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Upper and lower motor neurons

and their lesions with major


clinical manifestations

Professor Muhammad Subhan


Contents
• Classification of Motor Neurons.
• Spinal cord and Brain lesions of UMN and its effects on body
parts functions.
• Causes of UMN lesions.
• Definitions of the terms Monoplegia, Hemiplegia and
Paraplegia etc.
• Tendon jerks and abdominal reflexes with root values.
• How to differentiate UMN and LMN lesions. Increased Tendon
jerks, tone and Fasciculations.
• UMN and LMN Facial Nerve palsy.
• Clinical manifestations of LMN in skeletal muscles.
Learning out come
• Basic anatomical lesions and their Major clinical effects
(manifestations).
• Pathophysiological and anatomical basis of clinical
manifestations of UMN and LMN lesions.
• Upper motor neuron and lower motor neuron.
• Upper and lower motor neuron levels.
Upper motor neuron lesions – Brain level
• Stroke
• Multiple sclerosis
• Cerebral palsy
• Brain tumors
Upper motor neuron lesions – Spinal cord
level
• Cervical myelopathy
• Transverse Myelitis
• Multiple sclerosis
• Caries spine – Pott’s disease
• Spinal cord tumors
• Cord injury
Lower motor neuron lesions
• Brain stem lesions
• Facial nerve palsy
- upper motor neuron type
- lower motor neuron type
• other cranial neuropathies
Lower motor neuron lesions
• Anterior horn cell diseases
- ALS – MND
- SMAs
a) Werdnig- Hoffman disease
b) Kugelberg- welander disease
c) Kennedy ‘s disease
- Poliomyelitis
Lower motor neuron lesions
• Radiculopathy
- Cervical radiculopathy
- Lumbosacral radiculopathy
- Cauda equina syndrome
• Plexopathy
- Brachial plexopathy
- Lumbosacral plexopathy
• Neuropathy
- Radial neuropathy
- Ulnar neuropathy
- Carpal tunnel syndrome
- Femoral neuropathy
- Sciatic neuropathy
- Peroneal neuropathy
• Mono neuritis multiplex
• Poly neuropathy – Peripheral neuropathy
- GBS
- CIDP
- Diabetic peripheral neuropathy
- Chacot-Marie-Tooth diseases
• Neuromuscular junction disorders
- Myasthenia gravis
- Lambert-Eaton syndrome
- Botulism
• Myopathy
- Polymyositis
- Muscular dystrophy
Mixed upper & lower motor neuron lesions
• ALS
• Cervical spondylosis
• Some other related definitions
Superficial and Deep Tendon Reflexes
• Babinski’s sign/reflex
• Abdominal reflex
• Biceps reflex
• Brachioradialis reflex
• Triceps reflex
• Knee jerk
• Ankle jerk
Over 3 days, a 42 y.o. lady rapidly weakens in all
four limbs. She says “I think I have Guillain-
Barré!”

Which is the most urgent first step?

A. EMG
B. Spinal cord imaging
C. Lumbar puncture
D. Brain imaging

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A 61 y/o woman wakes up with a weak right arm.
Zero strength in finger extensors, wrist extensors, and
trace elbow extension. Flexion muscles are 5/5.

Which is the most likely diagnosis?

A. Left frontal stroke affecting motor cortex


B. Carpal tunnel syndrome
C. Right radial mononeuropathy
D. Peripheral polyneuropathy

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Decreased reflexes are seen in all of the
following except:

A. AIDP
B. Peripheral polyneuropathy
C. Carcinomatous polyradiculopathy
D. Alcoholic neuropathy
E. Steroid myopathy

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Weakness and sensory loss in the left hand can be
caused by all of the following except:

A. Right hemisphere stroke


B. Lung cancer invading brachial plexus
C. Median mononeuropathy
D. Amyotrophic lateral sclerosis
E. Cervical herniated disk
Which is the commonest symptom of radiculopathy
in the general public?

A. Weakness
B. Radiating pain down a limb
C. A patch of distinct sensory loss
D. Bladder incontinence

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