Transcribed by ______________ Transcribed by Joseph Schwimmer

Date of the Lecture

Neuroscience Lectures #4 Spinal Cord and Pathways by Dr. Juhee Jeon !"!#"$4 Slide 1 Spinal Cord Dr. Juhee Jeong Ok, so now we are done with the brain and mo in! on to the spinal cord" Ok, so # will start with the or!ani$ation of the spinal cord, so this will be the end of the lectures titled or!ani$ations of the C%S" &nd then mo e on to the spinal pathways lecture, ascendin! and descendin! spinal pathways, and also briefly co er spinal refle'es" Slide ( Or!ani$ation of the spinal cord Slide ) Or!ani$ation of the spinal cord Let*s start with or!ani$ation of the spinal cord" So let*s first look at the superior inferior or!ani$ation, or rostral caudal or!ani$ation of the spinal alon! our body a'is" Spinal cord is se!mented, )1 se!ments that we ha e" So if you look at this spinal cord here there are different colors, represent each re!ion, di ided into cer ical, thoracic, lumbar, !reen here, sacral, blue here, coccy!eal you cannot e en see but there is one se!ment coccy!eal" So in this picture, in this dia!ram, spinal cord is this one, and its surrounded by the ertebral column" Left side is the numberin! for the spinal cord se!ment" +i!ht side is the numberin! for the indi idual ertebra" &nd if you look at this, rostrally they match closely, the spinal cord, T1 is almost ri!ht ne't to the ertebra T1, thoracic" ,ut if you !o further caudally there is a bi! distance between the spinal cord, for e'ample, sacral number one here, and the ertebra sacral number 1 here, because the spinal cord is much shorter than the ertebral column" &nd the result is that the ner e fibers that are attached to the spinal cord, as they form more towards the posterior, and the spinal cord has to tra el further and further within the ertebral column before they e'it" So makin! this bundle of here, these are -ust bundle of fibers, spinal cord ended here around the le el of the first lumbar ertebra" So this bundle of fibers, ner es and when they are attached to the spinal cord, they are called roots, these ner e roots are e'tendin! here and they make somethin! that looks like horse tail, and this bundle of fibers is called cauda e.uina" &nd the fact that the spinal cord is shorter than the ertebral column is .uite important in terms of from the perspecti e of the medical practice, because that allows what*s called lumbar puncture, or spinal tap, you can insert a needle throu!h, in between the ertebra into the ertebral canal without touchin! the actual spinal cord, without dama!in! the spinal cord" So you can insert the needle and take some of the cerebrospinal fluid that can be used for dia!nostic testin!" So the spinal cord ends at about the first lumbar ertebra, so to be safe you a oid the second one, and then lumbar puncture is usually performed between )rd and /th lumbar ertebra, and you can insert the needle without touchin! the spinal cord" Slide 0 Or!ani$ation of the spinal cord &nd each se!ment of the spinal cord inner ates a dermatome" So from here, each se!ment here inner ates dermatome" 1ere this in the body here, the black lines are the boundaries for the indi idual dermatome" Dermatome means a discreet domain of skin

