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NAN Neuroanatomy > Module 4: Corticospinal Tract and Other Motor Pathways > Flashcards

Module 4: Corticospinal Tract and Other Motor Pathways Flashcards

1
Q

What are the 3 most important motor and sensory “long tracts”?

A

Lateral corticospinal tract
Posterior columns
Anterolateral pathways

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2
Q

What is the function of the lateral corticospinal tract?

A

Motor

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3
Q

What is the function of the posterior columns?

A

Sensory (vibration, joint position, fine touch)

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4
Q

What is the function of the anterolateral pathways?

A

Sensory (pain, temperature, crude touch)

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5
Q

Where are the primary motor cortex and primary somatosensory cortex located in the brain?

A

On either side of the central/Rolandic sulcus, which divides the frontal lobe from the parietal.

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6
Q

Which Brodmann’s area(s) are associated with the primary motor cortex?

A

Brodmann’s area 4

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7
Q

The primary motor cortex is in the ________ gyrus, while the primary somatosensory cortex is in the ________ gyrus.

A

Precentral; postcentral

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8
Q

Which Brodmann’s area(s) are associated with the primary somatosensory cortex?

A

Brodmann’s areas 3, 1, 2

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9
Q

Lesions in the primary motor and primary somatosensory cortices cause deficits on which side of the body?

A

The contralateral side

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10
Q

Where does the motor association cortex lie in relation to the primary motor cortex?

A

anterior

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11
Q

Name the two areas of the brain that consist of the motor association cortex.

A

supplementary motor areas (SMA)

premotor cortex

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12
Q

What are SMA and premotor cortex involved in?

A

Higher-order motor planning

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13
Q

Where do the SMA and premotor cortex project to?

A

primary motor cortex

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14
Q

Where does the somatosensory cortex receive input from?

A

secondary parietal association cortex, which is important in higher-order somatosensory processing

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15
Q

Which Brodmann’s area(s) are associated with the secondary parietal association cortex?

A

Brodmann’s areas 5 & 7

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16
Q

T or F: Lesions in the sensory or motor association cortex do not produce severe deficits in basic movement or sensation.

A

T; Instead, lesions in the association cortices cause deficits in higher-order sensory analysis or motor planning.

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17
Q

How are the primary motor and somatosensory cortices organized?

A

somatotopically, meaning adjacent regions on the cortex correspond to adjacent areas on the body surface.

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18
Q

How are cortical maps classically depicted?

A

by a motor homunculus and a sensory homunculus.

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19
Q

List the somatotopic organization going from the lateral surface of the cortex to the medial surface.

A

Goes from throat to face to hand/arm to the leg.

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20
Q

T or F: Somatotopic organization is confined to the cortex.

A

F: most motor and sensory pathways maintain a rough somatotopic organization along their entire length, which can be traced back from one level to the next in the nervous system.

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21
Q

What are two synonyms for column?

A

tract or funiculus

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22
Q

What is the butterfly-shaped center of the spinal cord called?

A

central gray matter

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23
Q

What is the central gray matter surrounded by?

A

ascending and descending white matter columns/tracts/funiculi

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24
Q

Where are the sensory neurons of the spinal tract located?

A

dorsal root ganglia

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25
Q

Sensory information is carried from the periphery into the dorsal aspect of the cord through ______.

A

dorsal nerve root filaments

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26
Q

Name the 3 segments of the central gray matter.

A

dorsal/posterior horn
intermediate zone
ventral/anterior horn

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27
Q

What is the dorsal horn of the central gray matter mainly involved in?

A

sensory processing

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28
Q

What does the intermediate zone of the central gray matter contain?

A

interneurons

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29
Q

What is the ventral horn of the central gray matter contain?

A

motor neurons

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30
Q

What are the 3 components of the spinal cord white matter?

A

Dorsal/posterior columns
Lateral columns
Ventral/anterior columns

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31
Q

Where is the spinal cord white matter thickest?

A

At the cervical levels because most ascending fibers have already entered the cord and most descending fibers have not yet terminated on their targets.

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32
Q

Motor neurons send their axons out of the spinal cord via _______.

A

ventral nerve root filaments

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33
Q

Where is the spinal cord matter thinnest?

A

The sacral level

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34
Q

What supplies the spinal cord with blood?

A

One anterior artery and two posterior arteries

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35
Q

What are the two main arteries from which the anterior artery and two posterior arteries branch out?

