CN

REFLEX

I
MONO SYNAPTIC REFLEXES

REFLEX It's Rapid

involuntary Stereotype Motor Response to a specific Stimulus 1) Stretch-Reflex/ Deep tendon Reflex
·
: a .
sensory
-

.
, , ,

detecting
REFLEX ARC : -This Receptor organ
·
is anatomical nervous
pathway
to produce Reflex action . => :- Muscle Spindle ,
for ,
the
change
in Muscle
length . Ms-Spindle is a
proprioceptor

I components : 1) Sensory receptor : -site

of Stimulus
. ⑧

flex mediated
by Ms .

Spindle = Stretch
Reflex/ Deep Tendon
Reflex

2) Afferent/sensory pathway ·
&

&
pouse 11 11 11 11 = Ms. Contraction .

3)Integration centre : -

part of CNS ,
can be cranial or .
withinSpinal Cord (Root value) ·
Emulus -Mild-Moderate
:

stretching of the muscle

2) Efferent/Motor pathway => Ms-Spindle Structure -> I t is a

receptor organ ,
It is a
proprioceptor (detects position
of Body)

5) Effector -
Muscle or
gland . >
It is a connective tissue
capsule ,
made up
of 2 intrafusal fibres

i Nuclear
Bag fibres (few not s
Spinal Lord
TS .

of Posterior median Sulcus

2) Nuclear chain
fibres (more
&

Posterior median Septum

> Nuclear
Bag fibres
made
up of central dilated portion filled w/ Nuclei

& D
Posterior (Dorsal) < >
Dorsal
Grey Column [Post-Horn] whereas Muc chain
fibres are thinner , slimmer Eshorte and attached to sides
of .
Nu
Bag fibres
.

↑
~ Funiculus
Lateral
~ white Column >
Grey Column Location
belly of Muscle,
=> : -
within the

·
Lateral
funiculus
G
> Central Canal S-Efferent

trioventralCommissure Ant White Comissue

> Ventral

Anterior
Grey
median
Column

fissure -

·
-
&

Dorsal Nerve
Root
(Sensory M

Plate
A

DNG endings
>
-

D
&
--
flower spray ending

~
Nerve
Spinal ,

in-
~

Ending
-

trail
[

.-
-

S
& -
> Ventral Nerve Root
(Motor)
msf
·

=> Ms spindles are in parallel with

extrafusal ..

·
Components of Reflex Sensory Receptor : -Site of Stimulus The
Intrafusal msf of Spindle are the in parallel with Extrafusal Ms .

f.

② Afferent) sensory pathway => There is a

difference in Visco-Elastic
property of different portions of Intrafusal Ms .

Fibres
.

Value
Root
③ Integration Centre :
-(part of CNS ,
within Brain or Spinal Cord) => Central Receptor portion of If ms .

f .
is
relatively less Contractile ,
but peripheral portions more contractile
relatively
.

④ efferent/motor path
way
.
⑤ Effector : -
can be
muscle/Gland
. => Nerve
supply of Us-Spindle

Receptor Interneman
① sensory supply
---SYi↑
=
=
- :-

sensory

-&- y
I mat
a

-
>
=> Primary/Annulo spiral N .

endings :

2S
1
These the termination
Conducting myleinated type Ia fibres
of Rapidly that wrapped spirally around
~

⑧
are are
,

both The Nuclear

bag & Nuc -
Chain
fibres
=> flower
spray endings Secondary Endings
#Classification of Reflexes
:

- ·
these are terminations
of type a
fibres ,
that
just supply Nuclear chain
fibres .

I
g
a) Inborn Reflex (Unconditioned Reflex) ,
eg
: - Salivation
after putting food in .
mouth ② Motor
supply :-

(3-6u)
6) Acquired Reflex (Conditioned Reflex) ""thought It is
by they of lesser diameter Ra Small Motor Nerve System
·
r-motor neurous Sor-motor
eg supply
: are n .

, <

II depending the location

of Integration Centre I
types of histological endings >Plateendings and trace ending
one
on
they have
. · -

(Nuc-chain fibres)
9)Ganial Reflex -eg -light Reflex : :
,
Accomodation
Reflex -
>
Mid Brain

Corneal Reflex Conjuctival Reflex

, >
-
Pons => Stimulation of Ms .

Spindle

6) Spinal Reflex : -

eg
:-
Defecation and micturation
Reflex-S2/53/Sy If When the central receptor portion of If fibres of M .

Spindle is stretched (wild to moderate)

Plantar
Reflex-Sc/ss)Sy it is ka Spindle
loading ,
it leads to Ms .

Spindle Stimulation.

triceps Reflex-CC ( 2) When the whole muscle contracts

,
the stretch of effibres is
gone Kla Spindle unloading
.
# No .

of synapsis 3) Muscle contraction

(Elf fibres) leads to spindle unloading beco2 If fibres are located parallel to
Elf fibres
cranial
2) Monosynaptic Reflex : -
THE STRETCH
REFLEX-eg : -

Tricep Bicep Supinator

, , ,
Knee ,
ankle
, -Jerk and that too in the
belly of
the muscle.

2) Bisynaptic Reflex : -
One interneuron tut ,
eg
: - Inverse Stretch
Reflex and Reciprocal innervation & Recip .
Inhibition => Mechanism
of Ms
. Spindle Stimulation/Spindle loading
.
Ref
3) Polysynaptic Reflex many :- interneurons ,
eg
: PlantarR ,
Withdrawl R ,
Crossed Extensor B
1) By mild-moderate
stretching of
SK-ms
,
bouz
If unsf of m .

