Clinical Examples:
The Cortex
Somatosensory Cortex. The sensory loss from head trauma or stroke that damages the somatosensory cortex will
- be contralesional, as decussations in all somatosensory pathways occur below the thalamus
- be more complex, as somatosensory information is integrated at cortical levels
- not result in analgesia, as pain is represented by multiple pathways (e.g. the neospinothalamic and paleospinothalamic pathways) and in multiple cortical areas
- often be accompanied by motor deficits, as the somatosensory cortex provides input to the motor cortex and motor control signals to the brain stem and spinal cord.
| Example 8 |
Figure 5.37 |
The patient suffers from deficits in discriminative touch and proprioceptive sensations involving the right side of his body and face. Tactile and pain sensations are also poorly localized on his right side. He has difficulty walking and controlling his right arm and hand and the right side of his face.
Symptoms: The patient exhibits deficits in fine motor control and in discriminative touch and proprioception on the right side of his body and face (Figure 5.37). He has problems manipulating and identifying objects placed in his right hand (stereognosis). He is unable to identify letters or numbers written on the skin of the right face and the palm of his right hand (graphesthesia). He also has difficulty in judging weight differences (baragnosis) and cannot appreciate textures with his right hand. He is unable to detect the passive movement of his right foot and the fingers of his right hand. Compared with the left side of his body pain sensations are not as sharp, well defined or easily localized on the right side of his body. Touch, vibration, position, thermal, and pain sensations are normal for the rest of the body and face. The patient has difficulty walking and the Romberg test is positive.
You conclude that the somatosensory losses in his body involve
- discriminative touch, proprioception and sharp pain on the right body
- discriminative touch, proprioception and sharp pain on the right side of his face
Pathway(s) Affected: You conclude that structures in the following somatosensory pathways (Figure 5.38) may have been affected
- the medial lemniscal pathway
- the main sensory trigeminal pathway
Side & Level of Damage: The sensory losses (Figure 5.39)
- involve the body and face
- are unilateral and complex in nature
- involve higher order cortical functions, e.g., graphesthesia
- do not include complete loss of pain information
- are accompanied by motor deficits
So, you conclude that the damage
- involves the left somatosensory parietal cortical area
- may involve a branch of the middle cerebral artery (Figure 5.40)
Figure 5.40 |
Somatosensory Cortex. Hemorrhage limited to somatosensory parietal areas produces contralesional astereognosis, baragnosis, and losses in the ability to discriminate object size and texture. Also decreased or lost on the contralesional side of the body are the ability to discriminate position and movement of body parts and the control of fine movements. The hemorrhage would not produce a total loss of pain sensation as other cortical areas are also involved in the perception of painful stimuli. For example, the cingulate gyrus in the frontal lobe and part of the insular cortex appear to be involved in the perception of, and emotional reaction to, painful stimuli (Figure 5.41).
| Example 1 | Example 2 | Example 3 | Example 4 | Example 5 | Example 6 | Example 7 | Example 8 |
Summary
From this chapter, you should have learned how the somatosensory system is organized from the skin, muscles and joints to the cortex. You have learned that stimulus features extracted by the somatosensory receptors are kept segregated in separate “information channels” and processed in parallel by different chains of neurons. Information coded and carried by thousands of spinal cord and cranial ganglion cells are distributed to millions of cortical neurons in the parietal lobe. The perceptions of coherent somatosensory stimuli and body image are recomposed out of these fragments of information by the simultaneous activation of large areas of cortex. You have learned how to use the somatotopic organization and the modality specificity of the different somatosensory pathways to determine the location and extent of damage to the somatosensory structures.
Make the best match between the named cortical functional area and the cortical structure area.
- Primary somatosensory cortex
- A
- B
- C
- D
- E
A. Insula
B. Postcentral gyrus
C. Precentral gyrus
D. Posterior parietal lobe
E. Parietal lobe pars opercularis
A. Insula This is an INCORRECT match.
B. Postcentral gyrus
C. Precentral gyrus
D. Posterior parietal lobe
E. Parietal lobe pars opercularis
A. Insula
B. Postcentral gyrus This is the CORRECT match!
The precentral gyrus (selection C) is the motor cortex.
