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descending motor pathways Flashcards

1
Q

what are the descending motor pathways divided into?

A

upper and lower motor neurons

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2
Q

what are interneurons?

A

They are not part of the two neuron chain in DMPs but they can influence it

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3
Q

where do a) corticospinal b)corticobulbar/corticonuclear and c) extrapyramidal go?

A

a) cortex to spinal cord
b) cortex to brainstem
c) originating in different regions of the brainstem

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4
Q

what are three pathways of the corticospinal tract?

A

anterior, lateral and corticonuclear fibres

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5
Q

where do UMNs originate?

A

in the cerebrum or subcortical structures

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6
Q

what do UMNs do?

A

they influence LMN activity, modify local reflex activity, superimpose more complex patterns of movement

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7
Q

where are the cell bodies of UMN found?

A

in the cortex or upper structures of the CNS

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8
Q

what happens with UMN in the subcortical or cortical regions?

A

these regions send UMNs to LMNs to the muscle that they wish to move

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9
Q

where do the lower motor neurons originate?

A

from the lower brainstem or the ventral grey horn of the spinal cord - where the cell bodies are

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10
Q

what are the functions of the LMNs?

A

they are peripheral nerves to motor end plates/neuromuscular junctions, spinal nerves to reach muscles

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11
Q

how do LMNs leave in the head?

A

as cranial nerves

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12
Q

how does the LMN axon leave the SC?

A

through the ventral rootlets/root - efferent - CNS to PNS

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13
Q

what are the four divisions of the extrapyramidal pathway?

A

tecto, rubro, reticulo and vestibulospinal

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14
Q

where are the cell bodies for the corticospinal pathway?

A

they are in the pre central gyrus

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15
Q

how does the corticospinal tract work?

A

UMN will descend from the precentral gyrus through the internal capsule via the cerebral peduncles in the midbrain and the ventral pons. It will eventually reach the pyramidal level where it will cross the midline and enter the corticospinal tract in lateral columns of white matter. It will then enter grey matter to synapse with the LMN for the muscle

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16
Q

how are the tracts organised?

A

somatotopically - legs medial, trunk and then arm laterally

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17
Q

what is the corticonuclear tract?

A

starts in the cortex - precentral gyrus - internal capsule - peduncles - specific cranial nerve nuclei - muscles

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18
Q

what are the similarities in corticonuclear and spinal pathways?

A

cerebral cortex - pre central gyrus - internal capsule - brainstem/spinal cord

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19
Q

how do the cortico nuclear and spinal pathways differ?

A

at the brainstem - fibres go wither to corticonuclear which is cortex to brainstem for cranial nerves or to corticospinal which is cortex to spine for spinal nerves

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20
Q

where do primary synapse with secondary neurons in the corticonuclear and spinal tracts?

A

nuclear - cranial nerve nuclei in brainstem

spinal - anterior horn of grey matter of spinal cord

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21
Q

what are the positions of the parts of the internal capsule?

A

anterior - between the head of the caudate nucleus and the lentiform nucleus
genu - where it bends
posterior - between the lentiform nucleus and the thalamus

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22
Q

where do descending fibres all travel?

A

in the posterior limb of the internal capsule somatotopically

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23
Q

where do the motor fibres of the face travel in the IC?

A

in the genu

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24
Q

what is the somatotopic organisation of the IC?

A

arms are anterior, then trunk and legs posterior

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25
Q

where are the cerebral peduncles?

A

connected to the IC and is in the ventral part of the midbrain

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26
Q

do the ascending sensory fibres use the IC?

A

yes - connect to the thalamus first before the cortex and do not connect to the peduncles

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27
Q

what is the somatotopic organisation of the crus cerebri and peduncles?

A

lateral posterior is the legs

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28
Q

where do fibres travel after the peduncles?

A

into the basal pons and down the medulla using the pyramids

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29
Q

where do the descending fibres cross?

A

they decusate at the level of the decussation of the pyramids

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30
Q

what is the connection at the pons between cerebellar hemispheres?

A

transverse pontine fibres

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31
Q

where do the fibres travel after decussation?

A

recollect at medulla and cross as caudal part and then travel in the lateral cortical spinal tract in the lateral white column of the cord

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32
Q

why is there bilateral control of some muscles?

A

not all fibres cross - 15% do not and travel ipsilasterally to their respective level - some ipsilateral but mostly contralateral limb control

33
Q

fibres that cross later travel where?

A

anterior cortical spinal tract in the ventral white columns of the cord

34
Q

where do UMN contact the second order neurons?

A

they contact the LMN which are second order at the ventral grey horn contralaterally

35
Q

how do LMNs leave the spinal cord?

A

they leave via the ventral rootlets through segmental spinal nerves

36
Q

what muscles are controlled ipsilaterally and contralaterally?

A

contra - limb muscles

ipsi - axial muscles

37
Q

what happens with ipsilateral control?

A

fibres do not decusate at pyramids they continue down and at suitable level they contact LMN that project to both sides of the spinal cord

38
Q

where can lesions form?

A

in the upper or the lower motor neurons

39
Q

what is poliomyelitis?

A

it is infection of the cell bodies of LMNs resulting in a atrophy or waste

40
Q

what can peripheral nerve injury result in?

A

lesion in the ventral grey horn of the spinal cord in LMN

41
Q

what can a lesions of the LMN neurons result in?

