MOTOR SYSTEM

CENTRAL MOTOR NERVOUS SYSTEMS

Pyramidal motor system
system

Extrapyramidal motor

Excitatory neurotransmitter : glutamate, aspartate Neurotransmitter : Glu, Ach, DA, GABA, 5HT
Neuropeptide : SP,enkephalin,CKK

PERIPHERAL MOTOR NS :

a. Cell body / nuclear :

spinal motor neurons
nuclei of the cranial nerves

b. Ventral roots( spinal / cranial nerves )

c. Plexus
a. Peripheral nerves

Central and peripheral nervous system

PYRAMIDAL MOTOR SYSTEM

Motor Cortex :
Primary Motor Cortex
( Broadmanns area 4 )
motor homonculus
Premotor cortex
( Broadmanns area 6 )

PYRAMIDAL MOTOR SYSTEM

Pyramidal tract =
corticospinal tract
The execution of precise voluntary
movements
The cell bodies lying in layer 5 of
the cerebral cortex
( >> giants Betz cells )
Pons medulla oblongata : pyramis
Med. Oblongata : decussatio pyramidum
Lateral corticospinal tract ( 85 % )
Anterior corticospinal tract ( 15 % )
<< still ipsilateral ( C, Th )

Pyramidal tract = corticospinal tract

Lateral corticospinal tract ( 85 % )

Anterior corticospinal tract ( 15 % )

Corticobulbar tract =
corticonuclear tract
to the contra / ipsilateral
nuclei of the cranial motor nerves
( N. V, VII, IX, X, XI, XII )

Broadmanns area 8
nuclei of the N. III, IV, VI

Type of paralysis
Monoparesis
Paraparesis

: weakness in single limb / extremity

: weakness in both arms or legs

Tetra / quadriparesis : weakness in all four limbs

Diplegia : legs > arms
Hemiparesis :
weakness in one side of the body
and extremities, limited by the median

Hemiplegia alternans :
weakness in one or more ipsilateral cranial nerves and
contralateral paralysis of the arm & leg

Hemiplegia alternans :
weakness in one or more ipsilateral cranial nerves
And contralateral paralysis of the arm & leg

Hemiplegia cruciata
Isolated paralysis (1 muscle groups)

Pattern of Muscular Weakness

1. Upper motor neuron ( UMN ) = supra nuclear

The cerebral cortex

Cerebral peduncles

Brain stem

Spinal cord

2. Lower motor neuron ( LMN ) = final common pathways

* motor neurons / nuclei of the cranial nerves

Ventral root of the spinal nerves or cranial nerves

Plexus

Peripheral nerves
3. Nuclear *
Motor neurons / nuclei of the cranial nerves
4. Muscle disease
5. Neuromuscular-junction

Pattern of Muscular Weakness

Sign
Tone

Tendon
reflexes

UMN

LMN

Nuclear

Muscle Dis

NMJ

Spastic
Clonus

Flaccid/

/
normal

hypo/atoni
a

Impaired /

(-)

(-)

(-)

(-)

(-)

(-)

/ (-)

/ (-)

Cutaneus
Reflexes

/ (-)

Pathologic
Reflexes

Muscle
atrophy

(-) / <<
(disused
atrophy)

UMN: upper motor neuron

LMN: lower motor neuron
NMJ : neuromuscular junction

+Fasciculation

 Lesion of the cerebral cortex

Motor homonculus : paracentral leg
precentral arm
Contralateral seizures
Contralateral paralysis / paresis

Lesion of the internal capsule

Contralateral hemiparalysis / paresis
( arm = leg )
Contralateral hemihypesthesia

 Lesions of the brain stem

Hemiplegic alternans

Mesencephalon
= hemiplegia
alternans superior
= Webers
syndrome

Contralateral lesion Ipsilateral lesion

hemiplegia
N. III palsy

Pons
= hemiplegia
alternans inferior
= MillardGublers
syndrome

Contralateral lesion Ipsilateral lesion

hemiplegia
N. VI, VII palsy
Contralateral gaze
palsy

Med.oblongata

Contralateral lesion Ipsilateral lesion

hemiplegia
N. XII palsy

Mesencephalon Lesions
Hemiplegia alternans superior = Webers syndrome
Contralateral lesion hemiplegia
Ipsilateral lesionN. III palsy

