laminae.
 Nuclei
 The prominent nuclear groups of cell columns within
the spinal cord from dorsal to ventral are the:
1. Marginal zone

2. Substantia gelatinosa

3. Nucleus proprius

4. Dorsal nucleus of Clarke

5. Intermediolateral nucleus

6. Lower motor neuron nuclei

 Rexed Laminae
 Laminae I to IV are concerned with exteroceptive sensation.

 Laminae V and VI are concerned primarily with

proprioceptive sensations.

 Lamina VII acts as a relay between muscle spindle to

midbrain and cerebellum.

 Laminae VIII & IX The axons of these neurons innervate

mainly skeletal muscle.

 Lamina X surrounds the central canal and contains neuroglia.

 Sensory and Motor Tracts
Posterior Column tract consists of:
Both carry proprioception, touch, pressure and
vibration
1. Fasciculus gracilis (FG)

Transmits information coming from areas inferior

to T6 (Sacral , Lumber & Lower thoracic)

2. Fasciculus cuneatus (FC)

Transmits information coming from areas superior
to T6 (Upper thorax and Cervical region)
Ascending Sensory Tracts
 Dorsal Column
 Carry impulses concerned with
proprioception and discriminative touch
from ipsilateral side of body

 Contain the axons of primary afferent

neurons that have entered cord through
dorsal roots of spinal nerves
 Dorsal Column
 Fibers ascend without synapsing where they
terminate upon 2nd order neurons in nucleus gracilis and
nucleus cuneatus

 The axons of the 2nd order neurons decussate in the

medulla as internal arcuate fibers and ascend
CROSSED through the brain stem as medial lemniscus.

 The medial lemniscus terminates in the ventral

posterolateral (VPL) nucleus of the thalamus upon
3rd order neurons, which project to the somatosensory
cortex (thalamocortical fibers)
 Clinical Application
Destruction of fasciculus
gracilis and cuneatus lead
to:

 Loss of muscle joint sense,

position sense, vibration sense
and tactile discrimination on
the same side below the
level of the lesion
 Spino-thalamic Tracts
 Located lateral and ventral to the ventral horn

 Carry impulses concerned with pain and

temperature (Lateral tract) and also touch and
pressure (Anterior tract)

 Fibers of the two tracts are intermingled to some

extent

 Information is sent to the primary sensory cortex

on the opposite side of the body
 Lateral Spino-thalamic Tract
 Cell body of second order neuron is present
in substantia gelatinosa of dorsal horn.

 Their axons decussate in the ventral white

commissure and ascend in the lateral white
column of opposite side.

 These ascending fibers terminate in the

VPL nucleus of thalamus.
 Anterior Spino-thalamic Tract
 First order neuron of crude touch pathway
has their cell body in dorsal root ganglion.

 Upon their entry into spinal cord, they also

give ascending and descending branches.

 Their second order neuron decussate, go

to anterior white column of contra lateral
side and ascends toward thalamus.
 Spinal Lemniscus
 Lateral spinothalamic tract, anterior spinothalamic tract
and spinotectal tract fuse together at the level of
medulla and ascend as a single bundle called spinal
lemniscus. Spinotectal tract become the part of spinal
lemniscus and terminates in tectum of midbrain.

 Fast pain fibers terminate in VPL nucleus of thalamus.

Slow pain fibers have different faiths. Some of them
terminate in VPL nucleus; some fibers terminate in
intralaminar nuclei of thalamus. On their pathway, slow
pain fibers also stimulate reticular formation.
 Third Order Neuron of
Anterolateral Tract System
 These neurons have their cell bodies in VPL
and their axons pass through posterior limb of
internal capsule, and their final destination is
post central gyrus (sensory cortex area 3, 1,
2).

 Some fibers of pain pathway will make special

connections to cingulate gyrus that deals with
associated emotional component of pain.
Crossing Tracts
 Clinical Application
 Destruction of LSTT
 Loss of pain and thermal
sensation on the
contralateral side

 Below the level of the

lesion patient will not
respond to pinprick
recognize hot and cold
 Clinical Application
Destruction of
ASTT

 Loss of touch
and pressure
sense below the
level of lesion on
the contralateral
side of the body
 Spinocerebellar Tracts
 The spinocerebellar system consists
of a sequence of only two neurons

 Two tracts: Posterior & Anterior

 Located near the dorsolateral and

ventrolateral surfaces of the cord
Ascending Sensory Tracts
 Spinocerebellar Tracts
 Contain axons of the second order
neurons (Clark’s & posterior horn neurons)

