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Spinal Cord Dr Fiona Sutton St George’s Hospital LondonAscending& DescendingSpinal PathwaysDescendingMotor Pathways DescendingMotor Pathways Corticospinal Tract Voluntary Motor Reticulospinal Tract Locomotion, Postural control Tectospinal Tract Reflex head movements Vestibulospinal Tract Posture & balance Pyramidal Corticospinal Tract Voluntary Motor Non-pyramidal Reticulospinal Tract Locomotion, Postural control Reflex head movements Vestibulospinal Tract Posture & balanceCorticospinal T ract • Major voluntary motor pathwayCorticospinal T ract = Pyramidal TractReticulospinal tract • Locomotion & postural controlTectospinal T ract • Reflex head & trunk turning to visual or auditory stimulus • Originates in tectum of midbrain from superior & inferior colliculiTectospinal T ract • Reflex head & trunk turning to visual or auditory stimulus • Originates in tectum of midbrain from superior & inferior colliculiVestibulospinalT ract • Maintenance of balance via anti- gravity musclesUpper Motor Neuron Interneuron Lower Motor NeuronComplete / T ransverse Spinal CordlesionTransverse Myelitis • C5-C7 • What clinical findings? • Motor • SensationDecussation • Why?Somatic twistAscendingSensory PathwaysAscendingSensory Pathways Anterolateral Pain, Temp, Crude touch Dorsal Column-Medial Lemniscus Position, Vibration, Fine touch Cerebellar ProprioceptiveAnterolateral system Pain, Temp, Crude touch • Spinothalamic • Spinoreticular • Spinomesencephalic • Spinotectal • SpinohypothalamicAnterolateral system Pain, Temp, Crude touch • Spinothalamic → Thalamus → Cortex • Spinoreticular → Reticular formation (arousal) • Spinomesencephalic → Periaqueductal gray matter & midbrain raphe nuclei (pain-inhibiting system); Amygdala (limbic system) • Spinotectal → Superior colliculi (reflex turning towards stimulus) • Spinohypothalamic → Hypothalamus (autonomic & endocrine response)SpinothalamicT ract Pain, Temp, Crude touchSyringomelia Central CanalDorsal Column-Medial Lemniscus Position, Vibration, Fine touch • Fasciculis cuneatus (T6 & above) • Fascululis gracilis (below T6)Dorsal Column-Medial Lemniscus Position, Vibration, Fine touch • Fasciculis cuneatus (T6 & above) • Fascululis gracilis (below T6)Cerebellar Subconscious proprioception • Anterior (ventral) spinocerebellar – trunk & lower limb • Posterior (dorsal) spinocerebellar - trunk & lower limb • Rostral spinocerebellar - head & upper limb • Cuneocerebellar – neck, upper limb, upper half of trunkCerebellarAscending Sensory Pathways Anterolateral Pain, Temp, Crude touch Dorsal Column-Medial Lemniscus Position, Vibration, Fine touch Cerebellar ProprioceptiveHemicord SyndromeAnterior Spinal ArterySyndrome• All columns accept Dorsal columns involved • Motor paralysis • Loss of pain & temp sensation • Preservation of fine touch, vibration & proprioceptionCauda Equina • L2 down Cauda Equina • Lumbar disc herniation • Severe back pain • Perineal sensory loss (saddle anaesthesia) • Bowel & bladder incontinence • Leg pain • LMN leg weaknessQuestions?