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FACULTY OF MEDICINE UPH

VS

By:

Dr. Vonny F. Goenawan, Sp. S

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NERVOUS SYSTEM

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TERMS

UPPER MOTOR NEURONS cortical neurons that innervate lower motor

neurons

axons contained within the pyramidal system,which is the corticospinal (pyramidal) andcorticobulbar tracts.

LOWER MOTOR NEURONS neurons that directly innervate skeletal muscle

the cell bodies are located within the ventralhorns of the spinal cord and within brainstem

motor nuclei.

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UPPER MOTOR NEURON

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UPPER MOTOR NEURON

(UMN)

UMN conveying impulses for voluntary

motor activity

Tracts

Corticospinal

Corticobulbar

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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 bilateralcorticobulbar input.

two exceptions:

Facial nerveThe neurons that innervate the muscles of the

lower face (below the forehead) receive mainly crossed input

from the opposite motor cortex.

Hypoglossal nerveThe neurons that innervate the

genioglossus muscle receive mainly crossed input from the

opposite motor cortex

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Corticobulbar tract

CORTICOBULBARTRACT

CAPSULA

INTERNA

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Loss of dexterity, voluntary skillful movements

Stiffness, slowness, and clumsiness, in particular,

rapid repetitive motions.

Spasticity is hallmark of the UMN diseaseSpasticity 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

SIGNS & SYMPTOMS

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UMN SIGN

UMN Syndrome Increased Deep Tendon Reflex

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UMN SIGN - TONE

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LOWER MOTOR NEURON

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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

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Anterior horn cell

Muscle

Neuromuscular juntion

Peripheral nerve

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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)

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SIGNS & SYMPTOMS

Weakness:

Denervation as well as decreased number of

functional LMN units reduces overall muscles

strength. Muscle atrophy & Hyporeflexia

Muscle hypotonicity & flaccidity

Fasciculations

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LMN SIGN

MUSCULAR ATROPHY

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UMN VS LMN

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UMN VS LMN

SIGNS UMN LMN

Atrophy - +++

Fasciculations - +++

Tone +++ -

Distribution Regional Segmental

Tendon

reflexes+++ -/--

Babinskis sign + -

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UMN DISORDERS

Stroke

Brain tumor

Multiple sclerosis (MS)

Mielitis

etc

Multiple sclerosis (MS)

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LMN DISORDERS

Poliomyelitis

Guillain-Barr syndrome

(GBS)

Multifocal Motor

Neuropathy

Poliomyelitis

http://www.ibiblio.org/herbmed/eclectic/thomas/pics/poliomyel-2.jpg

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Where could the lesion be??

Medulla?

Pons?Midbrain?

Cortex?

Which side??

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THANK YOU