OS 202B Integration and Control Systems

Correlative Neuroanatomy of the Sensory System

Lecturer: Jose Leonard Pascual, MD
OUTLINE
I. Introduction
A. Sensory Modalities
B. How We See Things
C. Basic Layout of the Sensory System
1. Neurons
2. Dermatomes
II. Pain
A. Tracing the Pain Pathway
B. How We Feel Pain
C. Pain/Temperature Pathway from Body
D. Pain/Temperature Pathway from Head
III. Touch
Note: This trans is based on Dr. Pascuals slides. Italicized
notes are lifted from 2019 trans.
Learning Objectives

FORM: Identify the important neuroanatomical structures

involved with the transmission of sensation (receptor,
nerve, nerve root ganglion, ascending tract, thalamus,
cerebral cortex)

FUNCTION: To be able to trace the pathways below from

receptor to cortex

A.
1.
2.
3.
4.

I. INTRODUCTION
Sensory Modalities
Pain and temperature - noxious stimuli; extreme situations
Light touch - subtle stimulus
Vibration sense - repetitive light touch
Proprioception - position and movement
Different sensory modalities each have their own
receptors
o Thermoreceptors heat
o Meissners corpuscle touch
o Nociceptor pain
o Pacinian corpuscle pressure
o Photoreceptors - light

B.

How We Sense Things

Nerve receptor picks up the stimulus
o Free nerve endings: PAIN (meaning they are naked
dendrites)
o Pain in the fingers must ASCEND to the brain so its
AFFERENT

The stimulus is sent to the thalamus

o Stimuli received by several receptors travel together
within the peripheral nerves, reach their respective
nerve ganglia (eg. dorsal root ganglia) and enter the
CNS
o Receptor peripheralnerve nerveganglia CNS
(via ascending tract)
The thalamus relays the stimulus to the cerebral cortex
The cerebral cortex understands the stimulus in its context
C. Basic Layout of the Sensory System
1. Neurons
a. First Order Neurons
b. Second Order Neurons

Receives impulses from first order neuron

Location:
o Neurons of the body: lies in the dorsal horn of the
spinal cord
o Neurons of the face: lies in the spinal nucleus of
CN V
Crosses the midline and ascends into the thalamus

c.

Date: March 1, 2016 Trans: 03-06

01-01
Third Order Neurons
From the thalamus to the cerebral cortex

Figure 1. Organization of Sensory Pathways.

2. Dermatomes

Dermatomes: areas on the skin supplied by a single

specific spinal nerve root

Each dermatome segment corresponds to one spinal

nerve

There is NO C1 dermatome
o C1 is a purely motor peripheral nerve

Two or three vertebral bodies separate the spinal nerve

from its origin in the spinal cord
o e.g. a lesion affecting the site of origin of T10 is not
necessarily at the level of T10 vertebra; it would most
probably be at the level of T8 vertebra

C1-7 exit ABOVE their corresponding vertebral bodies

C8 exits ABOVE T1

T1 downwards exit BELOW their corresponding vertebral

bodies

From the spinal cord exits a dorsal root (sensory), which

further becomes a dorsal root ganglion and a ventral root
(motor)
Table 1. Easy-to-remember dermatomal segments.

Anterior
C3
C6
C7
C8
T4
T10
L1
S2-3
L4
L5
S1

Front of neck
(lovebite)
Thumb
Middle finger
Little finger
Nipple
Umbilicus
Inguinal area
(bikini line)
Genitalia
Knee & big toe
Shin
Little Toe

Posterior
Back of the head

C2

Also innervates the

area at the angle of the
jaw and earlobe. Do
NOT include said area
when testing for CN V
function.

C5
S2-5

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Shoulder
Buttocks

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OS202B Correlative Neuroanatomy of the Sensory System

II. PAIN
A. Tracing the Pain Pathway

This pathway mediates nociceptive stimuli

o Two different modalities, one pathway = Pain and
Temperature

Each of those sensations have corresponding nociceptors

o Pain (pinprick): A-delta mechanical receptors
o Deep pain (tissue damage): C-polymodal (free nerve
endings
o Heat/cold: Free nerve endings

Figure 2. Diagram of dermatomal segments.

