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MOTOR SYSTEM
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CENTRAL MOTOR NERVOUS SYSTEMS
Pyramidal motor system Extrapyramidal motorsystem
Excitatory neurotransmitter : glutamate, aspartate Neurotransmitter : Glu, Ach, DA, GABA, 5HTNeuropeptide : P,en!ephalin,"##
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PERIPHERAL MOTOR NS :
a. Cell body / nuclear :
spinal o!or neurons
nuclei o" !#e cranial ner$es
b. %en!ral roo!s& spinal / cranial ner$es '
c. Ple(usa. Perip#eral ner$es
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"entral and peripheral ner$ous system
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P)RAMI*AL MOTOR S)STEM
Mo!or Cor!e( :
Primary Motor Cortex
( Broadmanns area 4 )
motor homonculus
Premotor cortex
( Broadmanns area 6 )
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PYRAMIDAL MOTOR SYSTEM
Pyramidal tract =corticospinal tract The execution o% precise $oluntary
mo$ementsThe cell &odies lying in layer 5 o%the cere&ral cortex
' (( giants Bet) cells *
Pons + medulla o&longata : pyramis
ed- .&longata : decussatio pyramidum
/ateral corticospinal tract ' 05 1 *Anterior corticospinal tract ' 25 1 * +33 still ipsilateral ' ", Th *
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Pyramidal tract 4 corticospinal tract
/ateral corticospinal tract ' 05 1 *Anterior corticospinal tract ' 25 1 *
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Cor!icobulbar !rac! +
cor!iconuclear !rac!
to the contra / ipsilateral
nuclei of the cranial motor nerves
( ! "# %II# $%# %# %$# ,II )
Broadmanns area &
nuclei of the ! $$$# $"# "$
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Type o" paralysis
Monoparesis ' eaness in sin*le lim+ / extremity
Paraparesis ' eaness in +oth arms or le*s
Te!ra / -uadriparesis' eaness in all four lim+s
*ipleia ' le*s , arms
Heiparesis'
eaness in one side of the +ody
and extremities# limited +y the median
Heipleia al!ernans'
eaness in one or more ipsilateral cranial nerves and
contralateral paralysis of the arm - le*
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!mipl!"ia cr#ciatasolated paralysis '62 muscle groups*
!mipl!"ia alt!rnans:
7ea!ness in one or more ipsilateral cranial ner$esAnd contralateral paralysis o% the arm 8 leg
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Pa!!ern o" Muscular ea0ness
1. 2pper o!or neuron & 2MN ' + supra nuclear
.he cere+ral cortex
Cere+ral peduncles
Brain stem
pinal cord
3. Lo4er o!or neuron & LMN '0 final common pathays
1 motor neurons / nuclei of the cranial nerves
"entral root of the spinal nerves or cranial nerves
Plexus
Peripheral nerves
$% N#cl!ar9 otor neurons nuclei o% the cranial ner$es&%M#scl! dis!as!'% N!#rom#sc#lar()#nction
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ignign ;N;N /N/N NuclearNuclear uscle Disuscle Dis Nexesre>exes ''?*?* '?*'?*
mpaired mpaired
NN '?*'?*
"utaneus"utaneus
@e>exes@e>exes ''?*?* NN NN NN NN
PathologicPathologic
@e>exes@e>exes '?*'?* '?*'?* '?*'?* '?*'?*
uscleuscle
atrophyatrophy'?*'?* 33 33
''disuseddisusedatrophy*atrophy*
'?*'?*
23asciculation
Patt!rn o* M#sc#lar +!a,n!ss
;N: upper motor neuron/N: lo7er motor neuronN< : neuromuscular unction
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Lesion o" !#e cerebral cor!e(
Motor homonculus ' paracentral le*
precentral arm
Contralateral seiures
Contralateral paralysis / paresis
Lesion o" !#e in!ernal capsule
Contralateral hemiparalysis / paresis
( arm 0 le* )
Contralateral hemihypesthesia
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M!s!nc!p-alonM!s!nc!p-alon
4 hemiplegia4 hemiplegia
alternans superioralternans superior4 e&erCs4 e&erCs
syndromesyndrome
"ontralateral"ontralateral lesionlesion
hemiplegiahemiplegiapsilateralpsilateral lesionlesion
N- palsyN- palsy
PonsPons
4 hemiplegia4 hemiplegiaalternans in%erioralternans in%erior
4 illard+Gu&lerCs4 illard+Gu&lerCs
syndromesyndrome
"ontralateral"ontralateral lesionlesion
hemiplegiahemiplegia
psilateralpsilateral lesionlesion
N- , palsyN- , palsy"ontralateral ga)e"ontralateral ga)e
palsypalsy
M!d%o.lon"ataM!d%o.lon"ata "ontralateral"ontralateral lesionlesion
hemiplegiahemiplegia
psilateralpsilateral lesionlesion
N- palsyN- palsy
Lesions o" !#e brain s!e
5emiple*ic alternans
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M!s!nc!p-alonM!s!nc!p-alonL!sionsL!sions
HHemiplegia alternans superioremiplegia alternans superior4 e&erCs syndrome4 e&erCs syndrome
"ontralateral"ontralateral lesionlesion hemiplegiahemiplegiapsilateralpsilateral lesionlesionN- palsyN- palsy
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PonsPonsL!sionsL!sions
!mipl!"ia alt!rnans in*!rio!mipl!"ia alt!rnans in*!riorr= Millard/0#.l!r1s syndrom!= Millard/0#.l!r1s syndrom!
