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Anatomy 6.

February 7, 2012
Dr. Melissa Calilao

Pyramidal System
I.
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B.
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E.
III.
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B.
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D.
IV.
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V.
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VI.
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B.

OUTLINE
Motor System
Pyramidal Tract
Two Main Pathways
Origin of Fibers
Motor Homunculus
Supplementary Motor Area
Descending
Pathways:
Anatomical
Organization
Corticospinal Tract
Pathway
Lateral Corticospinal Tract
Anterior Corticospinal Tract
Termination of Pyramidal Tract
Upper Motor Neuron vs Lower Motor
Neuron Paralysis
Upper Motor Neuron
Lower Motor Neuron
Corticobulbar Tract
Facial Motor Nucleus
Lower Motor Nucleus
Other Descending Tracts
Midbrain
Pons/Medulla

A.

TWO MAIN PATHWAYS


1. Corticospinal tract

Lateral Corticospinal Tract

Anterior /Ventral Corticospinal Tract


2. Corticobulbar tract

B.

ORIGIN OF FIBERS

1. Precentral gyrus (Brodmanns area 4)


Primary motor cortex
1/3 of the axons
Pyramidal cells of Betz
o 10% or 3% of CST fibers
o Large motor neurons located at the 5th layer of
cerebral cortex of areas 4 and 6
o Unique since their axons are sent directly to the
anterior horn cells (monosynaptic connection)
o Responsible for the highly skilled movements

Objectives:
Enumerate the tracts that constitute the pyramidal system
Trace the pathway of the pyramidal tracts
Locate the position of the lateral and anterior corticospinal tracts in a
section of the spinal cord
Differentiate an upper motor vs. a lower motor neuron lesion
Describe briefly the other descending tracts

2.Postcentral gyrus (Brodmanns area 3, 1, 2)


Primary sensory cortex
1/3 of the axons
Fibers are not involved in voluntary movement but
they are responsible in controlling sensory inputs

I. MOTOR SYSTEM
MOTOR SYSTEM
1. Pyramidal system

The primary control of voluntary movement


thru:
a. Corticospinal
b. Corticobulbarparthways
2. Extrapyramidal system
a. Basal Ganglia (nuclei)
b. Cerebellum

Supporting role in the production of wellcoordinated movements

Influence lower motor neurons indirectly


through modulation of the cerebral cortex and
brainstem

II. PYRAMIDAL TRACT


Longest and largest descending fiber tract of human CNS
Fibers are responsible for the formation of pyramids
(swellings)
Fibers pass through the medullary pyramids (in upper
medulla)
Concerned with voluntary, discrete, skilled movements of
the distal musculature of the limbs and control of muscles
involved in speech and vocalization

Known as the Sensorimotor Cortex because it is comprised


of three areas from which the fibers arise
1. Precentral gyrus
2. Postcentral gyrus
3.Premotor cortex and Frontal eye field

3. Premotor cortex and Frontal eye field (Brodmanns area 6)


1/3 of the axons
Secondary motor cortex
For controlling the posture
Some also arise from the frontal eye field (BA 8)

Figure 1. Sensorimotor Cortex


C.

MOTOR HOMUNCULUS

Group 17 | Esguerra, Eslao, Esling, Espelimbergo, Esternon, Estevanez, Estrada, Estrellado

The body has somatotopic representation on the primary


motor and premotor cortex. at the precentral gyrus
Each body is represented in specific portion

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Paracentral lobule is represented by the lower extremities,


feet, and the perineum
Most lateral, close to Sylvian fissure is represented by the
tongue and larynx
Hands, face, and lips occupy large areas since they are
involved in fine and highly skilled movements

Figure 1. Reflex Arc


III. CORTICOSPINAL TRACT
A.

PATHWAY

It forms pathways concerned with speed and agility to


voluntary movements and is used in performing rapid skilled
movements. (Lesion will not abolish movement but will become
slow and less agile)
Majority of corticospinal fibers are myelinated and are
relatively slow-conducting, small fibers
Most fibers synapse with internuncial neurons, which, in turn,
synapse with alpha motor neurons and some gamma motor
neurons
Corticospinal tract is believed to control the prime mover
muscles while the other descending tracts are important in
controlling basic movements
Corticospinal tract is a crossed tract, thus, the right sensory
motor cortex controls the left side of the body and vice versa.
(Lesion on one side will be manifested on the contralateral
side)
There is better motor control on the upper extremities and
body because more fibers terminate at this area

Figure 2. Motor Homunculus


D.

