1. Spinal Cord 2.Tracts & Syndroms

2. Ascending Tracts Ascending Tracts Modality: Touch, Pain, Temperature, Kinesthesia Modality: Touch, Pain, Temperature, Kinesthesia Receptor: Exteroceptor, Interoceptor, Proprioceptor Receptor: Exteroceptor, Interoceptor, Proprioceptor Primary Neuron: Dorsal Root Ganglion (Spinal Ganglion) Primary Neuron: Dorsal Root Ganglion (Spinal Ganglion) Secondary Neuron: Spinal Cord or Brain Stem Secondary Neuron: Spinal Cord or Brain Stem (Tertiary Neuron): Thalamus (Ventrobasal Nuclear Complex) (Tertiary Neuron): Thalamus (Ventrobasal Nuclear Complex) Termination: Cerebral Cortex, Termination: Cerebral Cortex, Cerebellar Cortex, or Cerebellar Cortex, or Brain Stem Brain Stem Ascending Tracts Ascending Tracts Modality: Touch, Pain, Temperature, Kinesthesia Modality: Touch, Pain, Temperature, Kinesthesia Receptor: Exteroceptor, Interoceptor, Proprioceptor Receptor: Exteroceptor, Interoceptor, Proprioceptor Primary Neuron: Dorsal Root Ganglion (Spinal Ganglion) Primary Neuron: Dorsal Root Ganglion (Spinal Ganglion) Secondary Neuron: Spinal Cord or Brain Stem Secondary Neuron: Spinal Cord or Brain Stem (Tertiary Neuron): Thalamus (Ventrobasal Nuclear Complex) (Tertiary Neuron): Thalamus (Ventrobasal Nuclear Complex) Termination: Cerebral Cortex, Termination: Cerebral Cortex, Cerebellar Cortex, or Cerebellar Cortex, or Brain Stem Brain Stem Spinal Cord Tracts Spinal Cord Tracts

3. Ascending Tracts Ascending Tracts 1. Posterior White Column-Medial Lemniscal Pathway 1. Posterior White Column-Medial Lemniscal Pathway 2.Spinothalamic Tract 2.Spinothalamic Tract Spinoreticular or Spinoreticulothalamic Tract Spinoreticular or Spinoreticulothalamic Tract 3.Spinocerebellar Tract 3.Spinocerebellar Tract 4.Spinomedullothalamic Tract 4.Spinomedullothalamic Tract 5.Cervicothalamic or Spinocervicothalamic Tract 5.Cervicothalamic or Spinocervicothalamic Tract 6.Spino-olivary Tract 6.Spino-olivary Tract 7.Spinotectal Tract 7.Spinotectal Tract Ascending Tracts Ascending Tracts 1. Posterior White Column-Medial Lemniscal Pathway 1. Posterior White Column-Medial Lemniscal Pathway 2.Spinothalamic Tract 2.Spinothalamic Tract Spinoreticular or Spinoreticulothalamic Tract Spinoreticular or Spinoreticulothalamic Tract 3.Spinocerebellar Tract 3.Spinocerebellar Tract 4.Spinomedullothalamic Tract 4.Spinomedullothalamic Tract 5.Cervicothalamic or Spinocervicothalamic Tract 5.Cervicothalamic or Spinocervicothalamic Tract 6.Spino-olivary Tract 6.Spino-olivary Tract 7.Spinotectal Tract 7.Spinotectal Tract Spinal Cord Tracts Spinal Cord Tracts

