Transcript Trigeminal pathways PP

05. The Trigeminal System
Somatic Sensation of the Face and Head
David A. Morton, Ph.D.
Thursday February 7th, 2013
Objectives:
1.
Outline the two pathways for facial sensation from the head.
2.
Contrast facial sensation from the head and somatic sensation from the body. In what
ways are they similar? Different? Try drawing this on the Haines atlas diagram at the
end of the lecture.
3.
Diagram the corneal reflex: the afferent and efferent limbs as well as nuclei involved in
the brainstem.
4.
If a person does not blink, how would you determine if the problem were in the sensory
(afferent) limb, motor (efferent) limb, or brainstem interconnections for the corneal
reflex?
5.
Explain how a single, small medullary vascular lesion could abolish pain and temperature
from the face on the right side and pain and temperature from the body on the left side.
What vessel is most likely occluded?
Peripheral Receptors and Sensation
• Structures served by trigeminal system
CN V-1
CN V-2
? Great auricular nerve (C2-C3)
CN V-3
How many neurons in sensory
pathway?
DCML/ALS
Trigeminal system
1. Peripheral ganglion (DRG)
1. Peripheral ganglion (Trig. gang.)
2. Spinal cord, medulla
2. 2 nuclei in brainstem (pons, medulla, sp cord)
3. VPL nucleus of the thalamus
3. VPM nucleus of the thalamus
II. Primary Sensory Neurons:
Trigeminal ganglion
CN V-2
Trigeminal
ganglion
Primary Sensory Neurons:
Trigeminal ganglion
CN V-2
Primary sensory
neuron
Second-Order Trigeminal Neurons
Originate in two brain stem nuclei:
• Principal (chief) trigeminal nucleus
• Spinal (descending) trigeminal nucleus
Young, Young and Tolbert, 2008 Fig 11-10 
Second-Order Trigeminal Neurons
A. Principal (chief) trigeminal nucleus
• Mediates fine touch, joint position,
vibration.
• Located in pons lateral to motor
nucleus of CN V.
This would be equivalent to what nucleus
of the brainstem? _____________
Young, Young and Tolbert, 2008 Fig 11-10 
Second-Order Trigeminal Neurons
B. Spinal (descending) trigeminal nucleus
• Mediates pain and temperature.
• Spinal (descending) trigeminal tract
• Descends caudally as far as C2-C3
and is continuous with dorsal horn.
This would be equivalent to what region
in the spinal cord? _____________
Young, Young and Tolbert, 2008 Fig 11-10 
Second-Order Trigeminal Neurons
C. Ascending Trigeminal Pathways
• Axons of second-order neurons form
the trigeminothalamic pathway to the
Secondary sensory
neuron
VPM nucleus of the thalamus.
Secondary sensory
neuron
a. Axons from neurons in the chief sensory
nucleus carry sensations such as: _____
b. Axons from neurons in the spinal
trigeminal nucleus carry sensations such
as: ____
Young, Young and Tolbert, 2008 Fig 11-10 
Second-Order Trigeminal Neurons
Secondary sensory
neuron
Secondary sensory
neuron
Young, Young and Tolbert, 2008 Fig 11-10 
Third-Order Trigeminal Neurons
Project from VPM in the thalamus to the Postcentral gyrus (primary sensory cortex)
• Axons course through the internal capsule
Pons
Chief trig nucleus
Medulla oblongata (rostral)
Spinal trigeminal
tract & spinal trig nucleus
Med lem
ALS
The right side of the pons is lesioned. What sensory loss would you expect?
The right side of the pons is lesioned. What sensory loss would you expect?
Below the lesion:
• Loss of facial sensation on right
• Loss of pain and temp from left side
• Loss of proprioception/vibration from left side
L
Self-assessment: When you think you have mastered the pathways, select 2
colors in both a dark and light shade. Use the dark color for the body and the
lighter color for the face pathways.
e.g.
Light blue-Trigeminothalamic (ventral)
Dark blue – ALS
Pink – trigeminothalamic (dorsal) from chief
Red – DCML