C. Precentral gyrus
D. Posterior parietal lobe
E. Parietal lobe pars opercularis
A. Insula
B. Postcentral gyrus
C. Precentral gyrus This is an INCORRECT match.
D. Posterior parietal lobe
E. Parietal lobe pars opercularis
A. Insula
B. Postcentral gyrus
C. Precentral gyrus
D. Posterior parietal lobe This is an INCORRECT match.
E. Parietal lobe pars opercularis
A. Insula
B. Postcentral gyrus
C. Precentral gyrus
D. Posterior parietal lobe
E. Parietal lobe pars opercularis This is an INCORRECT match.
- Secondary somatosensory cortex
- A
- B
- C
- D
- E
A. Insula
B. Postcentral gyrus
C. Precentral gyrus
D. Posterior parietal lobe
E. Parietal lobe pars opercularis
A. Insula This is an INCORRECT match.
B. Postcentral gyrus
C. Precentral gyrus
D. Posterior parietal lobe
E. Parietal lobe pars opercularis
A. Insula
B. Postcentral gyrus This is an INCORRECT match.
C. Precentral gyrus
D. Posterior parietal lobe
E. Parietal lobe pars opercularis
A. Insula
B. Postcentral gyrus
C. Precentral gyrus This is an INCORRECT match.
D. Posterior parietal lobe
E. Parietal lobe pars opercularis
A. Insula
B. Postcentral gyrus
C. Precentral gyrus
D. Posterior parietal lobe This is an INCORRECT match.
E. Parietal lobe pars opercularis
A. Insula
B. Postcentral gyrus
C. Precentral gyrus
D. Posterior parietal lobe
E. Parietal lobe pars opercularis This is the CORRECT match!
The pars opercularis of the parietal lobe forms the "upper lip" of the lateral fissure and contains both visceral sensory cortex and the secondary somatosensory cortex. The insula is the site of the gustatory cortex and more visceral cortex.
- Somatosensory association cortex
- A
- B
- C
- D
- E
A. Insula
B. Postcentral gyrus
C. Precentral gyrus
D. Posterior parietal lobe
E. Parietal lobe pars opercularis
A. Insula This is an INCORRECT match.
B. Postcentral gyrus
C. Precentral gyrus
D. Posterior parietal lobe
E. Parietal lobe pars opercularis
A. Insula
B. Postcentral gyrus This is an INCORRECT match.
C. Precentral gyrus
D. Posterior parietal lobe
E. Parietal lobe pars opercularis
A. Insula
B. Postcentral gyrus
C. Precentral gyrus This is an INCORRECT match.
D. Posterior parietal lobe
E. Parietal lobe pars opercularis
A. Insula
B. Postcentral gyrus
C. Precentral gyrus
D. Posterior parietal lobe This is the CORRECT match!
The posterior parietal lobe is located caudal to the postcentral gyrus and serves as the somatosensory association cortex.
E. Parietal lobe pars opercularis
A. Insula
B. Postcentral gyrus
C. Precentral gyrus
D. Posterior parietal lobe
E. Parietal lobe pars opercularis This is an INCORRECT match.
- Question 1
- A
- B
- C
- D
- E
Select the best answer: Electrical stimulation of the posterior paracentral lobe will result in the perception of a somatosensory stimulus at the _______.
A. tongue
B. hand
C. arm
D. chest
E. foot
Select the best answer: Electrical stimulation of the posterior paracentral lobe will result in the perception of a somatosensory stimulus at the _______.
A. tongue This answer is INCORRECT.
The tongue is represented in the postcentral gyrus near the lateral sulcus.
B. hand
C. arm
D. chest
E. foot
Select the best answer: Electrical stimulation of the posterior paracentral lobe will result in the perception of a somatosensory stimulus at the _______.