Spindle are -ut /ll to

Elf mof. of Skeletal Ms
.

* D
I Clinical Basis =>, hence the
stretching of Ms . leads to stretch
of If ms .

f ,
which
further leads to
Stretching of Central
Rec .

portion

1) Superficial Reflex :- Stimulus applied

superficially
on
skin/mucous memb.
of Spindle which leads to
,
Ms .

Spindle
loading ,
hence Ms .

Sp . Stimulation

eg Conjuctival
=>
Plantar R
.
,
Corneal
Reflex and Muscle
stretching done
by :
-Tapping the ms .
tendon
w/ hammer in Clinical
setting while
eliciting deep tendon
Reflex
2) Deep Ra External
Tendon
Reflex > -
,
Stimulus applied to Deeper Structure (like muscle/tendon) Stretch
of the muscle .

>
-

They are all

monosynaptic and Stretch
Reflexes 2) through X -
motor neurons .

>
-
eg : -Biceps , Triceps ,
Ankle
, supinator, Knee
ferk
 I
relatively
2) via r-motor neurons : -the central portion of Ilfusal ms .

f .
is Non-contractile ,
but peripheral portious Contractile .

2) Root value
of deep tendon
Reflexes help us know the level
of Spinal Cord lesion + on Clinical examination

=> the r-mu

supply peripheral portions ,
r-mn Stimulation leads to Contr
of peripheral portion of If . ms .

f. finding that
Reflex is tuff-ut helps the
Neurologist.

= the central portion

gets stretched , Ms .
Spindle gets loaded ,
leads to stimulation
of fibres . 3) All Deep tendon
Reflexes Below level
of lesion ,
get exaggerated/hyper active (dIt loss of Inhibitory higher Control),

=> Stretch Stretch

through
U-mh is Internal
of Muscle hence show the features of UMNL

[x-mn directly supply Elf fibres] u) Helps in

differentiating UMNLfLMNL

=>
Grading of a
Reflex
-
:

# Stretch Reflex :
Monosynaptic Spinal Reflex Grade o
Completely absent
reflex excitable
-

not
- ,

Contraction
>
-
When a muscle with its intact nerve
supply is stretched
,
it responds
by .

Grade I
Reflex becomes slower ,
delayed ,
Elicitable I
difficulty
.

·)
Stimulus : -Mildo
stretching of
SK-Ms
Grade 2
Normally Normally optimally
moderate . +ut Brisk
>
-
, ,

Receptor Organ -Musc Spindle (Very very

:

Grade 3 , Reflex becomes

hyper excitable Exaggerated Reflex
, Brisk)

↑
Outcome : -Muscle Contr < Clonus-most
Grade 4 appreciated in Knee & Ankle Reflex.

↓
Eg: -
All the deep tendon Reflexes (Biceps , triceps Supinator
, ,
Ankle
, Knee]
a
+ Clonus:-Rapid ,
Rhythmic Regulart , Repeated Contractions of Ms . In response to a
single stimulus or even to

Mild to moderate
stretching of skms
leading to Ms-spindle Stimulation a sustained stretch of the limb .

Contractions
Jerky
>
-
are

repeated feudt Baked of .

leg
inyleinated offerent fibres (Ia and /or
movement

fibres from NucBag &

of rapidly Conducting NucChan
summation Best appreciated in
Reflex t
a
>
-
Knee ankle
Reflex

Pendular
* movement
of Reflexes .

Central portion via

Repeated ,sow,Oscil atorymovementtyarethe classicalfeatureof Ceubellalresions.
of nerve fibres enter Posterior Root Post
Grey Column ,
then Anterior
grey
Column
, Reflexes Become a
pred
se

and
forms a
straight single synapse with the X-mn
supplying
that same muscle

Stimulation of X-motor neurons

Efferent/motor fibres from X-mn

supplying the Skeletal Muscle lead to Contraction
of Ms
.

i-e-contraction
of the Extrafusal Musc .

Fibres .

=> X-r Co-activation and

Damping Mechanism : -

C an
Muscle contract thre the activation
of directly by receiving the Continous
facilitatory Signals
·
X-mn

But the
intensity of Signals keep fluctuating
,
Hence
may
become
Jerky ,
but this can be made smooth

SN
& mon-Jerky by X-0
Linkage
·
X-U
linkage : -
It is the coactivation
of r-mn
along the X-mu . It keeps the r-mn stimulated which
further

keeps the ms-spindle loaded t Stimulated .

Hence make the Ms-Contraction Smooth Thus . a
Damping Mechanism
.

U-motor
discharge beted
by : -1
) king the
descending facilitatory discharge from Brain(Higher Centres the X-mu
·
can .
over .

2) Painful stimulations

3)
Anxiety
u
) Tendressik's
)

Manuveur/Reinforcement :-

-
It
may
make elicitation of Reflex Better
by Fing r-mn
discharge

>
-
Ask subject to hold the
fingers of one hand , I
pulling them
apart .

>
-

Clenching the teeth

.

=> Dynamic Response of Ms .

Spindle

·
there is Red
offerent sensory discharge from ms .

Spindle esp .
Nuc .

Bag fibres when the Ms is

Suddenly/ Rapidly Stretched .

=> Static Response of Ms .

Spindle :
-

red
afferent sensory discharge from spindle (N cainf) when is
slowly stretched/sustained Stretch
·
m .
.

,
mo.