4. Posterior White Column-Medial Lemniscal Pathway Modality: Discriminative Touch Sensation (include Vibration) and Modality: Discriminative Touch Sensation (include Vibration) and Conscious Proprioception (Position Sensation, Kinesthesia) Conscious Proprioception (Position Sensation, Kinesthesia) Receptor: Most receptors except free nerve endings Receptor: Most receptors except free nerve endings Ist Neuron: Dorsal Root Ganglion (Spinal Ganglion) Ist Neuron: Dorsal Root Ganglion (Spinal Ganglion) Posterior Root - Posterior White Column Posterior Root - Posterior White Column 2nd Neuron: Dorsal Column Nuclei (Nucleus Gracilis et Cuneatus) 2nd Neuron: Dorsal Column Nuclei (Nucleus Gracilis et Cuneatus) Internal Arcuate Fiber - Lemniscal Decussation Internal Arcuate Fiber - Lemniscal Decussation - Medial Lemniscus - Medial Lemniscus 3rd Neuron: Thalamus (VPLc) 3rd Neuron: Thalamus (VPLc) Internal Capsule ----- Corona Radiata Internal Capsule ----- Corona Radiata Termination: Primary Somesthetic Area (S I) Termination: Primary Somesthetic Area (S I) Posterior White Column-Medial Lemniscal Pathway Modality: Discriminative Touch Sensation (include Vibration) and Modality: Discriminative Touch Sensation (include Vibration) and Conscious Proprioception (Position Sensation, Kinesthesia) Conscious Proprioception (Position Sensation, Kinesthesia) Receptor: Most receptors except free nerve endings Receptor: Most receptors except free nerve endings Ist Neuron: Dorsal Root Ganglion (Spinal Ganglion) Ist Neuron: Dorsal Root Ganglion (Spinal Ganglion) Posterior Root - Posterior White Column Posterior Root - Posterior White Column 2nd Neuron: Dorsal Column Nuclei (Nucleus Gracilis et Cuneatus) 2nd Neuron: Dorsal Column Nuclei (Nucleus Gracilis et Cuneatus) Internal Arcuate Fiber - Lemniscal Decussation Internal Arcuate Fiber - Lemniscal Decussation - Medial Lemniscus - Medial Lemniscus 3rd Neuron: Thalamus (VPLc) 3rd Neuron: Thalamus (VPLc) Internal Capsule ----- Corona Radiata Internal Capsule ----- Corona Radiata Termination: Primary Somesthetic Area (S I) Termination: Primary Somesthetic Area (S I) Spinal Cord Ascending Tracts Spinal Cord Ascending Tracts

5. Posterior White Column - Medial Lemniscal Pathway Posterior White Column - Medial Lemniscal Pathway medial lemniscus lemniscal decussation internal arcuate fiber posterior white column posterior root - ipsilateral loss of discriminative touch sensation and conscious proprioception sensation and conscious proprioception below the level of lesion below the level of lesion

6. Spinothalamic Tract Modality: Pain & Temperature Sensation, Light Touch Modality: Pain & Temperature Sensation, Light Touch Receptor: Free Nerve Ending Receptor: Free Nerve Ending Ist Neuron: Dorsal Root Ganglion (Spinal Ganglion) Ist Neuron: Dorsal Root Ganglion (Spinal Ganglion) Posterior Root Posterior Root 2nd Neuron: Dorsal Horn (Lamina I, IV, V) 2nd Neuron: Dorsal Horn (Lamina I, IV, V) Spinothalamic Tract - (Spinal Lemniscus) Spinothalamic Tract - (Spinal Lemniscus) 3rd Neuron: Thalamus (VPLc, CL & POm) 3rd Neuron: Thalamus (VPLc, CL & POm) Internal Capsule ----- Corona Radiata Internal Capsule ----- Corona Radiata Termination: Primary Somesthetic Area (S I) Termination: Primary Somesthetic Area (S I) & Diffuse Widespread Cortical Region & Diffuse Widespread Cortical Region Spinothalamic Tract Modality: Pain & Temperature Sensation, Light Touch Modality: Pain & Temperature Sensation, Light Touch Receptor: Free Nerve Ending Receptor: Free Nerve Ending Ist Neuron: Dorsal Root Ganglion (Spinal Ganglion) Ist Neuron: Dorsal Root Ganglion (Spinal Ganglion) Posterior Root Posterior Root 2nd Neuron: Dorsal Horn (Lamina I, IV, V) 2nd Neuron: Dorsal Horn (Lamina I, IV, V) Spinothalamic Tract - (Spinal Lemniscus) Spinothalamic Tract - (Spinal Lemniscus) 3rd Neuron: Thalamus (VPLc, CL & POm) 3rd Neuron: Thalamus (VPLc, CL & POm) Internal Capsule ----- Corona Radiata Internal Capsule ----- Corona Radiata Termination: Primary Somesthetic Area (S I) Termination: Primary Somesthetic Area (S I) & Diffuse Widespread Cortical Region & Diffuse Widespread Cortical Region Spinal Cord Ascending Tracts Spinal Cord Ascending Tracts