"ontralateral"ontralateral lesionlesion hemiplegiahemiplegiapsilateralpsilateral lesionlesion N- , palsyN- , palsy
"ontralateral ga)e palsy"ontralateral ga)e palsy
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M!d%o.lon"ataM!d%o.lon"ataL!sionsL!sions
"ontralateral"ontralaterallesionlesionhemiplegiahemiplegia
psilateralpsilateral lesionlesionN- palsyN- palsy
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Lesions o" !#e spinal cord
$psilateral l!m!n paralysis in the se*ment of the lesion
$psilateral u!m!n paralysis +elo the level of the lesion
$psilateral loss of proprioceptive +elo the level of the
lesion
Contralateral loss of extreroceptive ( pain
temperature ) +elo the level of the lesion
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Spinal Cord Somatotopic Or"ani2ation
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P!rip-!ral N!r3!s l!sions
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E4TRA PYRAMIDAL SYSTEM
n>uences spinal motor acti$ity
"onsists o% : cere&ral cortex
&asal ganglia mid &rain
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E,TRA P)RAMI*AL S)STEM
5asal anlia
7lo+us pallidus 0 pallidum 0 paleotriatum
Putamen 0 neostriatum 0 striatum
9 glo&us pallidus F putamen 4 lenti%orm lenticular nucleus
Caudate nucleus 0 striate +ody
u+stantia ni*ra
u+thalamic nucleus ( corpus 8uysi )
9ed nucleus
E4TRA PYRAMIDAL SYSTEM
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E4TRA PYRAMIDAL SYSTEM
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Lesion o" E(!rapyraidal Sys!e
.he main si*n '
:isorders of muscle tone ( dystonia )
$nvoluntary movement disorders ( hyper/hypo/a;inesia )
a+sent durin* sleep
Syndroes o" e(!rapyraidal lesions:
=! 5yperinesia ; hypotonia
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1. Hypo0inesia 6 #yper!onia syndroe
a! Parinsons disease 0 paralysis a*itans0 shain* palsy
+! Parinson syndrome 0 parinsonism
Par0inson7s *isease
:e*eneratif process hereditary
8oss of melanin containin* neurons of su+stantia ni*ra
- of dopaminer*ic neurons that connect ith the striatum
Bilateral
>nilateral
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8 cardinal sin o" Par,inson1s Dis!as!
a. 5rady / a0inesia
tartin* a movement +ecomes very difficult#
the mo+ility decreases!
.he entire +ody anteflexed position#
no sin* durin* alin*
5ypo / amimia a mas face
peech monotonous# dysarthic
Postural reflex decreases pro / latero / retropultion
$ di l i * P ,i 1 Di
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b. Riidi!y
Co*heel phenomenon
c. Treor
Passive tremor ' 4 & movements / sec
Pill rollin* 0 money countin* movement
9estin* tremor
$ cardinal si"n o* Par,inson1s Dis!as
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Par0inson syndroe + par0insonis
euronal loss in the su+stantia ni*ra caused +y '
Postencephalitic parinsonism
Cere+ral arteriosclerosis
.rauma
.umors
$ntoxication +y Co# M*# etc!
phenotiaines# reserpin
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3. Hyper0ine!ic 6 #ypo!onic syndroe
8esion in neostriatum
?ccasionally *lo+! pallidus# thalamus#cere+ral cortex
C-or!a
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C-or!ashort, %ast, er!y mo$ementsdistal proximal portion o% the extremities
C-or!a minor = Syd!n-am1s c-or!a
= St Vit#s danc!? in children? acute, sel>imiting? lin!ed to rheumatic %e$er ' 4 chorea in%ectiosa*
C#orea ra$idaru
; acute chorea
; early pre*nancy
Hun!in!on7s c#orea + c#orea a9or
dominant# hereditary# de*enerative disease
middle a*e
cortical neuron de*enerate dementia
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Heiballis + ballis!ic syndroe
lesion of the su+thalamic nucleus ( 8uysi ) and itsconnection
the muscle of shoulder - pelvis out reachin* -
hurlin* movements
Spasodic !or!icollis !orsion dys!onia
+iochemical a+normallity of the putamen# thalamus(centro median nucleus - in other extrapyramidal
nuclei)
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At-!tosis
"ontinuous, arrhytmic, slo7, 7ormli!emo$ementsDistal portion o% the extremitiesPosture 8 mo$ement are &i)arre"aused &y perinatal damage to the striatum
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