=>
functions of Muscle Spindle :-

1 It mediates Stretch
Reflex and hence
brings ms-contraction
.

2) It helps in maintenance of Muscle tone (Partial Ms-Contrh) sitting

(standing
↑

,
run
, , Walk etc)
M

Boz it contraction it t all e

activities
Voluntary
3) helps in helps in movements
us
,
Voluntary ms

4) Helps maintaining the position + posture

of body
.
# Cinical Applied : -

(Cs Co)
1) Root value
of deep tendon Reflexi-al Biceps , al Knee gerk /Ls ,
Lu , 23)

6) triceps (Co G) , 9) Ankle

Jerk (S, S2) ,

↓ Supinator (Co , G , (8)

 I
Reciprocal Inhibition & Reciprocal Innervation

BISYNAPTIC REFLEXES
·Bisynaptic
Spinal Re

Golgi-tendon Organ and Inverse Stretch

Reflexes on
agonistEantagonist muscle but the outcome
of Reflex is dependent on a action of Antagonist muscle.

Golgi tendon is
sensory receptor organ which is
Encapsulated It is like collection
of knobby
nerve endings
When the
agonist Ms Contracts
Simultaneously Antagonist Ms Relaxes of the side , this is Ra Reciprocal Juhibition
·
a ,
.
a net ·

,
.
same

present in the tendon of Petal mude ,

tut in the series with the Extrafusal Muscle
fibres .
·
The Julibition
of Antagonist ms . occurs
by Phenomena of Post
Synaptic Juribition mediated via
Bisynaptic Reflex

·
The
afferent fibres of Golgi tendon
Organ are : -

Rapidly Conducting myleinated type If fibres ·

The Neuronal circuit used to describe the Reciprocal Inhibition is called as Reciprocal Innervation (postulated by Sherington)
·
Stimulation : -

>
Increase in Muscle Tension (dIt active Contraction
of the
Ms) hence also called as
Sherington Law
of Reciprocal Innervation .

a
stretching of Ms much
of stress is taken
by Elastic
fibres of Skeletal muscle.

FanorE
> Severe the as the

ton
.
-

ms Spindle
Protagonists
.

Response -Muscle Relaxation of golgi bottleintermuron (GB T

· :
>

Inverse Stretch
Reflex/Autogenic Juribition
.

X
X-mn
of antagonist muscle

-
1/

i
I -
~
-
I

Bisynaptic Reflex Receptor Organ -Golgi tendon Organ Response : -Ms-Relaxation

: . I
>
-

, , I

[
· .
antagonist
mo

·)summon
a
homL Reflex Arc: Afferent fibres from of Agonist (travel fibres
mela, => Ms Spindle Muscle via Ia Ea
one arise
-
·

,
cine
Inhibitory intermediate >
cly
I
-

a Collateral
X-Anterior motor nemou Enter Post White Column after that arises
from these
offf they form 1st
Synapse
s
·
-
.

,
↓

I with Interneon GBN

(Inhibitory) it releases
Glycine (inhibitory NT)

and
-By Use in Muscle tension or severe
stretching of SK-ms ,
causes stimulation of Golgi tendon
Organ · It
forms synapse with X-mu in the Art .

Grey matter ,
supplying the antagonist Ms

Stimulation of rapidly Conducting myleinated offerent fibres (type It) Juhibits it & causes Relaxation
of Antagonist Muscle

Afferent f . enter thre postr root . Postr .

Grey
Column , + then enter Antr .

Grey Column . => function/disadvantage - I t : leads to relaxation

of antagonist Muscle
simultaneously when
Agonist me

It
forms 1st
Synapse wh the interneuron which is an
inhibitory i/nemon ,
releases NT : -
Glycine Contracts , hence helps in locomotion , there occus
find movement
of one limb Backed of Other (Both having Separate Reciprocal I .

gud
the interneuron
forms the
Synapse i the X-muJuhibits it

Motor/Efferent fibres from this X-mn causes relaxation

of Same SK-Ms
.
SND
Reaction
#
Lengthening
=> Functions of Golgi T O.: -1) It leads to Muscle Relaxation This is the
physiological Name
given to the Response of Sk/Ms to it's
lengthening stretching done
passively
·
or
.
.
a

2) It makes Contraction Smoother in the Ms activities where Resistance is

offered by sk/Ms
the
especially
in response to
stretching
Ms . . ⑧

rapid
switching is required bw the
flexion and extension
eg
:
-running
.
=>
Physiological Basis :-

3) It helps in
Equalizing
the distribution of Contractile
force among diff gp of .
SK-ms
fibres On
passively flexing the arm ,
initially during flexion tricep gets stretched
, ,
Stimul
leads to
of Stretch
Reflex in triceps

u) It helps to protect the muscle

Segment which
hyperactive by causing Relaxation .
its leads to contract"
of triceps which further opposes passive flexion of Arm

when tricep Contracts ,

its Ms-tension tes , causes
Stimulation
of the Inverse Stretch
Reflex in triceps

Triceps Muscle Relaxation , at this time we will be able to do passive flexion ,

it won't be opposed

Resistance to
=> Hence the passive movement is tut in
Beginning t at the end
of passive movements
.

Such
pathological Response is seen in the action
Spastic
of muscle when spastic ms is
flexed passively & is seen in case
of UMNL
.

especially
in
Pyramidal tract lesion Here .

only one
group of Muscle is involved either
agonist or
antagonist.
This whole
of Ned Rigidity in Spastic Muscle is Kla Clasp Knife Rigidity /Effect (Response similar to
Closing Clasp Knife)
·

response .