There is a difference between the length of the spine and

length of the cord
o Spine > cord
o There is a difference between a vertebral level and a
cord level
o Cord will terminate at L1-L2, which is important when
doing a spinal tap
In every interval between each vertebral body, there is a
gap where the spinal nerves will exit

B. How We Feel Pain

Unmyelinated nerve endings are preferentially stimulated

(nociceptors)
o If its myelinated, you will feel the pain very rapidly
and very painfully

Impulse travels along the nerve assigned to the area

affected (dermatome)
o Each spinal nerve has a dorsal root ganglion (DRG)
and each DRG is assigned a cord segment

Pain is carried from periphery into CNS by dorsal root

ganglia
o The trigeminal ganglion is structurally similar to a
dorsal root ganglion

The stimulus is passed to clusters of neurons whose

axons cross to the other side of the CNS
o Dorsal horn grey matter and spinothalamic tract
(spinal cord to thalamus)
Second order neuron = where decussation
occurs
The tracts either ascend or descend to cross over to the
contralateral side
o Trigeminal spinal nucleus and tract
The spinal trigeminal tract will cross at the level
of C2 segment and ascend together with the
spinothalamic tract
All of the decussations must pass through the
spinal cord

Figure 4. Spinal trigeminal and spinothalamic tract.

Figure 3. Spinal nerves coming out of the roots.

The tracts terminate in the thalamus, which then

processes the stimuli and relays them to the cerebral
cortex
Lesion at the spinothalamic tract area ABOVE the level of
C2 will manifest as loss of pain and temperature sensation
at the CONTRALATERAL half of the face and body

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C. Pain/Temperature Pathway from the Body
1. First Order Neurons: Lies within the DRG

Dendrites travel within the spinal nerve, passing through

the intervertebral foramen to reach the DRG

Axons from the DRG ascend or descend (more often) one

or two spinal cord segments before synapsing on the
dorsal horn
Axons of nociceptive receptor cells travel 1-2 spinal cord
segments up or down within the dorsolateral fasciculus
(Lissauers tract) and synapse within the second order
neuron within the dorsal horn of the spinal cord

Figure 5. Lissauers tract (Red).

2. Second Order Neurons

Lies in the postmarginal nucleus within the outermost

layer (lamina 1) of the dorsal horn

The second order neurons axons immediately decussate

within the anterior commissure to ascend within the lateral
fasciculus as the spinothalamic tract
Going caudally to rostrally, the spinothalamic tract fibers

are pushed laterally by each spinal nerves decussating

fibers
o Tumor growing from outside = affects outermost
fibers = ascending loss of pain and temperature
sensation
o Tumor growing from inside of spinal cord = affects
innermost tract fibers = descending loss of pain and
temperature sensation (i.e. cervical nerve fibers first
before thoracic, lumbar, and sacral)

At the level of the medulla, the spinothalamic tract

ascends within the reticular formation adjacent to the
spinal tract and nucleus of the trigeminal nerve
o If this is harmed, the patient will manifest with cross
numbness (ipsilateral half of face and contralateral
extremities)

From the trigeminal ganglion, CN V arises and

pierces through the middle cerebellar peduncle of the
pons
o Axons of nociceptive receptor cells within CN V enter
the pons via the sensory root
o Descends within the spinal tract of CN V to terminate
on the pars caudalis of the spinal nucleus of CN V
(second order neuron)
CN IX (petrosal) and CN X (jugular) ganglion
o The dendrites travel within the glossopharyngeal and
vagus nerves, which enter the skull via the jugular
foramen

Both penetrate the brain stem

o Axons of the nociceptive receptor cells within CN IX
and X enter the medulla
o They join the spinal tract of CN V to terminate on the
pars caudalis of the spinal nucleus of CN V (second
order neuron) as well as in the dorsal horn of the
upper cervical cord

2. Second Order Neurons

Spinal Nucleus of CN V

o Pain and temperature

o Decussates in the cervical cord (C2) to ascend as the
trigeminal lemniscus together with the spinothalamic
tract

Divided into:
o Pars oralis
o Pars interporalis
o Pars caudalis
Histologically indistinguishable from the dorsal
horn of the spinal cord

3. Third Order Neurons

The axons of the secondary order neuron synapse with

the third order neurons within the ventroposterolateral
(VPL) thalamus (L for limbs)

Figure 6. Spinal nucleus divisions.