A

vertebral artery and spinal radicular arteries

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36
Q

What do the anterior artery and two posterior arteries combine to form?

A

the spinal artery plexus, which surrounds the spinal cord

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37
Q

Vulnerable zone

A

The mid thoracic region (T4-T8) between that lies between the lumbar and vertebral arterial supplies wherein there is relatively decreased perfusion.

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38
Q

What region is most susceptible to infarction during thoracic surgery or other conditions decreasing aortic pressure?

A

The vulnerable zone (T4-T8)

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39
Q

The anterior spinal artery supplies what part(s) of the spinal cord?

A

2/3rds of the anterior cord, including the anterior horns and the anterior and lateral white matter columns/tract/funiculi

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40
Q

The posterior spinal arteries supply what part(s) of the spinal cord?

A

Posterior columns and part of the posterior horns

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41
Q

What two important structures of the brain participate in feedback loops that project back to the cortex via the thalamus?

A

Cerebellum & basal ganglia

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42
Q

Legions in which circuits can lead to apraxia?

A

Those involving the association cortices in the supplementary motor area (SMA), premotor cortex, and parietal association cortex, all of which are crucial for planning and formulation of motor activities.

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43
Q

____________ carry motor systems output to ____________, located in the spinal cord and brainstem, which then project to muscles in the periphery.

A

upper motor neurons; lower motor neurons

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44
Q

What are the two divisions of the descending motor pathways?

A

lateral motor systems

medial motor systems

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45
Q

Lateral motor systems

A

travel in the lateral columns

synaps on more lateral groups of ventral horn neurons

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46
Q

Medial motor systems

A

travel in the anteromedial spinal cord columns

synapse on medical ventral horn neurons

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47
Q

What do the two lateral motor systems pathways form?

A

lateral corticospinal tract

rubrospinal tract

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48
Q

What do the lateral corticospinal and rubrospinal tracts control?

A

movement of the extremities

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49
Q

The lateral corticospinal tract is essential for what types of movement?

A

rapid, dexterous movements

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50
Q

What are the 4 major medial motor system tracts?

A

anterior corticospinal tract
vestibulospinal tract
reticulospinal tract
tectospinal tract

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51
Q

What do the four medial motor system tracts control?

A

proximal axial (muscles of the trunk) and girdle muscles involved in postural tone, balance, orienting movements of the head and neck, and automatic gait-related movement

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52
Q

Which way do the lateral motor systems pathways descend, ipsilaterally or contralaterally?

A

contralaterally, thereby controlling the contralateral extremeties

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53
Q

Which way do the medial motor systems pathways descend, ipsilaterally or contralaterally?

A

ipsilaterally/bilaterally

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54
Q

Which two tracts of the medial motor systems pathways extend only to the upper few cervical segments?

A

rubrospinal tract

tectospinal tract

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55
Q

The medial motor pathways tend to terminate on what?

A

Interneurons that project to both sides of the spinal cord, controlling movements that involve numerous bilateral spinal segments

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56
Q

Unilateral lesions of the medial motor systems produce what?

A

No obvious deficits

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57
Q

Lesions to the lateral corticospinal tract produce what?

A

dramatic motor deficits

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58
Q

Which of the lateral tracts is the most clinically important descending motor pathway in the nervous system?

A

Lateral corticospinal tract

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59
Q

Internal capsule

A

area of white matter in the brain
contains both ascending and descending motor pathways
shaped like V when cut transversly
Separates the caudate nucleus and the thalamus from the caudate nucleus and the globus pallidus

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60
Q

Corona radiata

A

White matter sheet that continues ventrally as the internal capsule and dorsally as the centrum semiovale
Contains both ascending and descending fibers that carry nearly all of the neural traffic from and to the cerebral cortex
Associated with the corticospinal tract, corticopontine tract, and the corticobulbar tract

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61
Q

The _____ and _____ are always lateral to the internal capsule.

A

putamen and globus pallidus

62
Q

The _____ and _____ are always medial to the internal capsule.

A

caudate nucleus and thalamus

63
Q

What are the 3 parts of the internal capsule?

A

anterior limb
posterior limb
genu

64
Q

The anterior head of the internal capsule separates which structures?

A

the head of the caudate nucleus from the putamen and globus pallidus

65
Q

The lateral head of the internal capsule separates which structures?

A

thalamus from the globus pallidus and putamen

66
Q

Which tract lies in the posterior limb of the internal capsule?