Lead Pipe
=>
Rigidity :
1) Seen in Extra
Pyramidal tract lesion

Both
2)
Agonist &
Antagonist involved

3) Resistance to passive movement of limb is the

throughout the
Range of movement
.

Parkinson's disease
=>
Cog-wheel Rigidity -1) : Seen in

2) Resistance to
passive movement and
Rigidity
tut interrupted w/
 ⑫

I
POLY-SYNAPTIC REFLEX 5) Mass
Reflex
1 ) Flexor
.

Reflex and Withdrawl

Reflex .
>
-
Seen in Chronic Spinal animal

It's
>
- When a
noxious/painful stimulus
applied to
skin/sub-cutaneous Tissue/Muscle (not Spindle), >
-
stimulated in Response to a minor noxious stimulus

>
-
Response = Contraction
of Agonist Muscle and
This"/Relax" of Antagonist Ms of
simultaneously Ipsilateral Side -
during the execution
of this
reflex , Spinal Cord becomes
hyper excitable .

>
-
As Result
a
, Ipsilateral limb is
flexed and withdrawn
away from
noxious Stimulus ( : Protective
Reflex) -
Whenever
offerent f arising
-

dit minor stimulus , enters the spinal Cord

,
impulse travels
up down

>
-
The Phenomena of After discharge O bserved
is various
segments of Spinal Lord

After Discharge : -Motor

Reflex Response still remains even
after the Removal Stimulus
. >
-
It involves multiple somatic neurons
supplying
SK-Ms
,
also involves Autonomic centres
having
Greater of After discharge Autonomic
strength of
Stimulus Greater
the duration
supplying
,
the . motor neurons various Smooth .
Ms

>
-
Impulse irradiates to the other /g of Spinal Lord (involves Somatic & Autonomic
Segments)

⑳
i
&
Y
Leads all
Flexor widespread features
Contr
>
-
to
of SK-MFSM-Ms of body ,
hence the :-

&↓- I
and
Reflex
S ( 1) whole into
flexor (dlt couth
of SK-Ms)
· body goes spasm

-
· Crossed

&
I
I
& Extensor (SM-Ms
(t)
2) Extreme Vasocons Contraction
of Blood
Vessels) >
-
palor of Skin

Reflex

Fear
- (+) 3) 111 of BV : -Use in BP( > 200 mmHg)

h Mo
&
Do
·

&
↑ u) Reflex Urination , Reflex defecation

S ·
S X Extensor My
outralatual
Side) 5)
Extreme
SweatingHyperhydros(dinnuvation
of Symp .
Nerve
sap to
Ipsilateral Side)

Bladder
>
-
Other Stimuli- Overdistention
of or Bowel

2) Crossed Extensor
Reflex >
-
Intentional Mass
Reflex : -

by stroking inner
thighs ,
to Control urination , defecation
It's
Polysynaptic Reflex be initiated
by
Chronic
paraplegic
·
a > can
.
persons
-

· It occurs in Response to
very noxious stimulus and a Protective
Reflex
There Contraction
occurs
of Agonist Ms and Relaxation of Antagonist Muscle
·
.

whereas there occurs Cout"

of Extensor/Antagonist muscle & Relax"/0 of flexor ms

on Controlatual side .
Hence the Affected lime is
flexed & withdrawn
away
but also

extension occurs on other side which helps to maintain posture & protects from falling down

After
·

discharge plenomena Observed

is (Explain here tool

Duration
of " is much more than
flexor Reflex ,
we use in
Strength of
Noxious Stim

·
Impulses from aff
the . Stimulus ,
irradiate and travel to
multiple Jute Neuron from Ipsilatuary to
Controlatual 1 of Spinal Lord

③ Plantar Babinski'sSign
Reflex and

Polysynaptic Superfic Reflex

,
. .

slightly painful stimulus on sole

of foot , from Heel to lateral side
, upwds to little toe &
medially
to
Bigtoe . Response = Plantar Flexion of Big toe & adduction of All toes
.

Planter
Normally present in Normal Rf S, So
·

person
=

·
In LMNL : -Absent

Babinski's
In UMNL
(normally If Reflex-nt) But here
sign
·
:
.
-

=> BABINSKI's SIGN : When above mentioned

Stimulus applied ,
Dorsiflexion of Big toe , Abduch/ faning of All toes

-Physiologically tut in
Infants
-

↓
,
in sleep ,
in
Chayn Stock's
Breathing
in
Hypoxia
aren't
desc .

Pyramid . tract

myleinated (till 21 yrs)

Pathologically tut in UMNL

(eg -Pyramidal tract lesion)
: and once
appears ,
remains
for life
(Patho
these patients can'tR un
I walk
longer or
faster

4) Magnet Reaction / + ve
supporting Rxn

>
-

Occurs in Chronic Spinal thimal ,

When a
finge is placed on sole
of foot or
slight
P
applied on foot pad

of animal ,
there occurs Contraction
immediate
of Ms
of Limb (Both Agonist and
Antagonist Ms)
: Limb is Converted to
Rigid Pillar

animals can't
>
- these stand ,
Unsupported But with this
Reflex they can be made stand unsupported

may
be
awkwardly &9-3 min duration be
.
may
~

Phen
>
- when stimulus removed , this Response disappears ,
also an active Phenomena ,
this is-we
Support

during this time limbs can be used

for performing other activities
.
 Stampg
gait the person raises
leg v .

high and bring down then

Cerebellar ataxia - incoord movements even wh
eyes open
stamping forcefully we hel first kclosed
CdIt loss
of
.

sens

I
Lesions
of Dorsal Column tract

TRACTS
.

oflesion .