E.

SUPPLEMENTARY MOTOR AREA


Located at BA 6, in front of paracentral lobule
Has a special role in controlling movement that are
performed simultaneously on both sides of the body
Together with premotor, they are concerned with planning
movements

DESCENDING PATHWAYS: ANATOMICAL ORGANIZATION

st

1 order of neuron(N1)
o Nerve cell body in the cerebral cortex
nd
2 order of neuron(N2)
o Internuncial neuron (connecting neuron) in
anterior gray column of spinal cord
o Has short axon
rd
3 order of neuron(N3)
o Lower motor neuron
o In the anterior gray column of the spinal cord
o Axon directly innervates the skeletal muscles
through the anterior root of spinal nerves
o Lower Motor Neurons (Alpha motor neuron) the final common pathway
Reflex
o Involuntary response to a stimulus and requires
fast action
o Higher centers of the brain is not needed
Reflex arcs
o Important in maintaining muscle tone for
posture
o Components:
1. Receptor organ
2. Afferent neuron
3. Efferent neuron
4. Effector organ

Group 17|Esguerra, Eslao, Esling, Espelimbergo, Esternon, Estevanez, Estrada, Estrellado

st

1.

Origin: Cerebral cortex (1 order neuron)


1/3 from primary motor complex (area 4)
1/3 from secondary motor complex (area 6)
1/3 from parietal lobe (area 3, 1, 2)
OR
2/3 from precentral gyrus
1/3 from postcentral gyrus (fibers do not control motor
activity but influence sensory input to the nervous system

2.

Corona radiata

Where descending fibers from cerebral cortex will


converge

Afferent and efferent fibers situated deep in the


medullary substance

3.

Internal capsule

From corona radiata, it will pass through the posterior


limb of the internal capsule

V-shaped on horizontal view, with the anterior and


posterior limb joined at the genu

Fibers closest to the genu are concerned with cervical


portions of the body, while the those situated posteriorly
are concerned with lower extremity

A broad, compact band which separates lentiform


nucleus from thalamus and caudate nucleus
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4.

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6.

7.

8.

Descending fibers : Grouped closely at the genu and in


the anterior 2/3 of posterior limb

Motor fibers of upper extremity:


o At the rostral part of posterior limb
o Behind these are the lower extremity fibers

Anterior limb: Made up of fibers passing to and from the


frontal lobe

Posterior limb: Fibers from the parietal lobe


Cerebral peduncles (middle 3/5)

Cervical portions of the body: Fibers located more


medially

Lower extremities: Fibers located more laterally


Pons

Fibers will leave the mesencephalon to continue at this


site

Tract will then break up into many bundles or numerous,


smaller fascicles in basilar portion of pons by the
transverse pontocerebellar fibers

Scattered in these fascicles are pontine nuclei and


pontocerebellar fibers
Medulla oblongata

From Pons, the bundles will group together along the


anterior border to form a swelling known as Pyramids
(upper medulla)

Collects into a discrete bundle, some fibers cross


Pyramidal decussation (caudal medulla)

Crossing over of fibers at the junction of medulla


oblongata and the spinal cord
a. Lateral CST

From the decussation of fibers, it will enter the lateral


white column of the spinal cord (lateral funiculus) to form
this tract

Formed by the decussation of 75-90% of fibers at the


caudal medullary level

Termination: Anterior gray column of all spinal cord


segments

Figure 2. Lateral Corticospinal Tract

8.b. Anterior / Ventral CST

Some fibers do not cross in the decussation but descend in


the anterior white column of the spinal cord to form this
tract (anterior funiculus of spinal cord close to the ventromedian fissure)

They will eventually cross before terminating on anterior


horn cells in cervical and upper thoracic regions

Formed by the 10-15% uncrossed fibers


B.

