Sensory decussation in the context of "Dorsal column nuclei"

The dorsal column–medial lemniscus pathway (DCML) (also known as the posterior column-medial lemniscus pathway (PCML) is the major sensory pathway of the central nervous system that conveys sensations of fine touch, vibration, two-point discrimination, and proprioception (body position) from the skin and joints. It transmits this information to the somatosensory cortex of the postcentral gyrus in the parietal lobe of the brain. The pathway receives information from sensory receptors throughout the body, and carries this in the gracile fasciculus and the cuneate fasciculus, tracts that make up the white matter dorsal columns (also known as the posterior funiculi) of the spinal cord. At the level of the medulla oblongata, the fibers of the tracts decussate and are continued in the medial lemniscus, on to the thalamus and relayed from there through the internal capsule and transmitted to the somatosensory cortex. The name dorsal-column medial lemniscus comes from the two structures that carry the sensory information: the dorsal columns of the spinal cord, and the medial lemniscus in the brainstem.

There are three groupings of neurons that are involved in the pathway: first-order neurons, second-order neurons, and third-order neurons. The first-order neurons are sensory neurons located in the dorsal root ganglia, that send their afferent fibers through the two dorsal columns. The first-order axons make contact with second-order neurons of the dorsal column nuclei (the gracile nucleus and the cuneate nucleus) in the lower medulla. The second-order neurons send their axons to the thalamus. The third-order neurons are in the ventral posterolateral nucleus in the thalamus and fibres from these ascend to the postcentral gyrus.

The medial lemniscus, also known as Reil's band or Reil's ribbon (for German anatomist Johann Christian Reil), is a large ascending bundle of heavily myelinated axons that decussate in the brainstem, specifically in the medulla oblongata. The medial lemniscus is formed by the crossings of the internal arcuate fibers. The internal arcuate fibers are composed of axons of the gracile nucleus and the cuneate nucleus. The cell bodies of the nuclei lie contralaterally.

The medial lemniscus is part of the somatosensory dorsal column–medial lemniscus pathway, which ascends in the spinal cord to the thalamus. Lesions of the medial lemniscus cause an impairment of vibratory and touch-pressure sense.

The anterior white commissure (ventral white commissure) is a bundle of nerve fibers which cross the midline of the spinal cord just anterior (in front of) to the gray commissure (Rexed lamina X). A delta fibers (Aδ fibers) and C fibers carrying pain sensation in the spinothalamic tract contribute to this commissure, as do fibers of the anterior corticospinal tract, which carry motor signals from the primary motor cortex.

Two of the five sensory modalities, pain and temperature, cross sides at the anterior white commissure, reaching the contralateral side about two vertebral levels rostral to their origin. The spinothalamic tract thus decussates very soon after entering the spinal cord, ascending in the spinal cord, contralateral to the side from where it provides (pain and temperature) sensory information. Therefore, a lesion that is caudal to the sensory decussation where the remaining three-fifths modalities decussate (at the superior medulla) will result in contralateral (opposite sided) pain and temperature loss (as this has already crossed over at the anterior white commissure), whereas loss of crude touch, pressure, and proprioception will be ipsilateral (same sided) as these have not yet crossed over.