① The tract is
completely uncrossed in scord there occurs loss
of sensation on same side
of body ,
same as side

in CNS

·
Tract is a collection
of Nerve fibres within CNS ,
connecting various masses
of Grey matter 2f the tract is uncrossed in SC ,
if lesion I tumor tut
medially ,
there'll be loss
of sensation from lower seg)[and
Collection
of fibres Origin Seg(T C)
,
termination .
· Nerve with same ,
course f if """
laterally
, 11 "11Il Upper

# CLASSIFICATION 3)
Sensory Ataxia -Inco-ordination :
of movement
(ataxial if it occurs
during eyes
closed it means

2) Ascending Tracts :-the fibres .

ascend
from Sp . C and terminate in Brain it is
occuring due to loss
of general sensation :
-Sensory Ataxia .

2
)
.

Descending
Tracts - start
from periphery ,
ascend
from SC ,
end in Brain
. =>
Romberg's Sign/test :
-Inability to maintain
standing upright unsupported Balanced position and , , ,
feet together

fibres originate in Brain ,

descend down terminate at various levels in Sp C
..
w/
eyes
Closed this is
Romberg's + ve due to loss
of sensation

#
Classification of Ascending tracts
. 2) Stamping Gait : -while walking , person raises leg very high &Bringing
it downward

1) Post/Dorsal Column tract

Stamping forcefully or the
floor with the heel
first.
Lateral

2) Spinothalmic Tract , Anterior

- Aut

3) Spino Cerebellar tract-Post # Spino thalmic tract

4) Spino-tectal It's Stypes-Lateral ST tract

Sensory Ascending
·
tract (located-lateral White Column)
,

5) Spino-olivary >
-
Anterior ST tract (located =
Anterior white Colmu)
Post (Dorsal) Column tract

) Spino-reticular
[fasciculus Cuneatus
6 Fasciclus Gracilisp ·
Sensations Carried -
Lateral StT : -

Pain and temperature

Ascending) (Descending)
Anterior StT: -crude touch ,
crude Pressure
,
Sexual Sensations

~
Dorsal Spino Cerebellar Lateral Corticospinal Cerebral
(Somatosensory area)
T

>
. Cortex

i
-
> Rubro SpinalT.

&
> 30 Neurons in Thalmus
(VPL)

IOlivospinal of SC /Substantia Gelatinosa)

°
· 2 Neurons in Post Column

&
!
.

=
Reticular -Lateral

--
~
⑨
7 /101 DRG
e
"

Vestibulo Spinal
·

>

Ifibres
spinal

a -
"Medial Reticulo

Tectospinal /
D
from various
rec]
Ventral Corticospinal satualec
Anterior Spinothalmic

=> Dorsal Column tract- 2) Post-White Column

Ascending tract located in .

2) It remains uncrossed within Spinal Cord this tract

completely
·
is crossed within the spinal Cord

Static Perception of
3)Sensations carried
if fine touch 6) Position Sense(orientation of · COURSE 1 )
.

Neurons are Dorsal Nerve Root

Ganglia (DNG) their Peripheral process will
carry
above
diff Body parts .

2) touch localisation 7) Conscious Kinesthetic sense

(movement of diff B parts Of .
mentioned sensations
from Periphery
. Central processes
pass thre Post Nerve
Root & enter tip

muscles)
3) touch discrimination of Post
Grey Column
,
Proprioception

4) Pressure Sensation
they form
In Post Colum &Neurous Substantia Gelatinosa
8) Stereognosis 2) Grey + ut in .

(ability to
Object by
identify
touch w/ eyes closed)
5) VibrationSense 3) Axons of So Neurous pass thre
Grey f
Commissure crossed to opposite side

4) Course : -Peripheral and Central processes

of DNG
carrying above sensations and enter the white matter column
.

pla Psuedo Unipola

enter S Cord
. thre posterior Nerve Root ,
this is 1st
degree Neurons => for Lateral STT +

preferably fibres cross within same spinal segment

and reach Lat
WC and

Cerebral Cortex
lat STT
Enter Post-White matter
of S cord I start
ascending up
three Spinal Lord ascend as

post a
-
.

unrale
a

↓ while
ascending tract remain uncrossed
. => for Anterior STT - fibres may ascend 1-2
segments and then cross to opposite side ,

- >
-
Fibres from lower
segment (sacral ,
Luntar , Lower
thoracic) lie
Medially enter anterior WC and ascend as Anterior STT.

F. from
⑧
O while
ascending As the
fibres lower lie
laterally
in tract while
ascending
*
cross
segments up
:

I (T
UPLEVPMThalmus ,
2,
5)
(3o namous
Mid-B
fibres
from upper Segment (Cervical .