7. Spinothalamic Tract spinothalamictract anterior white commissure posterior root decussation - contralateral loss of pain and temperature sensation below the level of lesion sensation below the level of lesion

8. Spinothalamic Tract & Spinoreticular Tract Widespread cortical region cortical region CL (intralaminar thalamic nuclei) thalamic nuclei)reticulothalamic pathways pathwaysspinoreticular tract tract Primary Motor Area (M I) Area (M I) VPLc (ventrobasal nuclear complex) nuclear complex) (spinal lemniscus) spinothalamic tract tract thalamus reticular formation NeoSTT PaleoSTT

9. Fast PainSlow Pain Fast PainSlow Pain Sharp, prickingDull, burning Group III (A  ) fiberGroup IV (C) fiber Short latencySlower onset Well localizedDiffuse Short durationLong duration Less emotional Emotional, autonomic response Not blocked by morphineBlocked by morphine Neospinothalamic TractPaleospinothalamic Tract Comparison of Fast and Slow Pain ------ Spinothalamic Tract Comparison of Fast and Slow Pain ------ Spinothalamic Tract

10. Spinocerebellar Tract Modality: Unconscious Proprioception Modality: Unconscious Proprioception Receptor: Muscle spindle, Golgi tendon organ Receptor: Muscle spindle, Golgi tendon organ Ist Neuron: Dorsal Root Ganglion (Spinal Ganglion) Ist Neuron: Dorsal Root Ganglion (Spinal Ganglion) Posterior Root, [Posterior Column] Posterior Root, [Posterior Column] 2 nd Neuron : 1. Clarke’s column 2 nd Neuron : 1. Clarke’s column Posterior Spinocerebellar Tract Posterior Spinocerebellar Tract 2. Accessory Cuneate Nucleus 2. Accessory Cuneate Nucleus Cuneocerebellar Tract Cuneocerebellar Tract 3. Posterior Horn 3. Posterior Horn Anterior Spinocerebellar r Tract Anterior Spinocerebellar r Tract Termination: Cerebellar Cortex Termination: Cerebellar Cortex Spinocerebellar Tract Modality: Unconscious Proprioception Modality: Unconscious Proprioception Receptor: Muscle spindle, Golgi tendon organ Receptor: Muscle spindle, Golgi tendon organ Ist Neuron: Dorsal Root Ganglion (Spinal Ganglion) Ist Neuron: Dorsal Root Ganglion (Spinal Ganglion) Posterior Root, [Posterior Column] Posterior Root, [Posterior Column] 2 nd Neuron : 1. Clarke’s column 2 nd Neuron : 1. Clarke’s column Posterior Spinocerebellar Tract Posterior Spinocerebellar Tract 2. Accessory Cuneate Nucleus 2. Accessory Cuneate Nucleus Cuneocerebellar Tract Cuneocerebellar Tract 3. Posterior Horn 3. Posterior Horn Anterior Spinocerebellar r Tract Anterior Spinocerebellar r Tract Termination: Cerebellar Cortex Termination: Cerebellar Cortex Spinal Cord Ascending Tracts Spinal Cord Ascending Tracts