A

corticospinal tract

67
Q

Fibers projecting from the cortex to the brainstem, including motor fibers for the face, are called _____.

A

corticobulbar (because they project from the cortex to the brainstem aka “bulb”)

68
Q

The continues into the midbrain _________.

A

cerebral peduncles

69
Q

Basis pedunculis

A

White matter located in the anterior portion of the cerebral peduncles

70
Q

The middle 1/3rd of the basis pedunculis contains fibers from which two tracts?

A

Corticobulbar and corticospinal (the other portions of the basis pedunculis contains the corticopontine fibers)

71
Q

The corticospinal tract is also known as:

A

The pyramidal tract

72
Q

About 85% of the pyramidal tract fibers cross over in the _______________ to enter the lateral white matter columns of the spinal cord.

A

pyramidal decussation

73
Q

Corticospinal fibers descend from the cerebral peduncles through the ventral pons and collect on the ventral surface of the medulla to form what structure?

A

The medullary pyramides

74
Q

After the fibers cross in the pyramids, they enter what structure?

A

The cervical spinal cord as the lateral corticospinal tract.

75
Q

The axons of the corticospinal tract enter the spinal cord central gray matter to synapse onto what?

A

anterior horn cells

76
Q

What happens to the remaining 15% of corticospinal fibers that do not cross in the medulla?

A

They continue into the spinal cord ipsilaterlly and enter the anterior white matter columns to form that anterior corticospinal tract.

77
Q

T or F: The autonomic nervous system only contains afferent pathways.

A

False! The ANS only contain EFFERENT pathways.

78
Q

What are the two main division of the autonomic nervous system?

A

Sympathetic

Parasympathetic

79
Q

What is the sympathetic ANS also known as?

A

thoracolumbar division

80
Q

What is the parasympathetic ANS also known as?

A

craniosacral division

81
Q

What is the thoracolumbar/sympathetic division of the ANS mainly involved in?

A

fight or flight functions (e.g. increased heart rate and blood pressure, bronchodilation, and pupil dilation.

82
Q

What parts of the spine does the thoracolumbar division arise from?

A

T1 to L2/L3

83
Q

What is the craniosacral/parasympathetic division of the ANS mainly involved in?

A

rest & digest functions (e.g. increased gastric secretions and peristalsis, slowing down heart rate, decreasing pupil size.

84
Q

What does the craniosacral division arise from?

A

The cranial nerve nuclei from S2-S4.

85
Q

Where are the preganglionic neurons of the sympathetic division located?

A

Intermediolateral cell column in the central gray matter of the spinal cord from levels T1 to L2/L3.

86
Q

Paired sympathetic chain ganglia

A

ganglia of the sympathetic NS
deliver information to body about stress and impending danger
bilaterally symmetrical
run down from cervical to sacral levels on each side of the spinal cord

87
Q

Parasympathetic preganglionic fibers

A

arise from cranial nerve parasympathetic nuclei and sacral parasympathetic nuclei (S2, S3, & S4)

88
Q

Sympathetic postganglionic neurons primarily release which NT?

A

NE

89
Q

Parasympathetic postganglionic neurons primarily release which NT?

A

ACh

90
Q

Sympathetic and parasympathetic are controlled both directly and indirectly by what parts of the brain?

A

Hypothalamus
Brain stem nuclei (e.g. nucleus solitaris)
amygdala
several regions of the limbic cortex

91
Q

Upper motor neurons project to what?

A

lower motor neurons located in the anterior horn of the spinal cord

92
Q

What do lower motor neurons project to?

A

skeletal muscles with the peripheral nervous system

93
Q

What system is analogous to the upper and lower motor neuron system?

A

The coritcobulbar to the cranial nerve motor nuclei

94
Q

Signs of lower motor neuron lesions

A

muscle weakness
atrophy
fasciculations
hyporeflexia

95
Q

Signs of upper motor neuron lesions

A

muscle weakness
spasticity (i.e. combination of increased tone and hyperreflexivity)
possible abnormal reflexes (e.g. Babinski’s signs)

96
Q

How might a patient with acute upper motor neuron lesions present?

A

initially, flaccid paralysis with decreased tone and decreased reflexes may be present that can transform to spastic paresis within hours or even months.

97
Q

The process of localizing motor lesions involves which steps?

A

choosing the correct motor system level, side, and specific neuroanatomical structures affected.