, Upperthoracic) lie
laterally "Upper (andTp) lie
medially
III 11

( (
Medial
>
eminiscus eNGANC
pom
>
-
Fibres enter medulla ,
they for synapse
and
with
Degree Neurons 3) These
fibres start
ascending
to /medulla , pous ,
Midbrain] Brain Stem .
Collaterals from

-Nu
I
12 Neurons)
Nu
gracillisE
. Cureates
Ra Nucleus Gracillis
(medially) Nucleus Cuneatus
(latually) these
fibres also enter into Reticular activities

I
.

l
Medul
sing While
passing thre sc medial
of fibres Fasciculus
gracillis Readlamic 6) Now and wh
syndrome they Thalamus like VPLN
>
-
,
gp - enter in
Synapse 3 Neurons
,
MN ,
ILN
,
SRN

gp of fibres
latual >
-
Fasciculus cuneatus

-pathway (Ventro-postro Lateral Specific Relay Nu

Midline Nuc , Intralaminar N
Dorsal
Column
, ,

-gra
>
-

Fun

&E?*
Neurons

-
-- 7
inDN
/of Termination : -3 terminate in Somato Area I Post-Central Cerebral
Axons
2°
of Neurons Both Nucleus) cross to opposite site this constitutes
Sensory
located in
Gynus in
·
axons
~
>
-
,
Cortex

Sensory Decussation .
And After
crossing in medulla ,
fibres ascend => Lesions of Spinothalmic tracts

and pass Brain

S tem Now called Medial eminiscus 1) Stous it best of body of Spinal
through carried
by o n side that cord
. as . are as

-
they're joined by extra fibres from Spo Nuc .

from EMNerve (sens" from face) 2) Lesion on medial of tract ,

sensations lost
from per segments

>
-

Synapse u/3rd degrees

they Neurons =
VPL & VPM (Ventral Postero lateralt medial 11 "lateral I 11 Il
Lower segments
nuclei
-

in thalmus
SNA
3) Dissociate Anesthesia and (ouch sens)
Syringomylia
: -Selective less of pain and temp sense but intact

>
- Axons

Somatic
of 3 Neurons reach the cerebellar Cortex

Post central
& terminate in the

&ia -
Classically seen in
Syringomyleia
: -Cavitations
surrounding
Central Canal

Sensory
Area I in
gyrus damage to grey comissure occurs

>
-
fibres of tract while
crossing , pass thre grey
comiss .
are
damaged ,
hence thin loss
DCT

>
-
whereas Dorsal Column tract is spared
(initially -
touch sens"
of it are intact
.

>
-
but later on as size
of Cavitation Yes ,
may
involve DCT
,
thus loss
of touch in later

stages
 I
#
DescendingTracts
Controls movement
of Distal gp of Muscles ,
ie-

1) pyramidal tract finet still movements

,
eg-drawing play guitar
,
.

.) Extrapyramidal tracts
2 > 1) Rubrospinal 4) Medial/Pontine Reticulo spinal
(Control movets of
proximall axial ) .
us

2) Olivoin 5) tacto spinal

nee maintaining
in a

3)
Lateral/Medullary Reticulo Spinal 6) Vestibulospinal (Latual Vestib .

Nuc

Photos
1) Pyramidal tract aka
(Corticospinal tract
CEnlarged at the
end)
·
Desc .
Motor
tract-Stypes -
Lateral CST (tht in Lat white
matter) I
control distal gp of muscles

Control axial muscles

>
-
Ant/Ventral CST) Aut White Column)
+

pre-motor
Originates from Cerebral Cortex Fibres from 1 Motor Cortex 30 %
-Supplementary
40 % Somato
·
301.
sensory
>
-

,
area
, ,

and also some from parietal Cortex as well

- of total (60um)
- f. Some Cortex are
of 16Um
(large diameter) originate from ,
BIG Sized
Pyramidal/Betz allo

LMNL UM NL
they are
rapidly conducting fibres

I
of fibres slowly conducting fibres
Neuron
directly supplying the
Ms : LMN these
Regulate the LMN = UMN
· ·
> 97 %
-
rest are

·
Course 1) Descend down called as Corona Radiata ①

Single/Individual Musc .

affected ·
Group of Ms are
affected
.

Muscle tone Led Muscle tone Ted

2) Pass thre
Posterior limb of Hypotonia Hypertonia
·
Internal packed
·
Capsule & densely
= =
.

3) Desend thre Brain Stem (thru crus Cerebri

of Midbrain , pons , enter upper part of Medulla
·

flaccid Paralysis of Ms occurs

· Spastic Paralysis (w/ Ted
tone) occurs
.

n) Here
forms Swellings R/a Medullary pyramids ,
while
passing thou lower part
of Medulla 80 %
f. cross to opp side Muscle
wasting/Atrophy occurs ·

wasting of Ms not appreciated

.

Babinski's Babinski
and enter latual white Matth
of SC -
Descend down as Latual CST
·
Sign not seen
. ·
Sign the

All Reflexes exaggerated If. Reflex-lost

5) Crossing of these fibres constitute
Pyramidal Decussation ·
Sft Deep reflexes are lost ·
Deep ,

CLONUS-nt CLONUS be
of F
·
6) Rest 20 % remain uncrossed E enter Ant White Column Descend Ant CST ·
the
may
.
.

+ as .

Clasp knife
7) At time of termination
they opposite side
of S No
Rigidity Seen and lead pipe Rigity .
·
, cross to ·

· Termination : -

terminate on X motor neurons U-motor nurons and intervenous also

, ,

function : -1 .

) At time of Birth , tract

f are
unmylinated myelinated ,
start
after weeks completed
by Sysoftge #Spinal Cord Lesions (Hemi , complete , Incomple sections)
hence complete
voluntary
control
of movements are dev .

by S-5 5 .

yes of age 1) Hemisection of SC/Brown Sequard Syndrome .

(studied by Charles Edward Brown
Sequard)
2 .

) Controls movement
of Distal
gp of Muscles ,
ie-fired skill movements ,
eg-drawing play guitar ,
.
>
-
Classical US-Yg of SC is
damaged ,
One complete lateral half involved .