11. Spinocerebellar Tract Inferior cerebellar peduncle peduncleposterior spinocerebellar spinocerebellar tract tractClarke’s column columnposterior white column white column posterior root Posterior SCbllT Inferior cerebellar cerebellar peduncle pedunclecuneocerebellar tract tract (upper body) (upper body)posterior white column white column posterior root Anterior SCbllT (superior cerebellar cerebellar peduncle) peduncle)anterior spinocerebellar spinocerebellar tract tract anterior white commissure commissure posterior root

12. Spinocerebellar Tract

13. Corticospinal Tract Origin: Cerebral Cortex Origin: Cerebral Cortex Brodmann Area 4 (Primary Motor Area, M I) Brodmann Area 4 (Primary Motor Area, M I) Brodmann Area 6 (Premotor Area, PM ) Brodmann Area 6 (Premotor Area, PM ) Brodmann Area 3,1,2 (Primary Somesthetic Area, S I) Brodmann Area 3,1,2 (Primary Somesthetic Area, S I) Brodmann Area 5 (Anterior Portion of Sup. Parietal Lobule) Brodmann Area 5 (Anterior Portion of Sup. Parietal Lobule) Corona Radiata Corona Radiata lnternal Capsule, Posterior Limb lnternal Capsule, Posterior Limb Crus Cerebri, Middle Portion Crus Cerebri, Middle Portion Longitudinal Pontine Fiber Longitudinal Pontine Fiber Pyramid - pyramidal decussation Pyramid - pyramidal decussation Corticospinal Tract - Lateral and Anterior Corticospinal Tract - Lateral and Anterior Termination: Spinal Gray (Rexed IV-IX) Termination: Spinal Gray (Rexed IV-IX) Corticospinal Tract Origin: Cerebral Cortex Origin: Cerebral Cortex Brodmann Area 4 (Primary Motor Area, M I) Brodmann Area 4 (Primary Motor Area, M I) Brodmann Area 6 (Premotor Area, PM ) Brodmann Area 6 (Premotor Area, PM ) Brodmann Area 3,1,2 (Primary Somesthetic Area, S I) Brodmann Area 3,1,2 (Primary Somesthetic Area, S I) Brodmann Area 5 (Anterior Portion of Sup. Parietal Lobule) Brodmann Area 5 (Anterior Portion of Sup. Parietal Lobule) Corona Radiata Corona Radiata lnternal Capsule, Posterior Limb lnternal Capsule, Posterior Limb Crus Cerebri, Middle Portion Crus Cerebri, Middle Portion Longitudinal Pontine Fiber Longitudinal Pontine Fiber Pyramid - pyramidal decussation Pyramid - pyramidal decussation Corticospinal Tract - Lateral and Anterior Corticospinal Tract - Lateral and Anterior Termination: Spinal Gray (Rexed IV-IX) Termination: Spinal Gray (Rexed IV-IX) Spinal Cord Descending Tracts Spinal Cord Descending Tracts

14. - ipsilateral UMN syndrome at the level of lesion at the level of lesion Corticospinal Tract Corona Radiata lnternal Capsule, Posterior Limb Crus Cerebri, Middle Portion Longitudinal Pontine Fiber Pyramid Pyramidal Decussation Corticospinal Tract - Lateral and Anterior - Lateral and Anterior CR IC LPF Pyr PD LCST ACST