Group 17|Esguerra, Eslao, Esling, Espelimbergo, Esternon, Estevanez, Estrada, Estrellado

TERMINATION OF PYRAMIDAL TRACT FIBERS


Cervical spinal cord level 55%
Thoracic level 20%
Lumbar/sacral level 25%

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IV. UPPER MOTOR NEURON VS LOWER MOTOR NEURON


PARALYSIS

o
o

A.

UPPER MOTOR NEURON (UMN)


o

1st order neuron (N1) located in motor area of cerebral cortex


Processes connect with motor nuclei in anterior horn of spinal
cord (N2)
UMN from precentral gyrus initiate impulses to skeletal
muscles
o Those that originate in other areas do not initiate
impulses. Rather, they suppress or inhibit lower motor
neurons

The pyramidal tracts normally tend to increase muscle


tone, while extrapyramidal tracts inhibit muscle tone
In clinical practice, it is rare to find a lesion that is limited
solely to the pyramidal tract or extrapyramidal tract
Usually, both sets of tracts are affected to a variable
extent, producing both groups of clinical signs
Table 1. Differentiation of LMN from UMN Lesion

LMN LESION
Complete paralysis
(complete loss of action,
since main innervations
of muscles are severed)
Flaccidity - due to atonia

Arreflexia
(reflex arc is damaged)

Muscles undergo marked


atrophy

No Clonus
Figure 3. Motor Neurons Lesions

B.

LOWER MOTOR NEURON (LMN)

3 order neurons (N3) located in anterior horns of spinal cord,


their axons passing via peripheral nerve to skeletal muscle
When suppressor upper motor neurons have lesions, the LMN
will discharge at will, producing hyperreflexia or spasticity

No Babinski sign

rd

Notes:

Figure 4. A cross section of the spinal cord, dorsal and ventral


roots, and peripheral nerve [Important: Lesion 4, anterior horn
cells]

Notes:
o The pyramidal tract is used by physicians to refer
specifically to the corticospinal tract

Group 17|Esguerra, Eslao, Esling, Espelimbergo, Esternon, Estevanez, Estrada, Estrellado

UMN LESION
Paresis
(muscle weakness)
Spasticity
due to marked hypertonia
increase in muscle tone
lesion is on extrapyramidal tract
Hyperreflexia
(LMN over discharge
there is an absence of suppressor
action on LMN
related to increase in tone
lesion on extrapyramidal tract)
No muscle atrophy
minor in chronic state
in time, it will have disused
atrophy
Clonus manifested
rapid, strong muscle contraction
when paralyzing limb is grasped
firmly
lesion on extrapyramidal tract
(+) Babinski sign
dorsiflexion of big toe and
fanning out of other toes
lesion on corticospinal tract
Loss of certain superficial
reflexes
lesion on pyramidal tract
a. Superficial abdominal reflex
b. Cremasteric reflex

Areas exhibiting clonus:


Flexors of fingers
Gastrocnemius
Quadriceps femoris
Babinskis reflex (Extensor plantar reflex)is normally
present in children of about 1 year of age because the
corticospinal tract fibers are not yet fully myelinated.
Stimulation is through the application of pressure on the
lateral border of the sole of the foot from the back of the
heel to the base of the toes.
Superficial
abdominal
reflex
is
elicited
by
scratching/stroking the skin of the abdomen. Normally, the
muscles should contract.
Cremasteric reflex is elicited by stroking the inner aspect
of the thigh, normally causing the scrotum and testis to
retract on the same side.
Babinskis reflex, superficial abdominal, and cremasteric
reflexes are specific for a lesion on the pyramidal tract.
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A.