D. Pain/Temperature Pathway from the Head

The segmental innervation of the somatosensory system

of the body continues also in the head

Onion-skin pattern of innervation

o Upper cervical cord and caudal medulla = more
peripheral areas of face and head
o Upper medulla = more central areas (nose, cheeks,
lips)
o Pons = mouth, teeth, pharynx

1. First Order Neurons

1st order neuron: the free nerve endings are the tips of the

dendrites and its soma lies within the Gasserian/

trigeminal/semilunar ganglion (or in ganglia of VII/IX/X)
CN V (trigeminal) ganglion

o Dendrites pass through respective foramina to reach

trigeminal ganglion

Supraorbital fissure: V1

Foramen rotundum: V2

Foramen ovale: V3

4.

The second order neuron cell body lies within the pars
caudalis of the spinal nucleus of CN V, whose axons
decussate at the level of C2 and ascend as the trigeminal
lemniscus

3. Third Order Neurons

Axons of second order neurons synapse with tertiary

neurons within ventroposteromedial (VPM) nucleus of
the thalamus (M for mukha)
Postcentral gyrus
Primary somatosensory cortex
Brodmanns areas 3, 2, and 1
The more important the area, the higher the number of
neurons allocated
o Face and hands have the biggest representation of
the primary somatosensory cortex

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Figure 7. Primary somatosensory cortex and associated homunculus.

E. Pain Modulation

Within the spinal cord: substantia gelatinosa

Within the brainstem:

o Periaqueductal gray of rostral brain
o Periventricular gray of diencephalon
o Reticular formation: nucleus raphe magnus
III. TOUCH
A. How We Feel Touch
General Pathway
1. Touch receptors travel within nerves of their assigned
dermatome
2. Touch impulses travel UNCROSSED to the brainstem and
terminate in nuclei assigned for touch and vibration
3. Fibers from those nuclei CROSS over within the
brainstem and ascend to the thalamus
4. The thalamus relays the touch stimulus to the ipsilateral
sensory cortex and the rest of the brain
Differences with the Pain Pathway

First order neuron always travels upwards uncrossed

Second order neuron is in the medulla

Only the second order neuron decussates

B.

Tactile Pathway from the Body to the Head

This pathway mediates the following sensations:
o Touch (tactile), including

Two-point discrimination

Stereognosis (determine object by touching it)

Graphesthesia (determine whats written on skin)

Pressure (deep touch)
Vibration
Limb position
Limb motion

Figure 8. Arrangement of fasciculi gracilis and cuneatus in the spinal

cord. Note that f. gracilis is pushed medially
by the f. cuneatus.

2.

Each
of
these
sensations
have
corresponding
mechanoreceptors:

Light Touch
o Tactile (hairless skin): Meissner's corpuscles
o Tactile (hairy skin): hair follicle receptors

Pressure
o Merkel discs
o Ruffini endings

Vibration: Pacinian corpuscles

Limb position & motion: muscle spindles

1.

First Order Neuron

Soma lies within the dorsal root ganglion
Axon fibers from the leg enter lumbar/sacral spinal cord
via the dorsal root and are funneled medially into the
fasciculus gracilis (tract of Goll)
Axon fibers from the arm enter cervical/thoracic spinal
cord via the dorsal root and are funnelled medially into the
fasciculus cuneatus (Tract of Burdach)
Fibers coming from the upper body (including the arms)
push the fibers from the lower body medially, leading to
somatotopic organization of the posterior columns
Together, the axons within the posterior columns ascend
to the brainstem uncrossed

Second-order Neuron
Within the nucleus gracilis / nucleus cuneatus
Fasciculus gracilis and cuneatus terminate in their
respective nuclei (nucleus gracilis and nucleus
cuneatus), which lie under their respective tubercles
(gracile tubercle and cuneate tubercle)
Myelinated fibers from each nuclei reach the brainstem,
travel up the midline, and cross anteriorly
o The fibers are now seen as internal arcuate fibers
in the medulla, forming a structure in the midline
known as the medial lemniscus on the contralateral
side
o Lamination of the medial lemniscus (at the level of the
medulla):

Fibers from gracile nucleus are in the anterior

half

Fibers from cuneate nucleus are in the posterior

half

Figure 9. Lamination of the medial lemniscus. Nucleus gracilis is blue

and anterior; nucleus cuneatus is purple and posterior.

