Nervous System Module

Dr. Gamal Taha Abdelhady

Assistant Professor of Anatomy & Embryology

Motor
Tracts
 Motor Pathways

◼ Descending pathways in the brain and

spinal cord that control the activities of
skeletal muscle.

◼ Regulate the activities of skeletal muscle.

 Motor tracts
◼ CNS transmits motor commands in
response to sensory information

◼ Motor commands are delivered by the:

◼ Somatic nervous system (SNS): directs

contraction of skeletal muscles

◼ Autonomic nervous system (ANS): directs

the activity of glands, smooth muscles, and
cardiac muscle
 Motor Tracts
◼ There are two major descending tracts

◼ Pyramidal/Corticospinal tract: Conscious

control of skeletal muscles

◼ Extrapyramidal/ Subconscious tract:

Subconscious regulation of balance, muscle
tone, eye, hand, and upper limb position (i.e.
subconscious integrative coordination of
muscular activity)
 Motor Tracts
Upper Motor Neurons
Are entirely within the CNS. Originates in:
Cerebral cortex – Brainstem forming the
descending tracts regulating the LMN activity

Lower Motor Neurons

Begins in CNS: From anterior horns of spinal
cord and from brainstem cranial nerve nuclei.
Makes up spinal and cranial nerves that
innervate skeletal muscles
 Motor Tracts
◼ The Pyramidal Tract (conscious tracts), three
pairs of descending tracts ending directly on lower
motor neurons in the brainstem or spinal cord.

1. Corticobulbar (nuclear) tracts: conscious

control over eye, jaw, and face muscles (Cranial
Nerves)

2. Anterior and Lateral corticospinal tracts:

conscious control over skeletal muscles of trunk
and limbs
 Motor Tracts
◼ The Subconscious Motor Tracts

◼ Consists of four tracts involved in

monitoring the subconscious motor control

1. Vestibulospinal tracts
2. Tectospinal tracts
3. Reticulospinal tracts
4. Rubrospinal tracts
 Execution
◼ Cerebral cortex initiates voluntary movement.

◼ Information goes to the basal nuclei and

cerebellum

◼ These structures modify and coordinate the

movements, so they are performed in a smooth
manner

◼ Information goes from the basal nuclei and

cerebellum back to the cerebral cortex to
constantly monitor position and muscle tone
 Motor Pathways
Origin of Motor Signal

◼ The corticospinal tracts begin in the cerebral

cortex, from which they receive a range of inputs:

1. Primary motor cortex (area 4)

2. Premotor cortex (area 6)
3. Supplementary motor area

◼ They also receive nerve fibers from the

somatosensory area, which play a role in
regulating the activity of the ascending tracts.
 Pyramidal and
Extrapyramidal Systems
◼ Pyramidal and extrapyramidal systems can
only be separated anatomically but not
functionally!

◼ None of the two systems can work

properly alone, they constitute one motor
system together!!!
 Pyramidal and
Extrapyramidal Systems
◼ Pyramidal system is the chief organizer
and executor of voluntary movements.

◼ Extrapyramidal system includes all the

motor centres and pathways that lie
outside the pyramidal system and are
beyond voluntary control.
 Pyramidal Tract
◼ Starts in upper motor neurons in cerebral motor cortex
(approx. 1 million in number)

◼ Axons form internal capsule in cerebrum and pyramids in the

medulla oblongata

◼ Descending axons of upper motor neurons that terminate in

the motor nuclei of cranial nerves and in the spinal cord
constitute the corticonuclear and corticospinal tracts,
respectively.
CORTICOSPINAL TRACT
 Pyramidal Tract
◼ The corticonuclear tract reaches the
lower motor neurons of both sides
(bilateral innervation)

◼ While corticospinal fibres target the

lower motor neurons of the opposite
side only (crossed pathway).
 Pyramidal Tract
◼ Most of the fibers 90 % cross the midline
(motor decussation) descend in the lateral
column as LCST terminate on LMN of anterior
gray column at all spinal level

◼ Remaining uncrossed fibers descend as ACST

eventually fibers cross the midline and
terminate on LMN of anterior gray column of
respective spinal cord segments in cervical and
upper thoracic segmental levels.
 Pyramidal Tract
◼ Lateral corticospinal tracts
◼ Skilled movements (hands & feet)

◼ Anterior corticospinal tracts

◼ Controls neck & trunk muscles

◼ Corticobulbar tracts
◼ Cortex to nuclei of CNs
◼ 3,4,5,6,7,9,10,11&12

◼ For movements of eyes, tongue, chewing,

expressions & speech
 Sceletal
muscles of
the head and
neck

Sceletal muscles of
the trunk and
limbs
 Corticobulbar Tracts
◼ The corticobulbar tracts arise from the lateral
aspect of the primary motor cortex. They receive
the same inputs as the corticospinal tracts.