15. Descending Tracts from Brain Stem Dorsolateral (Motor) Pathway Dorsolateral (Motor) Pathway Rubrospinal Tract Rubrospinal Tract Ventromedial (Motor) Pathway Ventromedial (Motor) Pathway Tectospinal Tract Tectospinal Tract Vestibulospinal Tract Vestibulospinal Tract MLF (Medial Longitudinal Fasciculus) MLF (Medial Longitudinal Fasciculus) - interstitiospinal tract - interstitiospinal tract Sensory Modulation pathways Sensory Modulation pathways Raphespinal & Cerulospinal Pathways Raphespinal & Cerulospinal Pathways Descending Autonomic Pathways Descending Autonomic Pathways Descending Tracts from Brain Stem Dorsolateral (Motor) Pathway Dorsolateral (Motor) Pathway Rubrospinal Tract Rubrospinal Tract Ventromedial (Motor) Pathway Ventromedial (Motor) Pathway Tectospinal Tract Tectospinal Tract Vestibulospinal Tract Vestibulospinal Tract MLF (Medial Longitudinal Fasciculus) MLF (Medial Longitudinal Fasciculus) - interstitiospinal tract - interstitiospinal tract Sensory Modulation pathways Sensory Modulation pathways Raphespinal & Cerulospinal Pathways Raphespinal & Cerulospinal Pathways Descending Autonomic Pathways Descending Autonomic Pathways Spinal Cord Descending Tracts Spinal Cord Descending Tracts

16. ventromedial pathway dorolateral pathway DescendingTractsfrom Brain Stem Spinal Cord Tracts Tracts

17. upper motor neuron UMN UMN SOMATIC MOTOR SYSTEM lower motor neuron LMN Brain Stem Brain StemDescending Pathway Pathway Final Common Pathway EFFECTORS skeletal muscle Pyramidal Tract VOLUNTARY CONTROL AUTOMATIC CONTROL Rubrospinal Tract Tectospinal Tract Vestibulospinal Tract MLF Reticulospinal Tract REFLEX

18. Spinal Cord Syndrome Spinal Cord Syndrome Location of Symptoms in Spinal Disease ipsilateral to lesion contralateral to lesion

19. Upper Motor Neuron (UMN) vs Lower Motor Neuron (LMN) Syndrome UMN syndrome LMN Syndrome Type of Paralysis Spastic Paresis Flaccid Paralysis Atrophy No (Disuse) Atrophy Severe Atrophy Deep Tendon Reflex Increase Absent DTR Pathological Reflex Positive Babinski Sign Absent Superficial Reflex Absent Present Fasciculation and Absent Could be Fibrillation Present

20. Spinal Cord Syndrome Spinal Cord Syndrome Predominantly Motor Syndromes Predominantly Motor Syndromes Poliomyelitis (Infantile Paralysis) Poliomyelitis (Infantile Paralysis) - viral infection of lower motor neuron - viral infection of lower motor neuron - LMN syndrome at the level of lesion - LMN syndrome at the level of lesion Amyotrophic Lateral Sclerosis (ALS) Amyotrophic Lateral Sclerosis (ALS) - combined LMN and UMN lesion - combined LMN and UMN lesion - LMN syndrome at the level of lesion - LMN syndrome at the level of lesion - UMN syndrome below the level of lesion - UMN syndrome below the level of lesion - Lou Gehrig’s disease in USA - Lou Gehrig’s disease in USA

21. Spinal Cord Syndrome Spinal Cord Syndrome Amyotrophic Lateral Sclerosis Amyotrophic Lateral Sclerosis 1. corticospinal tract 2. lower motor neuron (LMN)

22. Spinal Cord SyndromeAmyotrophic Lateral Sclerosis (ALS) Lou Gherig’s Disease Spinal Cord SyndromeAmyotrophic Lateral Sclerosis (ALS) Lou Gherig’s Disease Lou "The Iron Horse" Gehrig (1903-41) 3.40, 2131(1925-39), 23 GSH, 147 RBI avg.