At the level of the pons, the medial lemniscus undergoes

dorsolateral rotation
o The medial lemniscus now appears flattened and on
a medial lateral axis
o Fibers from the legs are now more lateral

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Case 2
The security guard at the mall suddenly feels dizzy. You did a
neurologic examination and found that he has:

No sensation of pinprick on the left side of his body

No sensation of pinprick on the right side of his face

Difficulty swallowing (may be problem of medulla)

Answer: Cross numbness (see p. 3 under Pain/Temperature
Pathway to Head)

Lesion at C2 level; CN V fibers have not decussated while

spinothalamic tract fibers have already decussated

Figure 10. Dorsolateral rotation of the medial lemniscus; Laterally

placed fibers from the leg.

3.

Third-order Neuron
The medial lemniscus can now ascend without
decussating to the VPL nucleus of the thalamus (similar
to pain pathway)

C.
1.

Tactile Pathway from the Head

First Order Neuron
Large pseudounipolar cells within the Gasserian ganglion
Axons enter the pons via the sensory root of CN V and
pass dorsomedially to tegmentum of pons
Principal target of light touch for face is the principal
sensory nucleus of CN V
Counterpart of the gracilis and cuneatus

2.

Second Order Neuron

Lies within the principal sensory nucleus of CN V
Main sensory nucleus / principal nucleus
o Analogous to posterior column nuclei of the cord
o Concerned with proprioceptive sensations of the head
o Decussates and joins contralateral medial lemniscus,
which ascend to terminate in the thalamus (ventral
trigeminal tract)
o Axons of these second order neurons travel within the
ascending trigeminothalamic tract and terminate on
third order neurons within the VPM nucleus

Case 3
The fishball vendor suddenly feels his right hand is clumsy and
has right sided weakness of his face, arm and leg. You do a
neurological examination and find that he has:

No problems understanding you and follows what you say

Shallow nasolabial fold on the right

Weak right arm and leg

Walks like a drunk person and teeters to the right

He has lost his vibration sense and light touch on right

side
Answer: Lesion at L and stroke at the medial lemniscus at
the medulla (affected spinothalamic tract). Slight involvement
of the pyramidal (corticospinal tract) tract.
Case 4
The banana-Q vendor suddenly slumps to the ground and
snores loudly. You were nearby and did a neurologic
examination and found that he has:

Very drowsy mental state

Cannot feel anything on left side of face and body (even

with very painful stimuli)
Answer: L-sided hemianaesthesia. Stroke at the R thalamus
damaged R spinothalic tract, disruption of ARAS. Snoring is
sign of decreased sensorium and loss of consciousness.
Corona radiata and internal capsule are affected.
V. VISION
This part is heavily based on sir Pascuals lecture slides:
https://drive.google.com/file/d/0B_x7FtVlOWK_OERzX0VvQjBf
eVU/view
It is recommended that you check the slides while you read the
trans because there are a number of pictures there that may
be useful and the trans might have too much pictures if they
are included as they are part of a pathway.
A.

Figure 11. A more complete somatotopic representation

(homunculus) can be seen for the tactile pathway at the level of the
pons.

IV.