◼ The fibers converge and pass through the internal

capsule to the brainstem.

◼ The neurons terminate on the motor nuclei of the

cranial nerves. Here, they synapse with lower
motor neurons, which carry the motor signals to
the muscles of the face and neck.
 Corticobulbar Tracts
◼ The fibers terminate in several locations in the
midbrain (corticomesencephalic tract), pons
(Corticopontine tract), and medulla
oblongata (corticobulbar tract).

◼ The nerves within the corticobulbar tract are

involved in movement in muscles of the head.

◼ They are involved in swallowing, phonation, and

movements of the tongue.
CORTICONUCLEAR TRACT
 Clinical Significance

◼ Fibers of the corticospinal tracts are

damaged anywhere along their course
from the cerebral cortex to the lower end
of the spinal cord, this will give rise to an
upper motor neuron syndrome
 Extrapyramidal Systems
◼ Coordinates movements of various groups of muscles both in
space and time

◼ Regulates job and sport-specific automatic movements

consisting of periodic elements (e.g. walking, running, riding a
bike, dancing, driving a car, handwriting or typing, etc.)

◼ Controls emotional movements

◼ Helps to control posture and balance

◼ Regulates muscle tone.

 Extrapyramidal Tracts
◼ The extrapyramidal tracts originate in the
brainstem, carrying motor fibers to the spinal cord.

◼ There are four tracts in total:

◼ The vestibulospinal and reticulospinal tracts

do not decussate, providing ipsilateral
innervation.

◼ The rubrospinal and tectospinal tracts do

decussate, and therefore provide contralateral
innervation.
 Vestibulospinal Tract
◼ There are two vestibulospinal pathways; medial and
lateral.

◼ They arise from the vestibular nuclei (medial and

lateral nuclei), which receive input from the organs
of balance.

◼ The tracts convey this balance information to the

spinal cord, where it remains ipsilateral.

◼ Fibers in this pathway control balance and posture

by innervating the ‘anti-gravity’ muscles (flexors of
the arm, and extensors of the leg), via lower motor
neurons.
 Vestibulospinal Tract
◼ Function (Medial Vestibulospinal): head-
righting reflex to keep the head and vision
horizontal when the body is tilted.

◼ Function (Lateral Vestibulospinal): This

tract mediates excitatory influences upon
extensor motor neurons to maintain posture.

A loss of these tracts can produce

disorientation and postural instability.
 Reticulospinal Tracts

◼ Nerve cells start in reticular formation

◼ Fibers pass through midbrain, pons, and medulla

oblongata

◼ End at the anterior gray column of spinal cord

control activity of motor neurons

◼ They are important that they results in refining of

voluntary movement by preventing unnecessary
contractions that would result with shaking
 Reticulospinal Tracts
◼ The two reticulospinal tracts have differing
functions (Both uncrossed):

◼ The medial (Pontine) reticulospinal tract

arises from the pons. It facilitates voluntary
movements, and increases muscle tone to axial
and limb antigravity muscles

◼ The lateral (Medullary) reticulospinal tract

arises from the medulla. It inhibits voluntary
movements, and reduces muscle tone to axial
and limb antigravity muscles
 Rubrospinal Tract
◼ Nerve cells in red nucleus (tegmentum of midbrain
at the level of superior colliculus)

◼ Nerve fibers / axons cross the midline descend as

rubrospinal tract through pons and medulla oblongata

◼ Terminate in anterior gray column of spinal cord

(facilitate the activity of flexor muscles )
primarily in the cervical spinal cord

◼ Function: This tract is excitatory for

flexors and inhibitory for extensors in
distal limb (like corticospinal tract)
 Tectospinal Tracts
◼ This pathway begins at the superior
colliculus of the midbrain. The superior
colliculus is a structure that receives input
from the optic nerves.

◼ The neurons then quickly decussate, and

enter the spinal cord. They terminate at
the cervical levels of the spinal cord.
 Tectospinal Tracts
◼ It is responsible for motor impulses that arise
from one side of the midbrain to muscles on
the opposite side of the body.

◼ The function of the tectospinal tract is to mediate

reflex postural movements of the head in
response to visual and auditory stimuli.

◼ The tract descends to the cervical spinal cord to

terminate in Rexed laminae VI, VII, and VIII
to coordinate head, neck, and eye
movements, primarily in response to visual
stimuli
 Lower Motor Neurons ( LMN )
◼ Motor neurons that innervate the
voluntary muscles and skeletal muscles

1. In anterior gray column of spinal

cord.

2. Motor nuclei of brainstem

3. Or their peripheral nerves

 Lower Motor Neurons ( LMN )
◼ Form final common pathway

◼ Lower motor neuron are constantly

bombarded by nerve impulses (excitatory
or inhibitory) that descend from cerebral
cortex, pons, midbrain and medulla.