Pons Lesions
Hemiplegia alternans inferior= MillardGublers syndrome
Contralateral lesion hemiplegia
Ipsilateral lesion N. VI, VII palsy
Contralateral gaze palsy

Med.oblongata
Lesions
Contralateral
lesion
hemiplegia

Ipsilateral lesion
N. XII palsy

 Lesions of the spinal cord

Ipsilateral l.m.n paralysis in the segment of the lesion
Ipsilateral u.m.n paralysis below the level of the lesion
Ipsilateral loss of proprioceptive below the level of the
lesion
Contralateral loss of extreroceptive ( pain
temperature ) below the level of the lesion

Spinal Cord Somatotopic Organization

Peripheral Nerves lesions

EXTRA PYRAMIDAL SYSTEM

Influences spinal motor activity
Consists of : cerebral cortex
basal ganglia
mid brain

EXTRA PYRAMIDAL SYSTEM

Basal ganglia
Globus pallidus

= pallidum = paleotriatum

Putamen

= neostriatum = striatum

* globus pallidus + putamen = lentiform / lenticular nucleus

Caudate nucleus = striate body

Substantia nigra
Subthalamic nucleus ( corpus Luysi )
Red nucleus

EXTRA PYRAMIDAL SYSTEM

Lesion of Extrapyramidal System

The main sign :
Disorders of muscle tone ( dystonia )
Involuntary movement disorders ( hyper/hypo/a-kinesia )
absent during sleep

Syndromes of extrapyramidal lesions:

1. Hypokinesia hypertonia
2. Hyperkinesia - hypotonia

1. Hypokinesia hypertonia syndrome

a. Parkinsons disease = paralysis agitans= shaking palsy
b. Parkinson syndrome = parkinsonism

Parkinsons Disease
Degeneratif process hereditary
Loss of melanin containing neurons of substantia nigra
& of dopaminergic neurons that connect with the striatum
Bilateral
Unilateral

3 cardinal sign of Parkinsons Disease

a. Brady / akinesia
Starting a movement becomes very difficult,
the mobility decreases.
The entire body anteflexed position,
no swing during walking
Hypo / amimia a mask face
Speech monotonous, dysarthic
Postural reflex decreases pro / latero / retropultion

3 cardinal sign of Parkinsons Disease

b. Rigidity
Cogwheel phenomenon
c. Tremor
Passive tremor : 4 8 movements / sec
Pill rolling = money counting movement
Resting tremor

Parkinson syndrome = parkinsonism

Neuronal loss in the substantia nigra caused by :
Postencephalitic parkinsonism
Cerebral arteriosclerosis
Trauma
Tumors
Intoxication by Co, Mg, etc.
phenotiazines, reserpin

2. Hyperkinetic hypotonic syndrome

Lesion in neostriatum
Occasionally glob. pallidus, thalamus,cerebral cortex

Chorea
short, fast, jerky movements
distal proximal portion of the extremities
Chorea minor

= Sydenhams chorea
= St Vitus dance
- in children
- acute, selflimiting
- linked to rheumatic fever ( = chorea infectiosa)

Chorea gravidarum
- acute chorea
- early pregnancy
Huntingtons chorea = chorea major
dominant, hereditary, degenerative disease
middle age
cortical neuron degenerate dementia

Hemiballism = ballistic syndrome

lesion of the subthalamic nucleus ( Luysi ) and its
connection
the muscle of shoulder & pelvis out reaching &
hurling movements
Spasmodic torticollis, torsion dystonia
biochemical abnormallity of the putamen, thalamus
(centro median nucleus & in other extrapyramidal
nuclei)

Athetosis
Continuous, arrhytmic, slow, wormlike
movements
Distal portion of the extremities
Posture & movement are bizarre
Caused by perinatal damage to the striatum