 Carry information (unconscious

proprioceptive) derived from muscle
spindles, Golgi tendon organs and tactile
receptors to the cerebellum for the
control of posture and coordination of
movements
 Spinocerebellar Tracts
 Both spinocerebellar tracts ends
ipsilateral to the same side cerebellar
hemisphere

 The posterior spinocerebellar stays

originally uncrossed

 The anterior spinocerebellar crosses

twice, so eventually ends same side
 Spinotectal Tract
 Ascends in the anterolateral part in close
association with spinothalamic system

 Primary afferents reach dorsal horn

through dorsal roots and terminate on 2nd
order neurons
 Spinotectal Tract
 Axons of 2nd order neuron cross to opposite
side (Same segment), and project to the
superior colliculus in the midbrain

 The tract is from spinal cord—to reticular

formation to thalamus

 It is responsible for automatic responses to

pain, such as in the case of injury
 Spino-olivary Tract
 Indirect spinocerebellar pathway (spino-olivocerebellar)

 Impulses from the spinal cord are relayed ( CROSSED)

to the cerebellum via inferior olivary nucleus

 Conveys sensory information (Proprioception) to

the cerebellum

 Fibers arise at all level of the spinal cord

 Spino-reticular Tract
 Its fibers ascend in the lateral & ventral white
columns where it is intermingled with the spino-
thalamic tracts.

 Most fibers cross to the opposite side & ascend to

end on neurons of the ponto-medullary reticular
formation.

 A spino-reticulo–thalamo-cortical pathway was

suggested as a route for slow dull-aching pain
sensation.
Spino-reticular
tract
Motor Tracts
 Motor tracts
 CNS transmits motor commands in response to
sensory information

 Motor commands are delivered by the:

 Somatic nervous system (SNS): directs

contraction of skeletal muscles

 Autonomic nervous system (ANS): directs the

activity of glands, smooth muscles, and cardiac
muscle
 Motor Tracts
 There are two major descending
tracts

 Corticospinal tract: Conscious control of

skeletal muscles

 Subconscious tract: Subconscious

regulation of balance, muscle tone, eye,
hand, and upper limb position
 Motor Tracts
 The Corticospinal Tracts, three pairs of descending
tracts

1. Corticobulbar tracts: conscious control over eye,

jaw, and face muscles (Cranial Nerves)

2. Lateral corticospinal tracts: conscious control

over skeletal muscles

3. Anterior corticospinal tracts: conscious control

over skeletal muscles
 Motor Tracts
 The Subconscious Motor Tracts

 Consists of four tracts involved in monitoring

the subconscious motor control

1. Vestibulospinal tracts
2. Tectospinal tracts
3. Reticulospinal tracts
4. Rubrospinal tracts
 Execution
 Cerebral cortex initiates voluntary movement

 Information goes to the basal nuclei and cerebellum

 These structures modify and coordinate the

movements so they are performed in a smooth manner

 Information goes from the basal nuclei and cerebellum

back to the cerebral cortex to constantly monitor
position and muscle tone
 Motor Pathways

 Descending pathways in the brain and

spinal cord that control the activities of
skeletal muscle.

 Regulate the activities of skeletal muscle.

 Motor Pathways
Origin of Motor Signal

 The corticospinal tracts begin in the cerebral cortex, from

which they receive a range of inputs:

1. Primary motor cortex

2. Premotor cortex
3. Supplementary motor area

 They also receive nerve fibers from the somatosensory

area, which play a role in regulating the activity of the
ascending tracts.
 Pyramidal and
Extrapyramidal Systems
 Pyramidal and extrapyramidal systems can
only be separated anatomically but not
functionally!

 None of the two systems can work

properly alone, they constitute one motor
system together!!!
 Pyramidal and
Extrapyramidal Systems
 Pyramidal system is the chief organizer
and executor of voluntary movements.

 Extrapyramidal system includes all the

motor centres and pathways that lie
outside the pyramidal system and are
beyond voluntary control.
CORTICOSPINAL TRACT
 Pyramidal Tract
 Upper motoneurons are located in the cerebral cortex, while
lower motoneurons can be found in the motor nuclei of
cranial nerves or in the spinal ventral horn.

 Descending axons of upper motoneurons that terminate in the

motor nuclei of cranial nerves and in the spinal cord constitute
the corticonuclear and corticospinal tracts, respectively.

