Corticospinal tract pyramidal

tract
And corticobulbar tract

Peculiarities:

Important out put of motor cortex

Only tract having direct connections with -motor

neurons and neurons of motor cranial nerves

Developed only in higher animals

85-90% fibers slow conducting myelinated

end on interneurons

Fast conducting fibers arise from Betz cells

- end directly on -motor neurons

Thala.

Corona
radiata

Motor cortex

Post limb

III, IV

Cerebral
peduncles

Internal capsule
C.N.

Mid brain
Post.

V, VI, VII

Long.
fasciculi

Pons
Ant.

IX,XI,XII

Medulla

Pyramids
decussation
Lat. CST

SP.Cord
Ant.CST

Motor cortex

Internal capsule
Corticobulbar fibers

Decussasion of pyramids
Ant. corticospinal
Lat. Cortico spinal

Ant. Motor fibers

Origin:1. Primary motor cortex (area 4 ) 30% (3% large pyramidal cells- Betz cells )
2. Premotor cortex (area 6 ) & area 8 -30%
3. Somatosensory cortex (SI & SII) (3,1,2 & 40)
parietal lobe association areas (5,7) 40%

Inputs of motor cortex : Somatosensory, visual and auditory cortex

Motor cortex of opposite side
Thalamic sensory nuclei
Basal ganglia & cerebellum through thalamus
Intralaminar nuclei

Course :-

Corona radiata in subcortical areas

Genu & post limb of Internal capsule

Middle 3/5 of crus cerebri face medially & legs
laterally, fibers to III, IV

Longitudinal fasciculi in pons,

fibers to V, VI, VII

Pyramids in upper part of medulla,

80% cross

Lat. CST

fibers to IX, XI, XII

20% - uncrossed
In lower part of medulla

Ant. CST In the spinal cord

Termination :Cervical region 55%

Thoracic region 20%
Lumbosacral region 25%

Fibers ending in each segment turn medially

Directly on - motor
neurons -10%
Innervating distal
groups of limb muscles

Through
interneurons

Fibers arising from

somatosensory
cortex
end on Dorsal
horn cells

Collaterals of corticospinal tract

TO

cortex for lat inhibition

sharpness of boundaries.

To

Caudate and lentiform nuclei,

Red n. rubrospinal

To cerebellum

Reticular n. reticulospinal
Vestibular n. vestibulospinal
Pontine n. pontocerebellar
Olivary n. olivocerebellar

Direct / ventral / uncrossed corticospinal tract

-15% fibers directly descend in ant. white column
without crossing in medulla.
-Origin - supplementary motor areas
- Extend up to mid thoracic region
-Termination - on the interneurons of the
same side or of the opposite side
- Function - Control of axial muscles on both sides.

Corticobulbar pathways :Formed by the fibers leaving corticospinal tract in

the brain stem and ending in the nuclei of the
motor cranial nerves on opposite side
Mid brain

III, IV

Pons

V, VI, VII

Medulla

IX, X, XI, XII

Functions
control vol. movement of muscles of larynx,
pharynx, palate, face, jaw and eyes.

Functions of pyramidal tracts:1.

Lat.CST rapid, skillful movements of hands

Ant. CST postural adjustments and gross
movements of trunk.

Corticobulbar tract - vol. movements of

muscle of head and neck.

Forms part of pathway for superficial reflexes

Modify sensory input

Sensory motor co-ordination

Applied aspects :1. Phylogenetically, ant. CST is older

Lat. CST - in human beings and few vertebrates
2. Myelination is complete after the age of 2 yrs.
3. Most common lesion of pyramidal tract is hemorrhage
in the internal capsule
4. Apoplexy or stroke means sudden attack of paralysis
Monoplegia - primary motor cortex
hemiplegia - internal capsule
quadriplegia or paraplegia brain stem

Clinical picture in Pyramidal tract lesionsLesion above the level of sp. Cord effects on
opposite side of body
Lesion in the spinal cord effects on the same side
Impairment of vol., skilled movements
Increased muscle tone clasp knife rigidity
Exaggerated tendon reflexes and clonus
Extensor planter reflex Babinskis response
loss of superficial reflexes

Toes down
(flexion)
Fanning
of toes

Normal planter response

Extensor planter response

(Babinski sign)

Supranuclear lesion (UMN)

Motor area for face

Corticobulbar tract

Facial nerve n.

