Ascending Spinal tracts

Tract	Functions	Path	Decussation	Tests
Dorsal Columns: Fasciculus Cuneatus (UEX) Fasciculus Gracilic (LEX)	Fine touch Discriminatory touch Proprioception	Cuneatus: Fibres from UEX enter at upper thoracic and cervical levels. Gracilis Fibres from LEX enter at lower thoracic,lumbar and sacral levels. Both: Travel between dorsal median sulcus and horn.Terminate at corresponding nuclei at medulla oblongata.	Medulla Oblongata	2 point discrimination Joint position
Spinothalamic	Pain Temperature Pressure Coarse touch	Fibres ascend in ventral half of lateral funinculus. Terminates at the thalamus.	Ventral white commisure	Neuotips Cold tuning fork
Spinocerebellar	Muscle and joint receptors to cerebellum	Cell bodies originate from base of dorsal horn. Fibres pass through dorsolateral and ventrolateral spina cord. Terminates at the cerebellar cortex.	Ventral: Anterior white commisure Dorsal: No decussation	Joint position test Finger to nose Heel to shin

Brain Structures

Brain structures

Structure	Function	Blood Supply	Symptoms of dysfunction	Tests
Cerebellum	Motor coordination, precision and timing	– Superior Cerebellar art. – Posterior Inferior Cerebellar art. (PICA) – Anterior Inferior Cerebellar art. (AICA)	Dysdiadochokene.. Ataxia Nystagmus Intention tremor Slurred speech HypotoniaWide based gait Imbalance/toppling forward	Rapid alternating hand Heel-to-shin Finger-to-nose
Midbrain	Control of eye movement and localisation of sound (with pons)	Of Basilar art: – Posterior Cerebral art.– Superior Cerebellar – Posterior Communicating art. – Anterior Chorodial art.	Ipsilateral CNIII palsy – weak lateral gazeContralateral hemiparesis	‘H’ test Motor testing
Pons	Regulation of breathing, sleep cycles, arousal, relaying info between cerebellum and cerebrum	Pontine branches of Basilar: – Paramedian Branches – Short Circumferencial art. – Long circumferencial art. – AICA	Ipsilateral medial strabismus Contrlateral hemiparesis	Observation and ‘H’ test Motor testing
Medulla Oblongata	Regulation of breathing, digestion, sneezing, swallowing, heart and blood vessel function	Anterior spinal artery: Hypoglossal nerve, Vagus nerve, median longitudinal fasciculus (MLF), pyramids, medial lemniscus           – – – – – – – – – – –   PICA Spinothalamic tract Nucleus ambiguus Hypothalamic spinal tract	Medial Medullary syndrome Ipsliateral tongue deviation Contralateral hemiparesis Contralateral reduced discriminatory touch Contralateral reduced proprioception Contralateral reduced vibration sense – – – – – – – – – – –  Lateral Medullary Sydrome Dysphagia Dysarthria Dysphonia Ipsi. Reduced facial pain and temp Ipsi. Horner’s syndrome Ipsi. Cerebellar symptoms Contra. reduced body pain and temp Vertigo Vomiting	Protrusion of tongueMotor testing 2 point discriminatory Joint position test Vibrating tuning fork           ——————   Observation Further questioning Neurotips Cold tuning fork Ptosis, Miosis etc DANISH