98
Q

Weakness can be caused by

A

lesions or dysfunction at any level in the motor system

99
Q

Origin of upper motor neurons

A

motor region of cortex then down through the CNS via one of 6 pathways (corticospinal, coriticobulbar, colliculospinal, rubrospinal, reticulospinal, vestibulospinal tracts)

100
Q

Pure hemiparesis

A

One of the most commonly diagnosed forms of hemiparesis

involves weakness of the face (lower), arm, and leg with no associated sensory deficits

101
Q

What are the location rule-outs for pure hemiparesis?

A

cortical lesions (b/c that would impact the entire motor strip, likely causing sensory deficits)
spinal cord or medulla (then face would be spared)
Muscle or peripheral nerve (would require coincidental involvement of only one 1/2 of body).

102
Q

What locations should be ruled in for pure hemiparesis?

A

corticospinal and corticobulbar tracts below the cortex and above the medulla
posterior limb of internal capsul, basis pontis, or middle 1/3rd of cerebral peduncle

103
Q

Side of lesion in hemiparesis

A

contralateral to weakness

104
Q

Common causes of pure hemiparesis

A

Lacunar infarct of internal capsule or pons

occassionally infarct of the cerebral peduncle, but not common

105
Q

Associated features of pure hemiparesis

A

upper motor neuron signs (muscle weakness, spasticity, possible abnormal reflexes)
dysarthria
ataxia on affected side

106
Q

What locations should be ruled out in unilateral paresis of the face and arm without associated somatosensory deficits?

A

muscular/peripheral nerve damage

lesions at internal capsule and or below (uncommon, but not impossible)

107
Q

Why should lesions at the internal capsule or below be ruled out in unilateral paresis of the face and arm?

A

Because the corticobulbar ad corticospinal tracts are very compact in those areas and would therefore likely result in leg involvement in most lesions.

108
Q

What locations should be ruled-in for unilateral paresis of the face and arm without associated somatosensory involvement?

A

Face and arm areas of the primary motor cortex (lateral regions of the temporal lobe closest to the central sulcus)

109
Q

What side would you expect the lesion to be on in unilateral paresis of face and arm without associated somatosensory deficits?

A

Contralateral to the affected side (above the pyramidal decussation).

110
Q

What is the most common cause of unilateral face and arm paresis without associated somatosensory deficits?

A

classic cause =middle cerebral artery superior division infarct
other lesions
tumor
abscess

111
Q

Associated features of unilateral paresis of face and arm without associated somatosensory deficits

A

upper motor neuron signs

dysarthria

112
Q

What might you expect if a lesion in the face and arm areas of the motor cortex is in the dominant hemisphere?

A

Broca’s aphasia

aphemia (pure motor speech disorder)

113
Q

When might you expect to see associated somatosensory deficits in a patient with a lesion to the primary motor cortex?

A

when the lesion extends to the parietal lobe

114
Q

What is bilateral arm paresis also known as?

A

brachial diplegia

115
Q

What locations would be ruled out in bilateral arm paresis?

A

corticospinal tracts (would result in face and leg involvement as well)

116
Q

What areas are ruled-in in bilateral arm paresis?

A

medial fibers of both lateral corticospinal tracts
bilateral cervical spine ventral horn cells
peripheral nerve or muscle disorders affecting both arms

117
Q

What are the associated features allowing for further localization in bilateral arm paresis?

A

presence of a central cord or anterior cord syndrome

118
Q

Anterior cord syndrome

A

Caused by infarction of the anterior portion of spinal cord

119
Q

Central cord syndrome

A

Most common form of incomplete cord injury

characterized by impairment in the arms and hands and to a lesser extent in the legs

120
Q

Brown-Séquard Syndrome

A

incomplete spinal cord lesions reflecting hemisection of spinal cord, often in cervical cord region

121
Q

Symptoms of Brown-Séquard Syndrome

A

ipsilateral upper motor neuron paralysis
ipsilateral loss of proprioception
contralateral loss of pain and temperature sensation

122
Q

Symptoms of Central Cord Syndrome

A

paralysis or loss of fine motor control in arms and hands
sensory loss below the site of injury
loss of bladder control
painful sensations

123
Q

Symptoms of Anterior Cord Syndrome

A

loss of motor function below site of injury
inability to detect temperature and pain
preservation of fine touch and proprioception

124
Q

Common causes of bilateral arm paresis

A

Central cord syndrome: syringomyelia, intrinsic spinal cord tumor, myelitis
Anterior cord syndrome: anterior spinal artery infarct, trauma, myelitis
Peripheral nerve: bilateral carpal tunnel syndrome of disc herniation

125
Q

Gait disorders (causes)

A

abnormal function of almost any part of the nervous system

some orthopedic conditions

126
Q

Problems with _____ are one of the most sensitive indicators of subtle neurological dysfunction.