Transcribed by ______________

Date of the Lecture

and muscle as marked here you can di ide the body into a lot of dermatomes, and this is because durin! the de elopment, the spinal cord and the skin and muscle, they de elop ri!ht ne't to each other and they ha e a close relationship, and so each se!ment of the spinal cord connects to each se!ment of the dermatome" 2inaudible student .uestion34 Shin!les5 # don*t know that answer, sorry" Slide / Or!ani$ation of the spinal cord Ok, let*s look at the spinal cord or!ani$ation from the trans erse section of the spinal cord, # will !o from outside to inside" &nd, so this is the ertebra bone" Spinal cord also has the menin!es co erin! it, -ust like the brain" &lso there are ) layers of menin!es, dura, arachnoid, and pia mater" So here, this li!ht blue layer is the dura mater, and the kind of thin, but this pink layer is the arachnoid mater, and underneath this area with network is the subarachnoid space" 6ia mater -ust, ery closely surrounds the spinal cord itself is the pia mater" &nd, a!ain as # mentioned earlier for the brain, cerebrospinal fluid surrounds the spinal cord in the subarachnoid space, so that means when you do the lumbar puncture the needle will need to !o into the subarachnoid space to !et the cerebrospinal fluid" Slide 7 8 Or!ani$ation of the spinal cord 9hite :atter So now let*s !et, that*s the outside of the spinal cord and let*s !et into the spinal cord actually" Outer part of the spinal cord is the white matter, inner part is the !ray matter" So a!ain white matter contains ner e fibers, !ray matter contains cell bodies of the neurons" 9hite matter of the spinal cord is di ided into funiculi, or sometimes they are -ust called columns" 6osterior funiculus or posterior column, lateral funiculus or lateral column, anterior funiculus or anterior column" &nd there is a re!ion of the white matter that you need to remember is the Lissauer*s Tract, its located ri!ht here, ri!ht here, and ri!ht here, it*s -ust superficial to the tip of the posterior horn, so -ust outside of the posterior horn, and it contains the fibers enterin! throu!h the dorsal root" &!ain, the Lissauer*s Tract will be mentioned in the spinal pathways part" &nd it*s ri!ht here" &nother white matter structure that you need to remember is here, so in this picture # hope you already reali$ed the white matter looks purple not white actually" So this thin, purple line here, ri!ht in front of the what is called central canal, so this re!ion is the anterior white commissure, the white matter here, and this will be a!ain mentioned in the spinal pathways, ok5 &nd so the ner e fibers attach to the spinal cord like this, and ner e fibers attachin! from the dorsal side of the spinal cord are called dorsal root, and the fibers attached to the spinal cord from the entral side are called entral root" Slide ; 8 Or!ani$ation of the spinal cord <ray :atter &nd let*s now look at !ray matter which contains the actual cell bodies of the neurons" <ray matter, they ha e cell bodies, and also endin! of the ner e fibers, but not actually bundles of the ner e fibers" They are di ided into horns" They can be called dorsal lateral entral, or posterolateral anterior" So dorsal horn is this one, also called posterior horn, also contains the sensory neurons" Lateral horn, also called the intermediate !ray matter, contains isceral motor neurons, part of the autonomic ner ous system" &nterior horn contains the motor neurons" So if you happen to remember from the first lecture about embryonic de elopment, alar plate is the dorsal part, makin! the sensory neuron, basal

Transcribed by ______________

Date of the Lecture

plate of the embryonic spinal cord is the ones makin! the motor neurons, so that spatial relationship is maintained in the adult" Dorsally there will be sensory neurons, entrally there are motor neurons entrally" =ou can further di ide the !ray matter of the spinal cord into layers or lamina, which is shown in this dia!ram" So if you compare this and if you compare this and this, layer, the lamina 1 throu!h 7, four within the posterior horn domain, that means they ha e sensory neurons" Layer ; occupies the lateral horn, that means they ha e isceral motor neuron" &nd layer > and ? here occupies the anterior horn" &nd so they make the motor neuron" They ha e the motor neurons" &nd the layer 1@ is the one immediately surroundin! the central canal" So this is central canal here, ery small hole here that*s runnin! the len!th of the spinal cord, and this is continuous with entricular system of the brain and it also contains the cerebrospinal fluid" So that*s the central canal and in the pre ious slide the white matter -ust entral to the central canal was called anterior white commissure" Slide > 8 Or!ani$ation of the spinal cord So the basic cross sectional or!ani$ation of the spinal cord is the same from rostral to caudal, superior to inferior a'is, but the difference is the amount of proportion between the !ray matter and the white matter" So if you ha e the first section like theAis, the second section like this, which one do you this is more rostral, and which one do you think is the caudal" This is the rostral, this is the caudal" 9hy5 ,ecause the outer layer what is stained purple here is the white matter" &s you !o rostrally you !et a lot more white matter than the caudally" 9hy5 ,ecause the spinal cord contains the ner e fibers connectin! the body to the brain, and as you !o hi!her and hi!her the !i ers collected from all the le els below come to!ether to make bundle, so the bundle will !et thicker and thicker and thicker as you !o hi!her towards the superior" Slide ? &scendin! and Descendin! Spinal 6athways So now we are !oin! into the spinal pathways" &scendin! and descendin! spinal pathways" So Slide 1@ 8 Bunctional :odalities of the Spinal %er es ,efore # actually !et into the pathways, # want to -ust describe the functional modalities that we discussed in the central ner ous system" There are somatosensory, somatomotor, isceral sensory, isceral motor, so these will be mentioned" Birst of all so you need to distin!uish somatic ersus autonomic" Somatic means the ner ous system that mediates interaction with the en ironment" &utonomic means the ner ous system that coordinates the function of the internal or!ans, and maintains body homeostasis" &nd then there is for each of them, somatic and autonomic ner ous system there is a sensory and there is a motor component" So for somatic ner ous system, sensory components are called afferent, motor components are called efferent" # try to make this clear, because # ha e to repeat this a!ain and a!ain as we !o to the cranial ner es" # will call this &fferent and this Cfferent" So somatic afferent comes from the body, the outer body like -oints, skin, skeletal muscle, and they tra el throu!h somatosensory fibers, and then somatomotor, efferent, is !oin! to the skeletal muscles" Bor the autonomic ner ous system, the afferents come from the iscera and the blood essels and thin!s like that, and then the isceral

