VS

By: Dr. Vonny F. Goenawan, Sp. S

FACULTY OF MEDICINE UPH

NERVOUS SYSTEM

TERMS

UPPER MOTOR NEURONS

cortical

neurons that innervate lower motor neurons axons contained within the pyramidal system, which is the corticospinal (pyramidal) and corticobulbar tracts.

LOWER MOTOR NEURONS

neurons

that directly innervate skeletal muscle the cell bodies are located within the ventral horns of the spinal cord and within brainstem motor nuclei.

UPPER MOTOR NEURON

UPPER MOTOR NEURON (UMN)

UMN conveying impulses for voluntary motor activity Tracts

Corticospinal Corticobulbar

Corticobulbar tract

axons homologous to corticospinal fibers terminate in the motor nuclei of cranial nerves in the brain stem e.g., nuclei V ,VII, IX, X, XI and XII lower motor neurons of the brain stem receive bilateral corticobulbar input. two exceptions:

Facial nerve The neurons that innervate the muscles of the lower face (below the forehead) receive mainly crossed input from the opposite motor cortex. Hypoglossal nerve The neurons that innervate the genioglossus muscle receive mainly crossed input from the opposite motor cortex

Corticobulbar tract

CAPSULA INTERNA

CORTICOBULBAR TRACT

SIGNS & SYMPTOMS

Loss of dexterity, voluntary skillful movements Stiffness, slowness, and clumsiness, in particular, rapid repetitive motions. Spasticity is hallmark of the UMN disease Spasticity is a state of sustained increase in muscle tension in response to muscle lengthening, in particular, with passive movements.

Hyperreflexia. Babinskis sign (pathology reflex) positive

UMN SIGN BABINSKI SIGN (+)

Babinskis reflex

UMN SIGN

UMN Syndrome Increased Deep Tendon Reflex

UMN SIGN - TONE

LOWER MOTOR NEURON

LOWER MOTOR NEURON (LMN)

LMNlower motor neuron

Lower motor neurons (LMN) directly innervate the skeletal muscle In both CNS and PNS

Cell bodies in CNS (brainstem and spinal cord) Cranial and spinal nerves in PNS (anterior horn cell)

Motor unit=LMN & muscle fibers innervated by it

Neuromuscular juntion

Peripheral nerve

Anterior horn cell Muscle

These stations are

The

anterior (ventral) horn cell The peripheral nerve ( ventral and dorsal nerve roots ie radiculopathy or nerve ie neuropathy) The neuromuscular junction The muscle (ie myopathy)

SIGNS & SYMPTOMS

Weakness:
Denervation

as well as decreased number of functional LMN units reduces overall muscles strength.

Muscle atrophy & Hyporeflexia Muscle hypotonicity & flaccidity Fasciculations

LMN SIGN
MUSCULAR ATROPHY

UMN VS LMN

UMN VS LMN
SIGNS
Atrophy Fasciculations Tone Distribution Tendon reflexes Babinskis sign

UMN
+++ Regional +++ +

LMN
+++ +++ Segmental -/--

UMN DISORDERS

Stroke Brain tumor Multiple sclerosis (MS) Mielitis etc

Multiple sclerosis (MS)

LMN DISORDERS

Poliomyelitis
Guillain-Barr syndrome (GBS)

Multifocal Motor Neuropathy

Poliomyelitis

Where could the lesion be?? Medulla? Pons? Midbrain? Cortex? Which side??

THANK YOU