A

gait

127
Q

Multiple Sclerosis

A

autoimmune inflammatory disorder affecting the CNS myelin of unknown etiolgy

128
Q

T or F: Myelin in the PNS (Schwann cells) are not affected in multiple sclerosis.

A

T, only CNS myelin is affected (oligodendrocytes)

129
Q

What is believed to be the mechanism underlying MS?

A

Evidence suggests that T lymphocytes may be triggered by a combination of genetic and environmental factors to react against oligodendrocytic myelin.

130
Q

Sclerotic glial scars

A

Scars left behind from discrete plaques of demyelination and inflammatory response that reoccur in MS.

131
Q

Demyelination causes what?

A

slowed conduction velocity and ultimately conduction blockage

132
Q

Classical definition of multiple sclerosis

A

two or more deficits separated in neuroanatomical space and time

133
Q

Clinical diagnosis of MS is based:

A

presence of typical clinical features
MRI evidence of white matter lesions
slowed conduction velocities on evoked action potentials
presence of oligoclonal bands in CSF on lumbar puncture

134
Q

What MRI findings suggest MS?

A

multiple T2-bright areas representing demyelination plaques located in white matter

135
Q

About 50% of patients presenting with a single episode of ________ and _________ subsequently develop MS.

A

optic neuritis; transverse myelitis

136
Q

What are the courses of MS?

A

relapsing-remitting
progressive
combination of relapsing-remitting & progressive

137
Q

Median survival from time of MS onset

A

25-35 years

138
Q

Current drug therapies for MS

A

interferon beta

high-dose steroids

139
Q

Common associated symptoms of MS requiring multidisciplinary treatment

A 
spasticity
pain
extreme fatigue
impaired bowel, bladder, and sexual function
diplopia
dysphagia
psychiatric manifestations
140
Q

Motor neuron diseases

A

several uncommon disorders that can selectively affect upper motor neurons, lower motor neurons, or both, producing motor deficits without sensory abnormalities or other findings.

141
Q

Examples of motor neuron diseases

A

Amyotophic lateral sclerosis (ALS) (both)
Primary lateral sclerosis (upper motor neurons)
Spinal muscular atrophy (lower motor neurons)

142
Q

What does ALS stand for?

A

Amyotrophic lateral sclerosis

143
Q

ALS is characterized by

A

gradual progressive degeneration of both upper and lower motor neurons, leading eventually to respiratory failure and death

144
Q

T or F: Most cases of ALS are inherited.

A

F; Most cases occur sporadically, but there are also inherited forms.

145
Q

What are the initial symptoms of ALS?

A

weakness or clumsiness typically beginning focally and then spreading to adjacent muscle groups.

146
Q

Symptoms of ALS

A

muscular paresis
painful muscle cramps
fasciculations (sometimes best seen in tongue)
bulbar symptoms (dysarthria, dysphagia, respiratory problems)
psuedobulbar affect

147
Q

How might a patient with ALS present during a neurological exam?

A
  • evidence of upper motor neuron damage such as increased tone and brisk reflexes
  • evidence of lower motor neuron damage such as atrophy and fasciculations (sometimes best seen in tongue)
  • intact sensory and mental status
148
Q

What is the median survival from time of ALS onset?

A

23-52 months

149
Q

What are important differential diagnoses when assessing for ALS?

A 
lead toxicity
thyroid dysfunction
dysproteinemia
vitamin B12 deficiency
vasculitis
panneoplastic syndromes
multifocal motor neuropathy with conduction block
150
Q

Panneoplastic syndrome

A

syndrome that indirectly results from the presence of cancer in the body
most commonly associated with cancers of the lung, breast, ovaries, or lymphatic system

151
Q

Vasculitis

A

inflammation of blood vessels resulting

152
Q

The corticospinal tracts can be grouped together into what 3 large (& most important) categories:

A

1) lateral corticospinals - motor
2) dorsal column/medial lemniscus - somatosensory
3) spinothalamics - pain & tempertaure (as the representative for all the ventrolateral system)

NAN Neuroanatomy (5 decks)

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