A. tongue
B. hand This answer is INCORRECT.
The hand is represented in the lateral aspect of the postcentral gyrus.
C. arm
D. chest
E. foot
Select the best answer: Electrical stimulation of the posterior paracentral lobe will result in the perception of a somatosensory stimulus at the _______.
A. tongue
B. hand
C. arm This answer is INCORRECT.
The arm is represented superior to the hand in the lateral aspect of the postcentral gyrus.
D. chest
E. foot
Select the best answer: Electrical stimulation of the posterior paracentral lobe will result in the perception of a somatosensory stimulus at the _______.
A. tongue
B. hand
C. arm
D. chest This answer is INCORRECT.
The chest is represented in the superior aspect of the postcentral gyrus.
E. foot
Select the best answer: Electrical stimulation of the posterior paracentral lobe will result in the perception of a somatosensory stimulus at the _______.
A. tongue
B. hand
C. arm
D. chest
E. foot This answer is CORRECT!
The buttock, leg, foot, and genitals are represented in the posterior paracentral lobe, which is located on the medial aspect of the cerebral hemisphere.
- Question 2
- A
- B
- C
- D
- E
Select the best answer: Damage to the posterior funiculus at spinal cord level T6 produces a loss ______.
A. of sharp, cutting pain sensation
B. that is contralesional
C. of sensastion in the arms and hands
D. that produces a positive Rhomberg sign
E. that is called the Brown-Sequard syndrome
Select the best answer: Damage to the posterior funiculus at spinal cord level T6 produces a loss ______.
A. of sharp, cutting pain sensation This answer is INCORRECT.
This is incorrect, as the posterior funiculus contains first order afferents of the medial lemniscal pathway, which processes discriminative touch and proprioception. The neospinothalamic pathway processes sharp pain sensation from the body and the second order axons of this pathway are in the lateral and anterior funiculi (the spinothalamic tract).
B. that is contralesional
C. of sensastion in the arms and hands
D. that produces a positive Rhomberg sign
E. that is called the Brown-Sequard syndrome
Select the best answer: Damage to the posterior funiculus at spinal cord level T6 produces a loss ______.
A. of sharp, cutting pain sensation
B. that is contralesional This answer is INCORRECT.
This is incorrect, as the first order medial lemniscal afferents do not decussate. Consequently, the sensory loss is ipsilesional when these afferents are destroyed.
C. of sensastion in the arms and hands
D. that produces a positive Rhomberg sign
E. that is called the Brown-Sequard syndrome
Select the best answer: Damage to the posterior funiculus at spinal cord level T6 produces a loss ______.
A. of sharp, cutting pain sensation
B. that is contralesional
C. of sensastion in the arms and hands This answer is INCORRECT.
This is incorrect, as the medial lemniscal first order afferents innervating the arm and hand enter the spinal cord posterior funiculus via posterior roots above T6.
D. that produces a positive Rhomberg sign
E. that is called the Brown-Sequard syndrome
Select the best answer: Damage to the posterior funiculus at spinal cord level T6 produces a loss ______.
A. of sharp, cutting pain sensation
B. that is contralesional
C. of sensastion in the arms and hands
D. that produces a positive Rhomberg sign This answer is CORRECT!
The lesion produces a positive Rhomberg sign as there is a loss of proprioception in the ipsilesional leg and the patient is unable to maintain his balance when his eyes are closed and his feet are close together.
E. that is called the Brown-Sequard syndrome
Select the best answer: Damage to the posterior funiculus at spinal cord level T6 produces a loss ______.
A. of sharp, cutting pain sensation
B. that is contralesional
C. of sensastion in the arms and hands
D. that produces a positive Rhomberg sign
E. that is called the Brown-Sequard syndrome This answer is INCORRECT.
This is incorrect as the Brown-Sequard syndromeresults from hemisection of the spinal cord. The syndrome includes ipsilesional loss of discriminative touch and proprioception and contralesional loss of pain and temperature sensations.