Facial nerve
Facial paralysis

Functions of E.P.S.
1. Alternative channel for Vol.
and reflex activity
2. Coarse movements of trunk &
whole limb.
3. Changing tone of muscle
4. Background posture

EXTRAPYRAMIDAL TRACTS
Motor fibers arising from subcortical
areas
brain descending outside the corticospinal
tract,
-- reaching sp.cord
-- Ending on or motor neurons
--ipsilat. Or contralat.
--Multichannel system

EPS
1.Rubrospinal
2.Tectospinal
3.Lat. Vestibulospinal
4.Medial vestibulospinal
5.Pontine reticulospinal
6.Medullary reticulospinal

RRTV

Midline

cortex
putamen

C.N.
S.N.
Red n.

cerebellum

Pontine. Ret. formation

S.C.

Med. Ret. formation

Vesti. N.

+
-

-
+

Some peculiarities of individual tract

Rubrospinal crossed
- located in lat. White column
- part of lat. motor system
- extend up to mid tho. Level
- facilitatory to flexors of wrist
Tectospinal crossed
- from sup. colliculus
- lower cervical region
- visually guided move. of head

Rotation of head

Linear acceleration

Semicircular
canals
Medial vesti. N.

Utricle, saccule

Lat. vesti.
N.
Uncrossed
Uncrossed fibers
fibers
III. Medial vestibulospinal IV. Lat. vestibulospinal
Ant. White
column

Lat White
column
-motor neurons
Through out the length of sp.
cord
Facilitation of extensors and inhibition of

 Normally, inhibitory control

of medullary reticulospinal
tract is prominent on the
muscle tone

FUNCTIONS OF EPS
Control of tone, posture and equilibrium
Control of complex movements of the
body and limbs
Tonic inhibitory control over lower centers

Pyramidal system Extrapyramidal system

subcortical
Cortical
Origin
Myelination After birth
Course

Monosynaptic

Main control Upper extremity

controlled
muscle

Flexors of hand
and fingers

Functions

Skilled
movements

Effects of

During iu life
polysynaptic
Lower extremity
Postural
muscles

Gross
movements

LMNP
Site of
lesion

- or cranial
motor
neuron
-single muscle
on the same
sidelost

Neurons
forming
descending
Groups of
tracts
muscles
on opposite
side
lost

- flaccidity

Clasp-knife rigidity,
spastic paralysis

Muscle
s
Involve
Vol.
d
movements
Tone of involved
muscles

UMNP

Superficial reflexes
lost
Planter reflex
affected
Tendon jerks
lost
Muscle atrophy
wasting

LMNP

UMNP

lost
lost only if Babinskis +ve
S1 is

marked

Exaggerated,
clonus+
absent

 Site of lesion

LMNP

- - or cranial
motor neuron
Muscles Involved -single muscle
on the same side
Voluntary movements - lost
Tone of the muscles - flaccidity
involved
Superficial reflexes
Planter reflex
Tendon jerks
Muscle atrophy

UMNP

Neurons forming
descending tracts
Groups of muscles
on opposite side
lost
Clasp-knife
rigidity,spastic
paralysis
lost
Babinskis +ve

lost
lost only if S1
is affected
lost
Exaggerated,
clonus+
marked wasting absent

II. Stage of reflex activity

paralysis in flexion

o Appearance of ANS reflexes first after 1 wk

tonic symp. discharge. - sed response to pain

reflex contraction of bladder but

incomplete evacuation
- hyper active ,small bladder
- Vasomotor tone returns
Skin warm, pink due to
improved circulation
B.P. normal but baroreceptor
regulation absent so wide swings

LOWER MOTOR NEURON PARALYSIS -- POLIOMYELITIS

Viral infection of lower motor neuron

Lesion of Final common pathway

Muscles innervated are paralyzed
Paralysis on the same side of lesion
Tone --flaccidity hypotonia
Reflexes - deep lost,
superficial lost
Muscle atrophy present loss of specific
trophic factors, disuse

UPPER MOTOR NEURON PARALYSIS

Monoplegia - cerebral cortex
Hemiplegia of opposite side int. capsule

--with 3rd nerve of same side mid brain

Hemiplegia with VII,IX,X,XII nerves - Pons
medulla

CLINICAL CONDITIONS

UMNP

LMNP

Complete transection of Sp.

