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thalamic nuclei Many other cells of the dorsal column nuclei are interneurons, with both excitatory and inhibitory effects on local re exes or on the primary ascending neurons They are also under the in uence of the sensorimotor cortex Some act on descending corticospinal motor neurons The functions of many of the extrathalamic projections of dorsal column cells are unknown (Davidoff) Thinly myelinated or unmyelinated bers, subserving mainly pain sensibility, but some sensitive to touch and pressure, enter the cord on the lateral aspect of the dorsal horn and synapse with dorsal horn cells, mainly within a segment or two of their point of entry into the cord The dorsal horn cells, in turn, give rise to secondary sensory bers, some of which may ascend ipsilaterally but most of which decussate and ascend in the spinothalamic tracts, as described in Chap 8 (see Figs 8-1 and 8-2).

Observations based on surgical interruption of the anterolateral funiculus indicate that bers mediating touch and deep pressure occupy the ventromedial part (anterior spinothalamic tract) Also as remarked in Chap 8, an ascending tract of secondary sensory axons lies in or medial to the descending corticospinal system After the posterior columns terminate in the gracile and cuneate nuclei of the rostral cervical cord and medulla, synapses are made with bers that cross the midline and ascend to form the medial lemniscal tracts in the brainstem The lemniscal system is situated in a paramedian position, changing orientation slightly at different levels of the brainstem, and joining the spinothalamic system in the rostral midbrain to terminate in the posterior thalamic nuclei (see below and also Fig 8-2) Trigeminal Connections The pathways mediating cutaneous sensation from the face and head especially touch, pain, and temperature are conveyed to the brainstem by the trigeminal nerve.

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After entering the pons, the pain and temperature bers turn caudally and run through the medulla as the descending trigeminal tract, terminating in a long, vertically oriented nucleus that lies beside it and extends to the second or third cervical segment of the cord, where it becomes continuous with the posterior horn of the spinal gray matter Axons from the neurons of this nucleus cross the midline and ascend as the trigeminal lemniscus along the medial side of the spinothalamic tract (Fig 8-2) Thalamocortical Connections The posterior thalamic complex receives the bers from the medial lemniscal, trigeminal lemniscal, and spinothalamic tracts and projects mainly to two somatosensory cortical areas The rst area (S1) corresponds to the postcentral cortex or Brodmann s areas 3, 1, and 2.

where x is the distancefrom the end of the carricr.Estimate (a) velocity @.rldt') and (b) acccleration(duldrl using nunrericaldifferentiation. 19.13 Use the fbllowing datato find the velocitl'and accelerationat / : l0 seconds:

S1 afferents are derived primarily from the ventral posterolateral nucleus (VPL) and VPM (ventral posteromedial nucleus the terminus of trigeminal bers) and are distributed somatotopically, with the leg represented uppermost and the face lowermost (face and hand are juxtaposed) Electrical stimulation of this area yields sensations of tingling, numbness, and warmth in speci c regions on the opposite side of the body The information transmitted to S1 is tactile and proprioceptive, derived mainly from the dorsal column medial lemniscus system and concerned mainly with sensory discrimination The second somatosensory area (S2) lies on the upper bank of the sylvian ssure, adjacent to the insula Localization of function is less discrete in S2 than in S1, but S2 is also organized somatotopically, with the face rostrally and the leg caudally.

The sensations evoked by electrical stimulation of S2 are much the same as those of S1 but, in distinction to the latter, may be felt bilaterally Of note is the failure of cortical stimulation to evoke pain sensation..

reduces the vertigo and nausea, and that the slightest motion of the head aggravates them One common form of vertigo, benign positional vertigo (see further on), occurs only with the repositioning that accompanies lying down, sitting up, or turning The source of the gait ataxia associated with vertigo (vertiginous ataxia) is recognized by the patient as being in the head, not in the control of the legs and trunk It is noteworthy that the coordination of individual movements of the limbs is not impaired in these circumstances a point of difference from most instances of cerebellar disease Loss of consciousness as part of a vertiginous attack nearly always signi es another type of disorder (seizure or faint) Pseudovertigo To be distinguished from true vertigo are symptoms of giddiness and other types of pseudovertigo.

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