◼ Sensory inputs are carried through the

posterior root.
 UMNL Paralysis
◼Injury any where from the cortex till
AHC
Damage upper motor neurons = Spastic
paralysis
1. Paralysis (spastic) on opposite side from injury

2. Loss of fine skilled movements

3. Increased muscle tone

4. Exaggerated reflexes
 LMNL Paralysis
◼ Injury any where following the AHC

◼ Damage lower motor neurons = Flaccid

paralysis

1. No voluntary movement (paralysis) on same side

as damage

2. No reflex actions

3. Muscle limp & flaccid

4. Decreased muscle tone

Common Spinal
Cord Lesions
 Spinal Cord Lesions
Complete transverse section
(transection) of the spinal cord:

Above C5 → death (due to paralysis of

diaphragm and intercostal muscles).

Between C5 –T1 → Quadriplegia.

Below T1 → Paraplegia.
 Central Gray Matter - Central
Cord Syndrome
◼ Seen in syringomyelia (progressive cavitation
around or near the central canal of spinal
cord especially in cervical segments)

◼ Interrupt fibers of lateral spinothalamic tract

that passes in front of the central canal.

◼ Loss of pain and temperature sensibility on

both sides proprioception and light touch is
spared (sensory dissociation).
 Anterior Cord Syndrome
◼ Anterior spinal artery syndrome the primary blood
supply to the anterior portion of the spinal cord, is
interrupted, causing ischemia or infarction of the
spinal cord in the anterior two-thirds of the
spinal cord and medulla oblongata.

◼ It is characterized by loss of motor function

below the level of injury, loss of sensations
carried by the anterior columns of the spinal
cord (pain, temperature and touch) sparing
posterior column sensations
 Posterior Cord Syndrome
◼ Is a condition caused by lesion of the posterior
portion of the spinal cord caused by an
interruption to the posterior spinal artery.

◼ Unlike anterior cord syndrome, it is a very rare

condition.

Clinical presentation:

◼ Loss of proprioception + vibration sensation + loss

of two point discrimination +loss of light touch
 Brown-Sequard syndrome
Hemi-section of the spinal cord

1. Dorsal column damage

2. Lateral column damage
3. Anterolateral column damage
4. Damage to local cord segment and nerve
roots
 Brown-Sequard syndrome
◼ Same level of lesion

Loss of all sensation, hypotonic

paralysis and loss of all reflexes related
to the affected side
 Brown-Sequard syndrome
◼ Below the level of lesion

◼ On the side of lesion, dorsal column damage

1. Loss of position sense
2. Loss of vibratory sense
3. Loss of tactile discrimination

◼ Anterolateral system damage

1. Loss of sensation of pain, temperature and touch on
the side opposite the lesion

◼ Motor affection: UMNL, with spastic paralysis and

exaggerated reflexes
 Tabes Dorsalis
This is caused by syphilis - destruction of nerve
fibers of the dorsal root of spinal nerves.

Initially, irritation of the pain fibers: severe pain in the

dermatomes supplied by the affected dorsal roots.

Later on, degeneration of nerve fibers leads to:

1. Loss of deep sensations (e.g. squeezing
tendocalcaneus).
2. Loss of proprioception → sensory ataxia.
3. Loss of tendon reflexes.
4. Hypotonia of muscles.
 Poliomyelitis
It is caused by virus
affecting lower motor
neurons.

It is of two types:

Spinal type: affecting anterior

horn cells → LMNL.

Bulbar type: affecting motor

nuclei of the cranial nerves
→LMNL.
 Conus Syndrome
◼ Its not a disease in its own right, but rather the
product of a spinal trauma. In most cases, a blow
to the back—such as from a car accident or
gunshot—is to blame. Caused by S3 and S5
lesions. Lumbar stenosis (multilevel), spinal
trauma including fractures and herniated nucleus
pulposus are all causes of the condition

1. Saddle anesthesia (S3-S5)

2. Urinary retention with overflow incontinence (due

to detrusor areflexia)
 Conus Syndrome
3. Fecal incontinence.

4. Impotence.

5. Loss of anal reflexes (S4-S5).

6. Preserved motor function of lower limbs.

 Cauda Equina Syndrome
◼ Cauda equine is composed of lumbar,
sacral, and coccygeal nerve roots.

◼ Lesions of the cauda equine below L1

vertebral level result in cauda equina
syndrome.
 Cauda Equina Syndrome
◼ Lesions affecting the lower portion of
cauda equine may have lower limb
weakness but sensory loss only in saddle
area along with involvement of urination,
defecation and sexual dysfunction.
 Saddle
Numbness
◼ For further inquiries PLZ feel free
to contact at any time through
email

gamaltaha@med.asu.edu.eg
gamal.abdelhady@yu.edu.jo