 The corticonuclear tract reaches the lower motoneurons of

both sides (bilateral innervation), while corticospinal
fibres target the lower motoneurons of the opposite side
only (crossed pathway).
 Pyramidal Tract
 1 million upper motor neurons in cerebral
cortex

 Axons form internal capsule in cerebrum

and pyramids in the medulla oblongata

 90% of fibers decussate (cross over) in

the medulla
 Right side of brain controls left side muscles
 Pyramidal Tract
 Terminate on interneurons which synapse
on lower motor neurons in either:
 Nuclei of cranial nerves
 Anterior horns of spinal cord

 Integrate excitatory & inhibitory input to

become final common pathway
 Pyramidal Tract
 At the caudal part of medulla oblongata

 Most of the fibers 90 % cross the mid line (motor

decussation) descend in the lateral column as LCST
terminate on LMN of anterior gray column at all spinal
level

 Remaining uncrossed fibers descend as ACST eventually

fibers cross the mid line and terminate on LMN of
anterior gray column of respective spinal cord segments.
 Pyramidal Tract
 Lateral corticospinal tracts
 Cortex, cerebral peduncles, 90% decussation of axons in
medulla, tract formed in lateral column.
 Skilled movements (hands & feet)

 Anterior corticospinal tracts

 The 10% of axons that do not cross

 Controls neck & trunk muscles

 Corticobulbar tracts
 Cortex to nuclei of CNs

 III, IV, V, VI, VII, IX, X, XI & XII

 Movements of eyes, tongue, chewing, expressions & speech

 Pyramidal Tract
 After originating from the cortex, the neurons converge, and
descend through the internal capsule.

 After the internal capsule, the neurons pass through the crus
cerebri of the midbrain, the pons and into the medulla.

 In the most inferior (caudal) part of the medulla, the tract divides
into two:
1. Lateral corticospinal tract: which supply the muscles of
the body.
2. Anterior corticospinal tract: ipsilateral, descending into
the spinal cord. They then decussate and terminate in the
ventral horn of the cervical and upper thoracic segmental
levels.
 Sceletal
muscles of
the head and
neck

Sceletal muscles of
the trunk and
limbs
 Corticobulbar Tracts
 The corticobulbar tracts arise from the lateral aspect of
the primary motor cortex. They receive the same inputs
as the corticospinal tracts.

 The fibers converge and pass through the internal

capsule to the brainstem.

 The neurons terminate on the motor nuclei of the cranial

nerves. Here, they synapse with lower motor neurons,
which carry the motor signals to the muscles of the
face and neck.
 Corticobulbar Tracts
 The fibers terminate in a number of locations in the
midbrain (corticomesencephalic tract), pons
(Corticopontine tract), and medulla oblongata
(corticobulbar tract).

 The nerves within the corticobulbar tract are involved in

movement in muscles of the head.

 They are involved in swallowing, phonation, and

movements of the tongue.
CORTICONUCLEAR TRACT
 Clinical Significance
 Fibers of the corticospinal tracts are damaged
anywhere along their course from the cerebral
cortex to the lower end of the spinal cord, this will
give rise to an upper motor neuron syndrome.

 If the corticobulbar tract is damaged on only one

side, then only the lower face will be affected,
however if there is involvement of both the left
and right tracts, then the result is pseudobulbar
palsy.
 Extrapyramidal Systems
 Coordinates movements of various groups of muscles both in
space and time

 Regulates job and sport-specific automatic movements consisting

of periodic elements (e.g. walking, running, riding a bike, dancing,
driving a car, handwriting or typing, etc.)

 Controls emotional movements

 Helps to control posture and balance

 Regulates muscle tone.

 Extrapyramidal Tracts
 The extrapyramidal tracts originate in the brainstem,
carrying motor fibers to the spinal cord.

 There are four tracts in total:

 The vestibulospinal and reticulospinal tracts do

not decussate, providing ipsilateral innervation.

 The rubrospinal and tectospinal tracts do

decussate, and therefore provide contralateral
innervation.
 Vestibulospinal Tract
 There are two vestibulospinal pathways; medial and
lateral.

 They arise from the vestibular nuclei, which receive input

from the organs of balance.

 The tracts convey this balance information to the spinal

cord, where it remains ipsilateral.