Transcribed by ______________

Date of the Lecture

motor fi ers connect to the internal or!ans like !land, smooth muscles, cardiac muscles and so on" Slide 11 Bunctional :odalities of the Spinal %er es So combinin! somatic s" autonomic, afferent s" efferent you !et four functional modalities of the ner es, and they are called <S&, <D&, <DC, <SC" So they are essentially the same as # -ust described" <eneral somatic afferent is the sensory from the somatic structures such as skin muscles and -oints, con eys pain temperature, mechanical stimuli" <D& is !eneral isceral afferent comin! from the isceral structures like blood essel and di!esti e tracts" <DC is !eneral isceral efferent, the motor component of the autonomic ner ous system" <SC is !eneral somatic efferent, means the motor inner atin! skeletal muscles, controllin! oluntary mo ement" &nd the <SC contains the a'ons of the upper and lower motor neurons, which you will understand co er the upper and lower motor neurons, once we !o o er the descendin! pathway" Slide 1( Blow of #nformation in the Spinal Cord So this is kind of the !eneral o er iew of the flow of information in the spinal cord" So this is the section of the spinal cord, dorsal, entral" So afferent, the sensory ner es come from the dorsal side, and the efferent, the motor neurons always !o out throu!h the entral side" So afferent of the spinal ner es, so for e'ample in the case of somatic afferent ner es they ha e the a'ons fibers of the primary sensory neurons" So primary sensory neurons, their cell bodies are located in the dorsal root !an!lia, and then they will ha e the ner e endin!s terminatin! at our skin or muscles, which is where they will recei e the sensory information" &nd then the a'ons will come into the spinal cord as somatic afferent, and from here, it can !o in a couple of different directions, which # will talk about in a little bit" Cfferent, motor component" Somatic efferent contains from the spinal cord contains the a'ons of the lower motor neurons" So the ones that will inner ate the skeletal muscles, the somatic efferent will !o directly to the skeletal muscles and inner ate them, to control the muscle mo ement, contraction" &nd the isceral efferent will make a synapse at the autonomic !an!lion and then !o to the iscera" &!ain # will try to put all the emphasis on the somatic ner ous system, and mention the autonomic ner ous system only in contrast to the somatic ner ous system, because there is a separate lecture for the &%S later on" So the pathways that # mentioned will be focused on the somatic ner ous system" There are ) types of fibers in the white matter of the spinal cord" &scendin! fibers means the fibers !oin! to the brain, descendin! fibers means fibers comin! from the brain" So here, this will be the ascendin! fiber form the let*s say, the somatic afferent sendin! the information to the brain and this will be another e'ample of the ascendin! fibers" There are at least ( different ascendin! pathways that we will talk about" Descendin! fibers from the brain, these would be the descendin! fibers from the brain, and they also occupy the white matter" &nd there is a third type of fibers, propriospinal fibers, they are the ones interconnectin! different le els of the spinal cord, between the different se!ments of the spinal cord" Slide 1) &scendin! 6athways Let*s look at the, a!ain these are some of the more !eneral principles of the spinal pathways" &scendin! and descendin! pathways ha e defined locations in the spinal white