V. CORTICOBULBAR TRACT
Arise from the face region of the primary motor cortex (BA
4), also from BA 6 and 3, 1, 2
End at the midbrain
Project to:
o Motor nuclei of CN III, IV, V, VI, VII, IX, X, XI and XII
(every CN EXCEPT 1, 2, 8 which are sensory)
o Parts of reticular formation (Corticoreticular fibers) in
pons and medulla for controlling the movements of
emotions such as smiling, laughing
o Sensory relay nuclei (nucleus gracilis, nucleus
cuneatus, sensory trigeminal nuclei, nucleus of
solitary fasciculus) controls the sensory inputs that
arrive at CNS
Projections are bilateral receive innervations from both
contralateral and ipsilateral cortex EXCEPT:
o Facial motor nucleus
o Hypoglossal nucleus
Also pass through the internal capsule, located at the genu

FACIAL MOTOR NUCLEUS

Dorsal part
o Innervates upper half of the face
o Receives innervations from both contralateral and
ipsilateral cerebral cortex
Ventral part
o Innervates lower half of the face
o Only receives innervations from the contralateral
cerebral cortex
Central facial paralysis
o UMN/supranuclear lesion of the corticobulbar tract
o Dorsal part still receives innervations from the same
side of cerebral cortex thus, some functions are still
retained (able to wrinkle forehead muscle)
Peripheral facial paralysis (Bells Palsy)
o LMN lesion of facial nerve or motor nucleus
o Complete paralysis of half of the face on the same
side of the lesion (ipsilateral)

Figure 5. Shaded areas of the face show the distribution of facial


muscles paralyzed after a supranuclear lesion of the corticobulbar
tract & a lower motor neuron lesion of the facial nerve
PRACTICE PROBLEM 1

Case Scenario: A post-stroke patient with inability


to move the left half of the face but can still wrinkle
both eyebrows
Type of lesion? UMN
Where is the lesion? Right Supranuclear
PRACTICE PROBLEM 2

Case Scenario: A patient upon waking up in the


morning is unable to move the entire right half of his
face.
PHHx: had chicken pox 2 weeks prior
Type of lesion? LMN
Diagnosis? Bells Palsy
Where is the lesion? Right Nucleus of Facial Nerve
Prognosis? Excellent; 85% or more recover
B.

HYPOGLOSSAL NUCLEUS

Controls genioglossus muscle of the tongue: draws the


root of the tongue forward to the opposite side
Corticobulbar projections are largely contralateral
If the patient is normal (no lesion) tongue is protruded at
the midline
UMN lesion
o Tongue would point or deviate to the opposite side of
the lesion
o Without atrophy
o Example: if there is left UMN lesion, it will affect right
genioglossus muscle; thus, ability to draw the tongue

Group 17|Esguerra, Eslao, Esling, Espelimbergo, Esternon, Estevanez, Estrada, Estrellado

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to the left is defective, the tongue will then be drawn


to the right
LMN lesion
o Ipsilateral
o Tongue will be pushed on the same side of the lesion
o With atrophy

B.

Function: Mediate reflex postural movements in response


to visual and auditory stimuli (head turning and eye
movement)

RUBROSPINAL TRACT

Origin: Red nucleus (mesencephalic structure seen at the


level of superior colloculus)
FIbers: Crosses immediately in the ventral tegmental
decussation -> Diffuses as it descend through the
brainstem -> Enter the lateral funiculus of the spinal cord
and lie anterior and lateral to the lateral corticospinal tract
Termination: Internuncial neurons (anterior gray column)
Functions:
o Influences both alpha and gamma anterior horn cells
o Influences control of tone in flexor muscle groups
o Activates contralateral flexor motor neurons while
inhibiting contralateral extensor fibers

Figure 6. Lesion on Hypoglossal Nucleus

PRACTICE PROBLEM 3

Caes Scenario: The resident noted that the tongue


of a post-stroke patient is atrophied and deviated to
the LEFT
Type of lesion? LMN
Where is the lesion? LEFT Hypoglossal Nucleus
PRACTICE PROBLEM 4
Caes Scenario: The resident noted that the tongue
of a post-stroke patient is NOT atrophied and
deviated to the LEFT
Type of lesion? UMN
Where is the lesion? Right Corticobulbar Fibers

VII. OTHER DESCENDING TRACTS


MIDBRAIN
A.