 Fibers in this pathway control balance and posture by

innervating the ‘anti-gravity’ muscles (flexors of the arm,
and extensors of the leg), via lower motor neurons.
 Reticulospinal Tracts
 The two reticulospinal tracts have differing
functions (Both uncrossed):

 The medial (Pontine) reticulospinal tract arises

from the pons. It facilitates voluntary movements,
and increases muscle tone to axial and limb
muscles

 The lateral (Medullary) reticulospinal tract arises

from the medulla. It inhibits voluntary movements,
and reduces muscle tone to axial and limb muscles
 Reticulospinal Tracts

 Nerve cells in reticular formation

 Fibers pass through midbrain, pons, and medulla oblongata

 End at the anterior gray column of spinal cord control

activity of motor neurons

 They are important that they results in refining of

voluntary movement by preventing unnecessary
contractions that would result with shaking
 Rubrospinal Tract
 Nerve cells in red nucleus ( tegmentum of
midbrain at the level of superior colliculus)

 Nerve fibers / axons cross the mid line

descend as rubrospinal tract through pons and
medulla oblongata

 Terminate in anterior gray column of spinal

cord (facilitate the activity of flexor
muscles ) primarily in the cervical spinal cord
 Tectospinal Tracts
 This pathway begins at the superior
colliculus of the midbrain. The superior
colliculus is a structure that receives input
from the optic nerves.

 The neurons then quickly decussate, and

enter the spinal cord. They terminate at
the cervical levels of the spinal cord.
 Tectospinal Tracts
 It is responsible for motor impulses that arise from one
side of the midbrain to muscles on the opposite side of
the body.

 The function of the tectospinal tract is to mediate reflex

postural movements of the head in response to visual
and auditory stimuli.

 The tract descends to the cervical spinal cord to

terminate in Rexed laminae VI, VII, and VIII to
coordinate head, neck, and eye movements,
primarily in response to visual stimuli
 Lower Motor Neurons ( LMN )
 Motor neurons that innervate the
voluntary muscles

 In anterior gray column of spinal cord.

 Motor nuclei of brainstem

 Innervate skeletal muscles

 LMNL Paralysis
 Flaccid paralysis = damage lower motor
neurons

1. No voluntary movement on same side as damage

2. No reflex actions

3. Muscle limp & flaccid

4. Decreased muscle tone

 UMNL Paralysis
 Spastic paralysis = damage upper
motor neurons

1. Paralysis on opposite side from injury

2. Increased muscle tone

3. Exaggerated reflexes
Common Spinal
Cord Lesions
 Central Gray Matter Central
Cord Syndrome
 Seen in syringomyelia ( progressive cavitation
around or near the central canal of spinal cord
especially in cervical segments)

 Interrupt fibers of lateral spinothalamic tract

that passes in front of the central canal.

 Loss of pain and temperature sensibility on both

sides proprioception and light touch is spared,
sensory dissociation.
 Anterior Cord Syndrome
 Anterior spinal artery syndrome the primary
blood supply to the anterior portion of the
spinal cord, is interrupted, causing ischemia or
infarction of the spinal cord in the anterior two-
thirds of the spinal cord and medulla oblongata.

 It is characterized by loss of motor function

below the level of injury, loss of sensations
carried by the anterior columns of the spinal
cord (pain and temperature)
 Posterior Cord Syndrome
 Is a condition caused by lesion of the posterior
portion of the spinal cord caused by an interruption
to the posterior spinal artery.

 Unlike anterior cord syndrome, it is a very rare

condition.

 Clinical presentation:
 Loss of proprioception + vibration sensation + loss
of two point discrimination +loss of light touch
 Brown-Sequard syndrome
Hemi-section of the spinal cord

1. Dorsal column damage

2. Lateral column damage
3. Anterolateral column damage
4. Damage to local cord segment and nerve
roots
 Brown-Sequard syndrome
 Below the level of lesion

 On the side of lesion, lateral column damage, UMNL

1. Dorsal column damage
2. Loss of position sense
3. Loss of vibratory sense
4. Loss of tactile discrimination

 Anterolateral system damage

1. Loss of sensation of pain and temperature on the side
opposite the lesion
 Conus Syndrome
 Caused by S3 and S5 lesions. Lumbar stenosis
(multilevel) Spinal trauma including fractures.
Herniated nucleus pulposus are all causes of the
condition

1. Saddle anaesthesia s3-s5)

2. Urinary retention with overflow

incontinence( due to detrusor areflexia)
 Conus Syndrome
3. Fecal incontinence.

4. Impotence.

5. Loss of anal reflexes(S4-S5) and

bulbocavernosus(S2-S4).

6. Preserved motor function of lower limbs.

 Cauda Equina Syndrome
 Cauda equine is composed of lumbar,
sacral, and coccygeal nerve roots.

 Lesions of the cauda equine below L1

vertebral level result in cauda equina
syndrome.
 Cauda Equina Syndrome
 Lesions affecting the lower portion of
cauda equine may have lower limb
weakness but sensory loss only in saddle
area along with involvement of urination,
defecation and sexual dysfunction.
 Saddle
Numbness
 For further inquiries PLZ feel free
to contact at any time through
email

gamaltaha@med.asu.edu.eg
gamal.abdelhady@yu.edu.jo