23. Spinal Cord SyndromeAmyotrophic Lateral Sclerosis (ALS) Lou Gherig’s Disease Spinal Cord SyndromeAmyotrophic Lateral Sclerosis (ALS) Lou Gherig’s Disease Stephen Haking (1946- ) British Physicist, A Brif History of Time

24. Spinal Cord Syndrome Spinal Cord Syndrome Predominantly Sensory Syndromes Predominantly Sensory Syndromes Herpes Zoster Herpes Zoster - inflammatory reactions of spinal ganglion - inflammatory reactions of spinal ganglion - severe pain on the dermatomes of affected ganglion - severe pain on the dermatomes of affected ganglion Tabes Dorsalis Tabes Dorsalis - common variety of neurosyphilis - common variety of neurosyphilis - posterior colum and spinal posterior root lesion - posterior colum and spinal posterior root lesion - loss of discriminative touch sensation and conscious - loss of discriminative touch sensation and conscious proprioception below the level of lesion proprioception below the level of lesion - posterior column ataxia - posterior column ataxia - lancinating pain - lancinating pain - loss of deep tendon reflex (DTR) - loss of deep tendon reflex (DTR)

25. Herpes Zoster (Shingles) varicella-zoster virus varicella-zoster virus reactivation from reactivation from the dorsal root ganglia the dorsal root ganglia unilateral vesicular unilateral vesicular eruption within eruption within a dermatome a dermatome T3 to L3 dermatome T3 to L3 dermatome lesions are frequent lesions are frequent zoster ophtahalmicus zoster ophtahalmicus (ophthalmic division (ophthalmic division of trigeminal n., V 1 ) of trigeminal n., V 1 ) Ramsey-Hunt syndrome Ramsey-Hunt syndrome (sensory br. of VII) (sensory br. of VII) acyclovir, antiviral agent acyclovir, antiviral agent

26. Spinal Cord Syndrome Spinal Cord Syndrome Subacute Combined Degeneration Subacute Combined Degeneration (Combined System Disease) (Combined System Disease) Lesion Lesion - posterior white column - posterior white column - corticospinal tract (UMN) - corticospinal tract (UMN) Symptom Symptom - loss of discriminative touch sensation and conscious - loss of discriminative touch sensation and conscious proprioception below the level of lesion proprioception below the level of lesion - ipsilateral UMN syndrome below the level of lesion - ipsilateral UMN syndrome below the level of lesion

27. Spinal Cord Syndrome Spinal Cord Syndrome Subacute Combined Degeneration Subacute Combined Degeneration 1. corticospinal tract 2. posterior white column

28. Spinal Cord Syndrome Spinal Cord Syndrome Syringomyelia, Hematomyelia Syringomyelia, Hematomyelia Lesion Lesion - central canal of spinal cord - central canal of spinal cord - gradually extended to peripheral part of the cord - gradually extended to peripheral part of the cord Symptom Symptom - initial symptom is bilateral loss of pain - initial symptom is bilateral loss of pain (compression of anterior white commissure) (compression of anterior white commissure) - variety of symptoms appear - variety of symptoms appear according to the lesion extended from central canal according to the lesion extended from central canal

29. Spinal Cord Syndrome Spinal Cord Syndrome Syringomyelia - Initial Symptoms Syringomyelia - Initial Symptoms

30. Spinal Cord Syndrome Spinal Cord Syndrome Brown-Sequard syndrome Brown-Sequard syndrome (spinal cord hemisection) (spinal cord hemisection) Major Symptoms Major Symptoms 1. ipsilateral UMN syndrome below the level of lesion 1. ipsilateral UMN syndrome below the level of lesion 2. ipsilateral LMN syndrome at the level of lesion 2. ipsilateral LMN syndrome at the level of lesion 3. ipsilateral loss of discriminative touch sensation and 3. ipsilateral loss of discriminative touch sensation and conscious proprioception below the level of lesion conscious proprioception below the level of lesion (posterior white column lesion) (posterior white column lesion) 4. contralateral loss of pain and temperature sensation 4. contralateral loss of pain and temperature sensation below the level of lesion (spinothalamic tract lesion) below the level of lesion (spinothalamic tract lesion)

31. Spinal Cord Syndrome Spinal Cord Syndrome Brown-Sequard Syndrome (Spinal Cord Hemisection) Brown-Sequard Syndrome (Spinal Cord Hemisection)