Cord

Hemisection of Sp. Cord

Syringomyelia

Main Clinical features: Group of muscles are affected

Paralysis on the opposite side of lesion
Tone spasticity or rigidity hypertonia
Reflexes - deep exaggerated,
superficial lost they are
mediated by long tracts
Babinskis sign +ve

Muscle atrophy - absent

STROKE
UMNP Due To C.V.A.
SPASTICITY Signs Due To
Involvement of PS & EPS

BABINSKIS SIGN

Superficial reflex
Firm tactile stimulus to lat.
side of sole
Extension of great toe,
fanning of toes
Seen in lesions of CST,
infants, deep sleep, coma

Explanation:- CST
supresses withdrawal reflex.
Damage to CST reveals
withdrawal reflex

COMPLETE TRANSECTION OF SP.CORD

Causes :

# spine
Gunshot injury
Transverse myelitis
Occlusion of blood vessel

Sign and symptoms observed at the

level & below site of injury

Stages of spinal injury

1. Stage of flaccidity about 2 wks. in
human
2. Stage of reflex activity paralysis in flexion
3. Stage of failure of reflex activity
CHANGES OCCURE IN - ANS REFLEXES
MUSCLE TONE
SOMATIC REFLEXES

Stage of spinal shock

starts immediately, lasts for 2 wks.
Complete sensory loss
Motor system -- Complete paralysis
Muscle tone -- Flaccidity
Reflexes superficial - Absent
deep - Absent

ANS reflexes- vasomotor tone B.P.

paralysis of bladder& rectum
cold, dry, scaly skin leads to bed
sores,
cyanosis due to venous
return
Complications
malnutrition, -ve nitrogen balance,
osteoporosis, urinary stones, septicaemia etc.

Muscle tone normal but more in flexors,

repeated flexor response-flexor
contracture
no wasting
Attutude :- upper limb adducted and
semiflexed
lower limb abducted and

Reflexes

flexor response appears first,

Babinskis + ve

Exaggerated prolonged withdrawal

reflex
mass reflex after several
months
stretch reflexes exaggerated
No improvement in sensations

Mass reflex in chronic spinal animals

scratching of inner side of thigh
flexor spasm of both legs,
&
contraction of abdominal muscles
Emptying of bladder, profuse sweating.
Pallor and blood pressure swings
Occur due to irradiation of afferent stimuli from
one reflex center to another. Used by paraplegic
to have some control over urination and

III. Stage of reflex failure

Infections , malnutrition, muscle
wasting, bed sores, UTI, uraemia
Slow disappearance of mass reflex and
other reflexes
Coma death

MANAGEMENT
management of nutrition, fluid
balance
Use of antibiotics
Proper skin care
Acute administration of large doses of
glucocorticoids

Brown Sequard Syndrome

Hemisection Of Spinal
Cord
Causes:- gun shot injuries, accidents, tumors
Clinical
I. Below
picture
:- the site of

lesion
a) On same
side- Motor UMN lesion
spastic paralysis,
Babinskis,
reflexes

Clasp knife rigidity+ve

exaggerated tendon

Sensory - loss of proprioception,

vibration sense,
discrimination
b) On opposite side
Motor no
effect loss of pain and
Sensory
temperature
II. At the site of lesion LMN paralysis,
ipsilat. anaesthesia

On oppo.
side
Loss of

Left

pain,temp
.
Lat.STT

midlin
e

righ
t

On same
side 1.Loss
of
proprioceptio
Lat.STT
n,vibration
Site of
lesion
2.UMNP

Dorsal column
Dorsal column
Lat.CST
Pain ,temp.

Lat.CST

SYRYNGOMYELIA- dissociated anaesthesia

Cause :- central cavitation of spinal cord beginning in cervical region with

gliosis.
Interuption of crossing fibers.
Initially, Yolk like anaesthesia for pain & temperature over shoulder and
upper limb. With LMN weakness in upper limb. Fine touch preserved
Later, UMN paralysis in lower limb.
Rhombergs sign is +ve.