Transcribed by ______________

Date of the Lecture

matter" So a!ain, ascendin! fibers are the ones !oin! to the brain, and descendin! fibers are the ones comin! from the brain, they within the white matter they were di ided into posterior, lateral, anterior columns and they occupy defined locations, distinct locations" One primary afferent can participate in one or more ascendin! tracks so afferent sensory information can participate in one or more ascendin! tracks, and in one or more refle'es" So in this dia!ram, this is, let*s say somatic afferent, sensory information" So this would be the dorsal root !an!lia containin! the cell bodies of the primary sensory neurons, which has ner e endin!s at, let*s say, skin" #t recei es the information from the skin, which tra els throu!h the a'on of the primary sensory neurons, enters the spinal cord, and then makes a synapse here and it can do in this case, it can do like multiple thin!s here" =ou can see the arrow is !oin! into at least 1, (, ) branches here" That*s what it means one primary afferent can participate in more than one ascendin! tracts, here one !oin! to the cerebellum, one !oin! to the thalamus, or in refle'es because the a'ons branch, so the information can branch" So ascendin! pathways for somatic afferents, !o from the spinal cord to the thalamus and then to the cerebral corte', and this information would reach the consciousness, so if somebody touches you it will reach the consciousnessE temperature information it will reach your consciousness, because it !oes throu!h the thalamus and ultimately it !ets to the cerebral corte'" ,ut then spinal cord can send information to the cerebellum also, in this case the information does not reach the conscious le el, it stays subconscious, and if you remember the cerebellum functions on a subconscious le el" On the other hand the ascendin! pathways for the autonomic afferents !o to hypothalamus" Slide 10 &scendin! pathways So ascendin! pathways, a!ain there are multiple ascendin! pathways, but # will only talk about two of them in my lectures" Two principal pathways connectin! the spinal cord and the thalamus and e entually the cerebral corte' are posterior column8medial lemniscus tract and spinothalamic tract, and they carry different kind of information" The first one posterior column8medial lemniscus tract carries information on fine touch and proprioception" 6roprioception means information about the location of your body parts" Spinothalamic tract carries information on pain and temperature" So here, you will see it in detail but the !reen line is the posterior column8medial lemniscus tract, so in the dia!ram # will show after this you will see information comin! from only one side of the body, but ob iously these pathways are symmetric, so you !et a posterior column8medial lemniscus tract comin! from this side and !oin! like this, and this side and !oin! like this" &nd also spinothalamic tract comin! from this side and !oin! like this, and this side and !oin! like this" Slide 1/ &scendin! 6athways 8 6osterior column8medial lemniscus tract So, let*s look at this in details, step by step of the ascendin! pathways" The first one, posterior column8medial lemniscus tract carryin! the fine touch and proprioception information, this in ol es ) neuron pathway to !et the information from your body, like skin, all the way to your cerebral corte'" The first order sensory neuron -ust in case you don*t reco!ni$e this, this is a series of dissections alon! our body throu!h the central ner ous system, dorsal and entral, dorsal and entral here, and this would be at the spinal cord le el, and you should be able to reco!ni$e that we are !oin! throu!h the

Transcribed by ______________

Date of the Lecture

brainstem here" &nd then in this picture here, this is thalamus here" &nd then this would be the cerebral corte'" Ok, so let*s !o from periphery to the central" So first one, the primary sensory neuron or first order sensory neuron, their cell bodies are located at the dorsal root !an!lia which lies -ust outside of the spinal cord" So they ha e one connection to skin or muscle, and then the other side their a'ons enter the dorsal horn of the spinal cord" &!ain, the sensory information comes into the spinal cord from the dorsal side" &nd then they ascend all the way to the medulla, and then they throu!h the fibers called fasciculus !racilis and fasciculus cuneatus, they were mentioned when # was talkin! about the medulla, they are part of the posterior column8medial lemniscus tract" So the a'ons from the first orders sensory neurons tra els throu!h the fasciculus !racilis or cuneatus and they terminate at the medulla at the nucleus !racilis or nucleus cuneatus" &nd the difference between the two, if you look at this picture here, the fasciculus !racilis carries information from the lower body and it lies more medial" Basciculus cuneatus carries information from your upper body, like your arm, it lies more lateral to the fasciculus !racilis, and so they terminate at the medulla" &nd now they make a synapse to second order sensory neurons, whose cell bodies are at the medulla at the nucleus !racilis and nucleus cuneatus" &nd this second order sensory neurons send a'ons that decussate, the fibers from the second order sensory neurons decussate, meanin! they cross the midline, and then they further ascend throu!h the medial lemniscus" &nd they keep !oin! up and up and up all the way to the thalamus" The a'on terminates at the thalamus at a nucleus called entral posterolateral nucleus, that*s D6L, entral posterolateral nucleus" # mentioned when # was !oin! o er the thalamus that you don*t ha e to remember all the nuclei of the thalamus, but you ha e to remember when indi idual ones are mentioned a!ain in the conte't of specific function or pathways" So this is an e'ample so you need to remember that the somatosensory information ends up at the entral posterolateral nucleus of the thalamus" &nd from here now they make the synapse to the third order sensory neuron, whose cell bodies are at the thalamus, at the D6L , and the third order sensory neurons finally pro-ect to the cerebral corte', to the primary somatosensory corte', it*s located in the postcentral !yrus of the parietal corte'" Ok, any .uestions5 2lau!hter3" Ok, well you kind of ha e to remember all this" This, # will say, for the e'ams and thin!s like that, which structure the ner e fibers tra el, where they synapse, where they decussate, where their neuronal cell bodies are located, yeah this slide is a really important slide, and the followin! couple also, the ones describin! the pathways"