Figure 7.Rubrospinal Tract

NOTE: Red nucleus receives afferent fibers from cerebral cortex


and cerebellum which influences the activity of the alpha and
gamma motor neuron of the spinal cord.

TECTOSPINAL TRACT and TECTOBULBAR TRACT

Origin: Superior colliculus


Fibers:
o Level of midbrain: Crosses at the tegmental
decussation
o Level of medulla: Incorporated in the Median
Longitudinal Fasciculus (MLF)

Termination: Anterior gray column in the upper cervical


spinal cord in Rexed laminae VI, VII and VIII (Tectospinal)
Group 17|Esguerra, Eslao, Esling, Espelimbergo, Esternon, Estevanez, Estrada, Estrellado

Interstitiospinal tract
o Origin: Interstitial nucleus of Cajal
o Uncrossed and forms part of the MLF
o Termination: Anterior horn of upper cervical levels of
spinal cord including laminae VII and VIII
o Function: modulates reflex postural movements in
response to visual and vestibular stimuli
PONS/MEDULLA

A.

VESTIBULOSPINAL TRACT

Concerned with postural activity associated with balance


(maintains balance)
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Acts on the motor neurons in the anterior grey columns,


facilitating the activity of the extensor muscles and inhibiting
the flexor muscles
o Vestibular nuclei:

Situated in the pons and medulla oblongata beneath


th
the floor of the 4 ventricle

Receive afferent fibres from the inner ear through the


vestibular nerve and from the cerebellum

Axons give rise to the vestibulospinal tract

Tract descends through the medulla and spinal cord


uncrossed to the anterior white column

Terminate by synapsing with the internuncial neurons


of the anterior grey column of the spinal cord

o
o
o
o
B.

Reticulospinal Tract

Tracts enter the anterior grey columns of the spinal cord to gain
access to alpha and gamma motor neurons
Facilitate and inhibit activity of the alpha and gamma motor
neurons in the anterior grey columns, influencing voluntary
movement and reflex activity
Includes the descending motor fiber; allows access from the
hypothalamus to the sympathetic and sacral parasympathetic
outflows
Reticular Formation: groups of scattered nerve cells and nerve
fibres scattered throughout the midbrain, pons, and medulla
oblongata
Example: respiration, circulation, dilation, sweating, shivering,
sphincter control of GIT and urinary tract

1.

Lateral Vestibulospinal Tract


o Origin: lateral vestibular nucleaus
o Descend in anterolateral funiculus
o Extends the length of the spinal cord

Termination: rexed laminae VII and VIII on alpha and


gamma motor neurons on all cervical cord segments

Afferents: vestibular nerve and cerebellum

Excites motor neurons innervating neck, back, limb


muscles

ipsilaterally long

Termination: rexed laminae VII and VIII on alpha and


gamma motor neurons on all cervical cord segments
Afferents: primary vestibular, mesencephalic and
cerebellar
Excites motor neurons innervating neck and back
bilaterally short

1.

Pontine(Medial) Reticulospinal Tract


Origin: Pons
Descends into the spinal cord mostly uncrossed
Descends through the anterior white column (anterior
funiculus of SC) all cord levels, laminae VII and VIII
o Facilitate extensor motor neurons
o ipsilaterally long
o
o
o

2.

Medullary (Lateral) Reticulospinal Tract


Origin: medulla
Fibers project bilaterally to spinal levels
Descends into the spinal cord crossed and uncrossed
Descends through the lateral white column (lateral
funiculus) all cord levels, laminae VII and IX
o Inhibit extensor motor neurons
o
o
o
o

Figure 8. Lateral Vestibulospinal Tract

2.

Medial Vestibulospinal Tract


o Origin: medial vestibular nucleus
o Descend in MLF anterior funiculus of SC (until
midthoracic level only)

Group 17|Esguerra, Eslao, Esling, Espelimbergo, Esternon, Estevanez, Estrada, Estrellado

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