A

flaccid paralysis of affected muscles - weakness
diminshed or absent tendon reflexes at the level of the lesion
muscle wasting
muscle weakness
hypotonia
fasciculations or fibrillations

42
Q

why are reflexes affected?

A

although the sensory fibre may work to detect the stimuli, the motor cannot
dimished - hyporeflexia
absent - areflexia

43
Q

why does wasting occur?

A

not being used so degenerates

44
Q

what is hypotonia?

A

reduced level of contraction at any given time

45
Q

what are fasciculations/fibrillations and what is the difference?

A

they are abnormal spontaneous contractions

fibrillations are rapid and irregular and fasciculations are twitches

46
Q

how can you get a UMN only lesion?

A

lesion in the cerebral hemisphere or as they descend to lateral white column of the spinal cord e.g. through a stroke

47
Q

what is the initial result of a UMN lesion?

A

flaccid paralysis of the oppsite/contralateral limbs

loss of tendon reflexes as not contact to LMN

48
Q

what will happen after several days or weeks?

A

motor function recovers but there is hypertonia - increased contraction

49
Q

what is the LT result of an UMN lesion?

A

there is increased, brisk spinal reflex below the lesion - hyperreflexia
spastic paralysis of the involved muscles - weak and non compliant
loss of fine motor control so permanent inability to carry out fine movements of the hand and feet

50
Q

what is a sign of UMN lesions?

A

Babinski reflex
the foot is stroked with a sharp small object from front to back
normally results in flexion of toes
positive means that there will be extension of the large toe coupled with fanning of other toes

51
Q

why are other functions usually ok with UMN lesions?

A

other pathways appear to take over most corticospinal functions - movement will originate elsewhere in the cortex
axial muscle groups also have supply from other side so are spared

52
Q

what is the order of cranial nuclei in the midbrain from top to bottom?

A

occulomotor, trochlear, abducens

53
Q

what is the order of cranial nuclei in the pons and medulla top to bottom?

A

pons - trigeminal and then facial

medulla - glossopharyngeal and vagus, accessory and hypoglossal

54
Q

what do the UMNs do in the corticonuclear tract?

A

they influence the LMNs in the cranial nerves

55
Q

where do the UMNs for the corticonucler pathway originate?

A

more laterally within the lateral cortex/pre central gyrus

56
Q

what is different in the CNT to the CST?

A

in the CNT the innervation of the LMNs is largely bilateral - only two exceptions

57
Q

what is the innervation of head and neck muscles?

A

it is bilateral except for the lower facial and extrinsic tongue muscles - contralateral control

58
Q

what is the facial nerve for predominantely?

A

facial expression muscles

59
Q

what is the medial bump?

A

the facial nucleus - this is a colliculus and the motor fibres from CNVII wrap around the nucleus of 6 and leave via the cerebellarmedullary junction

60
Q

how is the upper face stimulated?

A

UMN from the genu to level of the facial nuclei - ipsilateral and contralateral projection (same for 3,4,6,4,9,10,11). This stimulates a LMN from both sides to go to both sides of the upper face

61
Q

how is the lower face stimulated?

A

UMN sends axon via IC to contralateral facial nucleus only (same for 12) and then LMN to lower portion of face

62
Q

how will damage to the facial nerve itself present?

A

all the fibres come together and travel as one nerve - therefore there will be paralysis of the whole of one side of the face

63
Q

how will unilateral damage to corticonuclear fibres present?

A

deprives the lower half of the opposite facial motor nucleus so paralysis of the lower half of the face on the side opposite to lesion

64
Q

how will unilateral damage to corticonuclear fibres present in UMN?

A

contralateral lower quadrant weakness - angle of the mouth

65
Q

how will unilateral damage to corticonuclear fibres present in LMN?

A

ipsilateral half of face - orbicularis oculi and facial muscles, angle of mouth, unable to close eyes, cannot elevate eyebrows

66
Q

where will deviation of tongue be in upper motor neuron lesion?

A

to the contralateral side - there is not UMN from same side therefore weakness in that muscle so deviates that way

67
Q

where will deviation of tongue be in lower motor neuron lesion?

A

hypoglossal nerve itself is paralysed and therefore ipsilateral

68
Q

what is innervation of the extrinsic muscles of the tongue?

A

it is contralateral

69
Q

what is the function of extrinsic muscles of the tongue?

A

change the shape and direction of it

70
Q

what are other pathways for?

A

they come from other parts of the cortex and they control other aspects that are non voluntary

71
Q

what is the reticulo pathway for?

A

for modifying voluntary movements and breathing and consciousness

72
Q

what is the vestibulo pathway for?

A

posture and stimulation further down pathways

73
Q

what is the rubro pathway for?

A

stimulating LMNs in spinal cord and controlling muscular tone

74
Q

what structures, other than the cerebral cortex can control muscles?

A

the vestibular system, the reticular formation, the tectum, red nucleus and the basal ganglia

75
Q

what is the reticular formation?

A

it is the pons and the medulla

76
Q

what is the course of the reticulospinal pathway?

A

from the reticular formation to the SC

77
Q

what is the vestibular nuclei?

A

the pons and the rostral medulla

78
Q

what is the course of the vestibulospinal pathway?

A

from the vestibular nuclei to the SC

79
Q

what is the course of the rubrospinal pathway?

A

from the red nucleus in the midbrain to the spinal cord

C&M (36 decks)

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