Transcribed by ______________

Date of the Lecture

Slide 17 8 &scendin! 6athways Spinothalamic tract Ok, now second ascendin! pathway, spinothalamic tract carries information about the pain, temperature, and pressure and non8discriminati e touch" So, in the first one, it says it carries the information on fine touch, this is also called discriminati e touch, which is the touch where you can identify where you are bein! touched, you can locate the position of the touch, that*s discriminati e touch" &nd indiscriminati e touch, or non8 discriminati e touch, you reali$e you are bein! touched but you don*t know where you are bein! touched" #t*s hard to ima!ine for you !uys, for us, because normally we don*t e'perience non8discriminati e touch because always the discriminati e touch and non8 discriminati e touch information are sensed to!ether, so whene er you are touched you know where you are touched but only in patholo!ical conditions when you ha e dama!e to the first pathway when you can e'perience non8 discriminati e touch, where you know you are bein! touched but you don*t know where you are bein! touched" So, # would say this is a little more detail than you will need to know, but -ust in case you are wonderin! about the difference between the touch carried by the first pathway and the touch carried by the second pathway" &nd so -ust to put it simply, you can -ust remember that pain and temperature, spinothalamic tract" That*s best two ma-or ones spinothalamic tract carries pain and temperature, and posterior column medial lemniscus carries fine touch and proprioception" So a!ain this is, -ust like the pre ious one this is the three neuron pathway, takes three neurons to !et the information from your skin, to all the way up to your cerebral corte', ok5 So the first order sensory neuron, a!ain the cell bodies are at the dorsal root !an!lia" &!ain, it has the ner e endin!s somewhere in your skin and they will collect the information from there and then pro-ect the a'on into the spinal cord throu!h the dorsal side, so fibers enter the dorsal horn" &nd then the difference is here" Brom here it becomes different from the pre ious one" So the let*s say, let*s look at this one here" So once the, this is the primary cell bodies of the first order sensory neuron, a'on enters the dorsal horn, it terminates at the dorsal horn, and makes the synapse at the dorsal horn" So if you remember the first pathway, it doesn*t, it terminates the a'ons of the primary sensory neurons terminate all the way up at the medulla" This one spinothalamic tract, the a'ons of the first order sensory neurons terminate within the spinal cord, at the dorsal horn" So sometimes the a'ons can enter the spinal cord and terminate ri!ht there" Sometimes the fibers ascend alon! the spinal cord one or two se!ments throu!h the Lissauer*s tract" That*s what this is showin!, dorsal horn, so here this is dorsal horn and this is Lissauer*s tract here, here, here -ust outside of the dorsal horn "so some fibers of the spinothalamic tract will terminate ri!ht after it enters the spinal cord, some will tra el a little lon!er in the spinal cord and terminate, but still it will terminate within the spinal cord, ok, at the dorsal horn" So it will synapse to the second order sensory neurons whose cell bodies are at the dorsal horn" So here in this case, here, and a'ons of the second order sensory neuron decussates throu!h the anterior white commissure, crosses the midline" So a!ain, decussation for the first pathway happened at the medulla" Decussation for the spinothalamic tract happens at the spinal cord" &nd then it enters the anterior and lateral funiculi or columns which are the white matter, and then they tra el all the way up to the thalamus a!ain, a!ain the same D6L, and they terminate here, make synapse to the third order sensory neurons which send the information to the somatosensory corte'" &nd the second order sensory neuron can !i e off branches in the brainstem to !i e off

Transcribed by ______________

Date of the Lecture

information to the brainstem also" ,ut the ma-or pathway is !oin! to the somatosensory corte'" So # think that*s all the time # ha e today, and # will !o to the descendin! pathway ne't week"

>