(Very rare)
3) Some
fibres from Cerebral Cortex also
supply Nuclei
of Cranial Nerves Kla Cortico nuclear
fibres
. >
- The
sign &
Symptoms of USC aka Brown Sequard Syndrome
CNE
Injury/any
supplied by
and
forms basis of UMNL or
supranuclear lesion of "
(eg-7thNerve) leg-conjugate mounts
of eyeballs => Causes : -

Gun Shot Trauma

4) Ant CST controls axial me (like extrapyramidal) > Infection

=> Lesions : -
tumor or lesion

distal Ms FEATURES
If Loss
of movements & fine skilled mov.
difficulty in
grasping objects and
drawing
=> : -
.

Side Opp side

2) Lesion fibres Same
to internal Capsule leads to widespread Paralysis to
many
ms . at time
,
ar are
densely packed in post -
.
Limb

3) spastic rigidity 1) sensory features (at the

level)- 1.) Almost all sens" are intact , except if fibres (STT)
non-lesion
to

crossing from lesion

u) Clasp Knife all Sensations level of
11 are
gone
. at lesion are
caught after Side
-

) Babinski ·
Post Column tract is uncrossed sensations Paint Temp also opposite side.
.
5
sign the ,
>
-

gone
on

6) All
Superf Reflexes
. lost but Deep Reflexes are
hyper active /exag
. (fine touch ,
touch discrimination ,
localis" , pressure ,
etc)

7) Clonus
may
be seen · Spinoth .
tract
Caught in lesion before cross (hencepainthost)

2) Sensory features ,
Below the level 2) Fibres
of STT cross
(N-les + les
side) ,
Hence ,
loss
of
carried-lost Paint temp.
>
-
DCT
being uncrossed
,
all sens sens? On Opp side ,
below level
of Lesion

on same side ,
Pain & temp are intact on

Side
same cuz STT crosses to lesion side

3) Motor
features at the level 3) Motor features are Normal at level

- like
of LMNL-toned single Ms flacid Paralysis , ,

us
wasting seen , Deep Esf Reflexes lost.

Vasomotor tone to Sm-ms

of Blood Vessel lost
-
->
.

4) features (Below level) Normal

Motor
4)

>
- like UMNL-> toney , Spastic Paralysis wasting ,
-nt

Deep Ref-Exag ,
If Ref lost ,
Rigidity4 ,
Babinski +ut

Vasomotor tone to BV is lost but later

>
-

initially , ,
they
their
regain excitability ,

But it's not under

Reg Control of higher VM Centre in Brain
.
 Sm-ms earlier than SK-ms
.
in
nemoval activity reappears
activity
of

Reflex

I
2) Complete transection > FEATURES : -
-

Sensory function : -Sens at/below the lesions are

gone from both sides

>
-

Damage to both halves

of SC because ,
there is
damage to all
Ascending tracts spol DCTESTT ,
on both sides

>
- CAUSES :-Gunshot wound ② Autonomic function :- Autonomic Sympathetic outflow from (thoraco lumbar segments) normally

>
-

trauma/Injury
it maintains vasomotor tone
MT
of Blood Vessels
,

(BP) (mean Art .

Pr)
>
-
Disloch
of SC
20) VMT of Su-ms
of BV reappears below lesion ,
hence MAP resumes to normal (Rest)
while doing
wide
Occlusion of BV
supplying SC
. But
regh by Baro receptor Reflex and Vasomotor Centre in Brain is lost
,
Hence
fluctuations in BP in Activity

STAGES I SPINAL SHOCK proximal is lesion in Thoraco lumbar variation in BP

.
>
-
>
- More
segment , more is

I REFLEX ACTIVITY 26- Milturation

Reflex Ref
:
If lesion above S23y ,
the local mict . . arc starts
working but

III REFLEX FAILURE starts

Hyperactive ,
as it is not under
inhibitory Control
of Higher centres
.

#V COMPLICATIONS
Reflex/Automatic Bladder : -small amt
of wine makes Bladder
HyperExcitable .

If Spinal Shock Sc
Reflex Defecation can also occur
.

Def
③ Motorfrusion
,
It occurs
immediately after SC
injury during which there is complete loss
of all the Neuronal
&
activity toned , flaccid paralysis ,
Remain same position as
gravity
are lost , M-Powerd
M-wasting , Stand Deeptendon Reflexes
Reflexes Below level
at and
of lesion : All Motor
features Mimic LMN
features weak a

>
-
REASON : -1 .

) Alt Sudden withdrawl of facilitatory impulses from Higher Centres to Spinal Cord 6) Below lesion :- Neuronal activity appears in Skms
after Su-ms ,
early appear
in
flexor me Extensor ms
than .

is
Here damage

flex flext to both Dylan .

Trast
2) local Reflexes & Neuronal activity have not
yet started again Below the level
. The
body adapts the posture of Paraplegia in ,
at hip at knee ,
and
feet Dorsiflexed) & extra pym.

>
-
DURATION : -
It depends on the degree of Encephalisation it-degree of development of Higher Cerebral
functions >
-

Bilaterally ,
motor
features Mimic UMNL (tonex ,
powert , spastic Paralysis ,
rigidityt If Ref lost , DeepT Reflex exaggerated
,
.