LOCALIZING LESIONS IN SOMATOSENSORY

PATHWAYS
Look at the pattern of the sensory phenomena (e.g., pain,
numbness, etc):
o Peripheral nerve
o Segmental dermatome
o Spinothalamic tract
o Postcentral gyrus

Case 1
Your friend was hurt in a vehicular accident. On your
neurologic examination you found that he has:

Loss of sensation below the umbilicus

o On the right side: cannot feel light touch/vibrations
o On the left side: cannot feel pinprick
Answer: Lesion at R T10

Below umbilicus = T10

Cannot feel light touch on R side = lesion on R side (no

decussation of nerves for light touch pathway)

Cannot feel pinprick on L side = decussation of nerves

How We See
Light and color stimulate photoreceptors in the retina
The visual impulse reaches the retinal ganglion cells,
whose axons converge into the optic disc
The axons continue on as optic nerve
Half of the axons from each eye cross over to the
contralateral optic tract within the optic chiasm
Visual impulses within the optic tract reach the thalamus
The thalamus sends forth optic radiations within the
subcortical white matter, which terminate within the visual
occipital cortex
Summary: Light and color Photoreceptors in the retina
Retinal ganglion cells axons Optic disc (papilla)
Optic nerve Optic tract Thalamus

Figure 12. The ganglion cell neurons and axons that form the optic
nerve.

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B.

Visual Pathway
Sight
o What objects look like
o Where objects are
o These would be recognition and location which are
primitive
The optic nerve exits the orbit via the optic foramen and
unite to form the optic chiasm
Due to the refractive properties of the lenses of our eyes,
the image that falls on our retinas will be inverted
upside down and flipped horizontally:

Figure 13. Image seen by eye (left); image refracted in the retina
(right).

Visual stimuli from the temporal halves of the image fall on

the nasal halves of the retina
Visual stimuli from the nasal halves of the image fall on
the temporal halves of the retina (Thats why at the level
of the retina, visual fields in each optic nerve are
represented as inverted mirror images).
Figure 15. The Visual Pathway.

Figure 14. Representation of image stimulus as received by the

temporal and nasal halves of the eyes.

Blindness can actually root from the optic nerve to the

retina itself
At the optic chiasm, the nasal fibers from each optic
nerve decussate to the contralateral optic tract
At the optic chiasm, the temporal fibers continue on the
ipsilateral optic tract
o Snakes and crocodiles have Ipsilateral Uncrossed
Visual Fibers
o This is actually needed to have front facing eyes
and for eye-hand coordination
o ALBINOS - Do not have front facing eyes (Optic
Chiasm) thus they also have poor eye-hand
coordination
From the optic chiasm, optic tracts emanate from each
side and pass posterolaterally along the surface of the
hypothalamus and cerebral peduncles
Axons of the retinal ganglion cells will terminate on the
lateral geniculate nucleus (LGN) of the thalamus on each
side

Third order neuron: Lies within the LGN

o Sends projections to the primary visual cortex or
cerebral (occipital) cortex (optic radiations a.k.a.
geniculocalcarine/geniculostriate pathways)
o Representation of the field of vision in the LGN

The area of the sharpest visual acuity is

subserved by the macula of the retina (has
large amount of neurons)

This small area is greatly represented within the

LGN and in the visual cortex (seeing sharp
image is very important to us and our brains)
o The optic radiations enter the retrolenticular portion of
the posterior limb of the internal capsule
o From the internal capsule, the fibers of the optic
radiation sweep to the lateral surface of the lateral
ventricle

The more dorsal (parietal) fibers proceed directly

posteriorly, through the parietal lobe and finally
the occipital lobe

The more ventral (temporal) fibers loop anteriorly

over the inferior (temporal) horn of the lateral
ventricle (Also known as the Meyers Loop,
which is the anterior most extension of the optic
radiations to the temporal horn)

Figure 15. Location of Meyers Loop.

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D. Localizing Lesions

At the level of the optic nerve

Figure 16. Location of Meyers Loop in imaging (left) and axial cut
section (right) of the brain.

