NEUROSCIENCES I: Disorders of the Motor System

Lecturer: Hazel L. Paragua-Zuellig, MD, MBA, FPNA (HPZ)

OUTLINE
I. Review of Motor System
II. Examination of Motor System
III. Cases
I. REVIEW
A. WEAKNESS
Lack or diminution of muscle strength
Leads to inability to perform the usual function of a given
muscle or group of muscles
Fatigue subjective perception
Usually referable to a dysfunction of the corticospinal tract
Could be associated with gait disturbances or muscle
atrophy but not all the time
B. PYRAMIDAL TRACTS
derive their name from the medullary pyramids of the
medulla oblongata, which they pass through
responsible for the voluntary control of the musculature of
the face and body
can be subdivided into two:
1. Corticospinal tracts supplies musculature of the
body (trunk and extremities)
2. Corticobulbar tracts supplies musculature of the
head and neck

04 JANUARY 2015
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1. CORTICOSPINAL TRACTS
begins in the cerebral cortex, from which they receive a
range of inputs
o primary motor cortex
o premotor cortex
o supplementary motor cortex
after originating from the cortex, neurons converge and
descend through the internal capsule, and then pass
through the brainstem
in the most caudal part of the medulla, the tract divides
into two:
1. lateral corticospinal tract

90% of the tracts

decussates at the medulla; contralateral

terminates at all segmental levels

2. anterior corticospinal tract

10% of the tracts

remains ipsilateral

terminates at the cervical and upper thoracic

segmental levels
synapse: anterior horn cell (UMN) ventral root (LMN)
MOTOR PATHWAY (CORTICOSPINAL TRACT)
Motor cortex
Corona radiata
Internal capsule
Cerebral peduncle
Brainstem
Lateral corticospinal tract
Anterior corticospinal tract
Cervicomedullary junction
Cervicomedullary junction
(decussation)
Spinal cord
Anterior horn cell
Ventral root (cervical and
Ventral root (all segmental
upper thoracic segmental
levels)
levels)
Peripheral nerve
Neuromuscular junction
Muscle
2. CORTICOBULBAR TRACTS
arise from the lateral aspect of the primary motor cortex
receive same inputs as the corticospinal tracts
nerve fibers converge and pass through the internal
capsule to the brainstem
neurons terminate on the motor nuclei of the cranial
nerves (VII and XII)
at the level of the CN: synapse with LMN, carrying signals
to muscles of face and neck
MOTOR PATHWAY (CORTICOBULBAR TRACT)
Motor cortex
Corona radiata
Internal capsule
Cerebral peduncle
Brainstem
Cranial nerves
BILATERAL INNERVATION
a cranial nerve on one side receives input from both the
right and the left motor cortex
therefore, UMN lesions must be bilateral in order to cause
a deficit
majority of the tracts are bilateral in nature except:
1. Facial nerve (CN VII)

only the forehead muscles are bilaterally

innervated

TRANSCRIBED BY: MALASO

Trans No. 5.1

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UMN lesion spastic paralysis in contralateral

lower quadrant of face; upper quadrant is saved
by the ipsilateral innervation

LMN lesion contralateral upper and lower

quadrants will have deficits
Hypoglossal (CN XII)

UMN lesion deviation of the tongue to the

contralateral side

2.

Skin lesions gangrene and diabetic frost are signs of

damaged peripheral nerves
C. NEUROLOGIC EXAMINATION
Distribution of weakness
Muscle bulk
Muscle tone
Key muscles involved
Deep tendon reflexes
D. LOCALIZATION
1. Laterality left or right
2. Level UMN or LMN

Muscle strength

Atrophy

UMN
-myopathy
Weak, usually
unilateral (hemi-)

LMN
-neuropathy
Weak, usually
bilateral (para-)

Proximal > distal

Mild (atrophy of
disuse)

Proximal < distal

Present, more
profound (atrophy of
denervation)

Electrical stimulation
can be done

Deep tendon reflex

Muscle tone

II. EVALUATION OF MOTOR SYSTEM

A. History- taking
B. Physical Examination
C. Neurologic Examination
D. Laboratory Work-up
E. Localization
F. Differential Diagnosis
A. HISTORY TAKING
1. Onset Kelan pa yan?
Rule of 7s
Within 7 hours stroke
Within 7 days infection
Within 7 months neoplastic
Within 7 years congenital or degenerative
a. Acute sudden
b. Chronic
2. Course Lumalala po ba? Nawawala tapos bumabalik?
a. Progressive lumalala
b. Remissions temporary recovery, will relapse
c. Exacerbations
3. Distribution
a. Ano pong mas mahirap, magsuklay o magbukas ng
door knob?
proximal UMN
distal LMN
b. Grading motor strength:
hemi one side
para one level and below
paretic grade above 0
plegic grade is 0
4. Associated Neurologic symptoms dysphagia, dysarthria,
diplopia, ataxia, numbness, paresthesias, seizures, etc.
5. Others fever, exposure to toxins, medications
B. PHYSICAL EXAMINATION
Tachycardia fever, dehydration
Evidence of liver and cardiac dysfunction spider angioma,
palmar erythema
Signs of hyperthyroidism manifests as distal weakness
NEUROSCIENCES I || Disorders of the Motor System

Abnormal
movements

Hyperactive
Hypertonic (spastic)
-kahit di mo
hawakan, tense
Withdrawal spasms,
abnormal reflexes
Purely motor

Putol na yung nerve,

di na kayang
magstimulate ng
muscle
Hypoactive or absent
Hypotonic (flaccid)
-lupaypay
Fasciculations
(ripples)
Sensorimotor

a
b
a. Make the patient smile. Shallow nasiolabial fold paralysis
on right lower quadrant of face
b. Make the patient close his/her eyes. Incomplete closing of
eyelids paralysis on right upper quadrant of face
Localization: LMN
E. ETIOLOGIES OF LESIONS
AFFECTING THE MOTOR TRACTS
What could it be?
Traumatic
Neoplastic tumor
Vascular stroke
Metabolic - diabetes
Toxic poisoning
Degenerative ALS
Congenital / Developmental
Infectious
Immunologic (inflammatory) multiple sclerosis
III. CASES

Trans No. 5.1

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