I become

Greate the control of Higher centres on lower ones

greater will be duration .
hyper excitable Babinski be tut
-> , ,
may

>
-

(few min in
frogs few ,
urs in dogs/cats , few days in
Monkeys , 2-3 weeks in Humans >
-
It becomes easier to ellicit Reflex, cur threshold
for Reflexes Led ,
eg -flexor
: Withdrawl
Ref >
-

Hyperexcitable even to small Stimulus

GENERAL FEATURES
- even duration
of Reflex longu than normal

Phenomena -Shocked ie-whole Nervous

1) Diaschisis :
throughout , System works as
singe unit,
damage to
any May be Conus appears

part of CNS ,
causes disturbances in rest
of intact portion of CNS
for sometime
. >
-
there
may
be appearence of Mass Reflex

2) Patient feels as
if body being out in Sportions upper part ,
with intact mind where as >
-

May be appearence of Magnet Rxn ; positive supporting Rxn ; -ve

Supp Rxn
.
.

lower part (AtBelow level) -

Completely deprived of Neuronal

activity
>
- MOTOR FEATURES

·
at Below
and lesion
,
on Both sides are like LMNL
(features previous) It
Stage of failure of Reflex activity
·
Extent
of features depends on the Clevel of lesion)-more proximal - more
severity of features, Def If: -

the conditions are not

favorable to patient in terms of treatment ,
there occurs
failure of this Reflex .

>
-

if lesion at
C-segment of SC + paralysis of 4 limbs =
Quadriplegia . -
FEATURES ① Ms becomes wasted E
flaccid

if lesion distal
(S-segments) - Paraplegia-paralysis of lower limbs ② threshold for Reflexed , Difficult to ellicit the
Reflexes .

C-segment lesion will involve

Respiratory me as well
,
cr
origin from C-segm , So
difficulty in Breathing
.
④ Le in Rec .

field for Reflexes .

· Ms . are
paralysed they ,
lie in position imposed by gravity effect on them
. Mass Reflex get abolise
e

As alt Pt N2-Balance of proteins

·
us not
contracting ,
action
of mus .

Pump ,
Venous Returnd
,
extremeties become Cold , blue >
- Complica ① is immobilised ,
there occus-ve due to Catabolism muscle

Calcemia
Hyper

andnationsoSfin(edCircu,Spy
skin-dry scaly Boy da of ② Breakdown Proteins from of Bones release Ca from Bones
prominence body
. of matrix also
&Hyper Calcemia
·
over
, , , >
-

more Renal Stone

.

SENSORY FEATURES ③ Ned Retention and Renal

Urinary
>
- Stone >
-
cause UTI

All Sensat" carried DCT &STT lost (touch pain , temp) Both sides
of body At and Below lesion ④
Pt have septicemia
by are
may
·
on
, ,

>
- AUTONOMOUS FEATURES ⑤ Decubitous ulcus/Bed sores
(features from previous Notes)

Les
· vasomotor tone to Su-ms
of BVs is lost att below lesion
of Both sides is lost
,
hence mean Art Pr
.

100
nomal Hommug
>
- Micturation
Reflex # In Complete Section of Spinal Cord

during this
Stage ,
MR
dysfutional ,
Rare
may
be intact -
leading to Retention
of wrine -
Neither
Complete nor Classical 1 of SC , there occus classical much
of Paraplegia in extension]
↓

Defaccation Reflex flexion

I
lost

I
>
-
also ie-ext" at lipt knee
,
with Plantar toes dowunds
,

dl+ ↑ed tone in extensor ms

.

II
Stage of Reflex activity . >
-
as there is
damage to
Py . trast but
Extra-p-tract (Vestibula
-
Medial Poutine
Spinal
or RST) escape inj my

regulate activity of
Ext .
ms

>
-

Def : -Neuronal
activity starts below the lesion , after spinal shock . Rather the Neuronal
activity
in
general >
-
In such situations Crossed Extensor reflex becomes
hyperactive along ,
with
exaggerated deep tendon
Reflexes
becomes
Hyper excitable
. and appearence of Clowns

The local
·
Lord
Reflexes become
functional ,
rather
they
also become
hyper excitable
um
REASONS - alt denervation Phenomena (3-sub reasons)
>
-

(or
Hypersensitivity
mech
.
)
a) 4 in no .

of Receptors of NT more than normal (up Regulation) Phenomena

↑
where Stimulus applied ③ Release
d/+ ithcrawl
Me in
of Receptive field muscle/other organ's
wi
6) are on memb.

of inhibition from
a delayed Re-uptake of NT to
prolong its action
Higher centres

② Sprouting of Collatuals from existinguemous

to other motor-n or Juter-n
 I
TABES DORSALIS
caused
by
>
-

Syphilis of CNS ,
leading to destruction
of all
sensory fibres ,

caused -Spirochetes named Trichodema pallidum

-
by : - .

·
It causes destruct at
point of entry of Post Root to s , ie-proximal to DNG

·
It invades CNs 3-18 months
after the
infection . But
Signs f Symptoms may appear much later (months/years)

FEATURES 1) There pain due to irritation

of these
fibres
may
occur
>
-

Initially to
2) Hypersenstivity of skin various stimulus

3) Numbness & Para-esthesia

later carried DCTASTT lost

2) all sensations
by
are

3) In Co-ord" of movements
sply w/ eyes Closed
(sensory ataxia)
6 Stamping gait may
be seen

< All Sf + Deep T

.

Reflexes lost

8) Sense
of position is lost and becomes unaware
of passive movement
of Body parts & limes

9) loss
of Sens"
of Bladder fullness ,
B .

fills ,
retention
of wine

10) Romburg's test the

11) &It pain sensation loss ,

there occus
repeated trauma
of joint-Juflam- & deformed joints) Charco s