Superior fibers of the optic radiation pass straight

through the parietal lobe to the occipital cortex

Only the inferior quadrant of the image appears

in the superior (parietal) optic radiations

The superior fibers terminate in the cuneus

Sees the ground and used for locating objects

Inferior fibers must fist loop around the temporal
horn of the lateral ventricle before going to the
occipital cortex

Only the superior quadrant of the image appears

in the inferior (temporal) optic radiations

The inferior fibers terminate on the lingual

(medial occipitotemporal) gyrus
Optic radiations as a whole will have the image
appear as just the contralateral half

o
o

At the level of the optic chiasm (lateral)

o
o
o
o

Figure 17. The contralateral halves.

o
o

Visual cortex: composed of primary visual (striate) cortex

and the extrastriate visual cortical areas
o Primary visual cortex (V1), also known as the striate
cortex

C. Visual Acuity

As previously mentioned, the macula has a great

representation of the visual cortex

While the occipital cortex receives most of its blood supply

from the posterior cerebral artery (PCA), the macular
vision area receives additional (collateral) blood supply
from the middle cerebral artery (MCA)

o
o
o

Damage to optic chiasm AWAY from midline

structures can affect fibers that run through inferior
fibers or Meyers loop
Results to loss of superior ipsilateral visual field
Also known as left superior quadranopia
May result to macular loss of vision

At the level of optic chiasm (central)

Damage to the retina or one of the optic nerves

before it reaches the chiasm results in a loss of
vision that is limited to the eye of origin
Anterior to the chiasm - loss of one eye or
monocular

Damage to the middle portion of the optic chiasm

(often the result of pituitary tumors, pharyngeal
tumors, rathke pouch tumors) results in damaged
fibers of the nasal retina
Intact temporal retina
Resulting loss of vision is confined to the temporal
visual field images from the temporal visual field
fall onto nasal retina
Called bitemporal/heteronymous hemianopia (due
to cut nasal fibers)
Also includes loss of lateral aspect of body space
Brain tumors or problems with the cavernous sinus
Pituitary gland and optic nerves are near

At the level of optic tract

o
o
o

Interruption of the L optic tract results in loss of sight

in the R visual field (i.e., blindness in the temporal
visual field of R eye and nasal visual field of L eye)
Called homonymous hemianopia (in this case, R
homonymous hemianopia)
Pathway was disrupted before the chiasm

Figure 18. Blood supply of the primary visual cortex.

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o
o
o
o

o
o
o
o

At the superior fibers of the optic radiation crossing

the parietal lobe

Results in loss of interior contralateral visual field

Called Inferior right quadranopia
Pie on the floor lower quadrant
Pie on the sky upper quadrant temporal lobe
problem

E. Case
Your girlfriend has a vague headache the past few years, and
recently it has gotten worse. She now tends to bump into
people while walking into BSLR-East. Her neurological
examination only showed this:

Transecting the whole optic radiations

o
o

Similar to transecting an optic tract

Manifests also as homonymous hemianopia

Transecting the striate cortex

o
o
o

Occipital lobe lesion: black pigmentations

Temporal lobe lesion: angel-like visions
Micropsia: objects appear smaller than actual size
Macropsia: objects appear larger than actual size

Results in the contralateral homonymous

hemianopia with macular sparing
Selecting preservation of foveal vision has not
been clearly understood, although this is a common
feature of damage in the striate cortex
Loss of blood supply, PCA was blocked, occipital lobe
lost blood supply but macular area is persistent

Damage to optic chiasm resulting to bitemporal

hemianopsia.
END OF TRANSCRIPTION

TRANSERS NOTE
I got fire for a heart, Im not scared of the dark. Youve never
seen it look so easy. I got a river for a soul and baby youre a
boat. Baby, youre my only reason All my life you stood by
me when no one else was ever behind me. All these lights,
they cant blind me. With your love, nobody can drag me
down. Drag Me Down by One Direction [#PUMPUPSONG
#READTHOSETRANSES]
My heart, your heart. Sit tight like book ends. Pages between
us. Written with no end. So many words were not saying.
Dont wanna wait til its gone. You make me strong. Strong
by One Direction [#GOTTABESTRONGFORTRANSES]
You and me got a whole lot of history. We can be the greatest
team that the world has ever seen. You and me got a whole lot
of history. So dont let it go, we can make some more, we can
live forever.-History by One Direction [Lets make history.]

In the primary visual cortex (Cortical blindness)

o Blindness may not be due to eye damage, but cortical
lesion

Pupils still react to light, but cannot see anything

Patient may experience hallucinations (Optic

nerve is working but the brain is blind)

Results to visual field defects/scotoma

APPENDIX A: Summary of the Lesions in the Visual Pathway

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