Anatomy · USMLE Step 1

USMLE Neuroanatomy

Spinal cord tracts, brainstem cross-sections, and classic lesion localization tested on USMLE Step 1, distinct from the clinical deficit focus of USMLE Neuro.

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What is the primary function of the lateral corticospinal tract?
Voluntary motor control of limb (skeletal) muscles
Where does the corticospinal tract decussate?
Pyramidal decussation, at the cervicomedullary junction (caudal medulla)
In which part of spinal cord white matter does the lateral corticospinal tract travel?
Lateral funiculus
What sensory modalities does the dorsal column-medial lemniscus pathway carry?
Fine touch, vibration, and proprioception
Where do dorsal column fibers decussate as they become the medial lemniscus?
Internal arcuate fibers, in the medulla
Which dorsal column fasciculus carries sensation from the lower body?
Fasciculus gracilis
Which dorsal column fasciculus carries sensation from the upper body?
Fasciculus cuneatus
What sensory modalities does the spinothalamic tract carry?
Pain, temperature, and crude touch
Where does the spinothalamic tract decussate?
Anterior white commissure, one to two spinal levels above the level of entry
In which part of spinal cord white matter does the spinothalamic tract travel?
Anterolateral funiculus
What is the general function of the spinocerebellar tracts?
Carry unconscious proprioceptive information to the cerebellum
Does the dorsal (posterior) spinocerebellar tract decussate?
No, it remains uncrossed and travels ipsilaterally
In Brown-Sequard syndrome, what is lost ipsilateral to a spinal hemicord lesion?
Motor function and proprioception/vibration sense below the lesion
In Brown-Sequard syndrome, what is lost contralateral to a spinal hemicord lesion?
Pain and temperature sensation, a level or two below the lesion
What is the classic sensory deficit pattern in syringomyelia?
Bilateral loss of pain and temperature sensation in a cape-like distribution

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