Spinothalamic tract in the context of "Brainstem"

An itch (also known as pruritus) is a sensation that causes a strong desire or reflex to scratch. Itches have many similarities to pain, and while both are unpleasant sensory experiences, their behavioral response patterns are different. Pain creates a withdrawal reflex, whereas itches lead to a scratch reflex.

Unmyelinated nerve fibers for itches and pain both originate in the skin. Information for them is conveyed centrally in two distinct systems that both use the same nerve bundle and spinothalamic tract.

The periaqueductal gray (PAG), also known as the central gray, is a brain region that plays a critical role in autonomic function, motivated behavior and behavioural responses to threatening stimuli. PAG is also the primary control center for descending pain modulation. It has enkephalin-producing cells that suppress pain.

The periaqueductal gray is the gray matter located around the cerebral aqueduct within the tegmentum of the midbrain. It projects to the nucleus raphe magnus, and also contains descending autonomic tracts. The ascending pain and temperature fibers of the spinothalamic tract send information to the PAG via the spinomesencephalic pathway (so-named because the fibers originate in the spine and terminate in the PAG, in the mesencephalon or midbrain).

The brainstem (or brain stem) is the posterior stalk-like part of the brain that connects the cerebrum with the spinal cord. In the human brain, the brainstem is composed of the midbrain, the pons, and the medulla oblongata. The midbrain is continuous with the thalamus of the diencephalon through the tentorial notch, and sometimes the diencephalon is included in the brainstem.

The brainstem is very small, making up around only 2.6 percent of the brain's total weight. It has the critical roles of regulating heart and respiratory function, helping to control heart rate and breathing rate. It also provides the main motor and sensory nerve supply to the face and neck via the cranial nerves. Ten pairs of cranial nerves come from the brainstem. Other roles include the regulation of the central nervous system and the body's sleep cycle. It is also of prime importance in the conveyance of motor and sensory pathways from the rest of the brain to the body, and from the body back to the brain. These pathways include the corticospinal tract (motor function), the dorsal column-medial lemniscus pathway (fine touch, vibration sensation, and proprioception), and the spinothalamic tract (pain, temperature, itch, and crude touch).

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.