upper and lower motor neuron lesions
TRANSCRIPT
صدق الله العظيم 58االسراء اية
ByBy
Dr. Abdel Aziz M. HusseinDr. Abdel Aziz M. HusseinAssist prof of PhysiologyAssist prof of Physiology
Somatic Motor System Somatic Motor System
• Origin:Origin:• From area (6) and area (4) → descends to
corpus striatum → Globus pallidus→ from the globus pallidus fibers pass to;
1.Reticular formation2.Vestibular nuclei3.Red nucleus 4.Tectum of midbrain. • From these nuclei the following extrapyramidal
tracts arise:
Motor areas 4 and 6
Basal Ganglia
Corpus striatum
Globus pallidus
RF Vest. Nuclei
Ret.Spin T. Vest.Spin.T.
Red Nucl.
Rubrospin. T.
Tectum
Tectospin. T.
Red nucleus
Cerebellum
Cerebrum
Basal ganglia
Lateral AHCs
Rubrospinal T.
++
Functions:Functions:1.Mediates motor signals concerned with the
skilled voluntary movements performed by distal limb muscle.
2.Also facilitates & motor neurons of the distal flexors
Pontine RF Lateral RST.
Medial AHCs
Medial RST++ ----
Medullary RF
• Functions: Functions: • a. Medial R.S.T.• It mediates facilitatory effect on the motor
neurons of the antigravity ms to maintain postural support.
• b. Lateral R.S.T. • It inhibits the tone in the antigravity ms
under some postural conditions, which provides background to perform other motor activities.
Lateral V.N.Medial VST.
Medial AHCsLateral VST ++ ++++
Medial VN
• Functions: Functions: • a. Lateral V.S.T.• It is facilitatory to & motor neurons of the
antigravity ms to maintain body posture & equilibrium in response to impulses from the vestibular apparatus which evoked by charges in head position or exposure to acceleration.
• b. Medial V.S.T. • It is facilitatory to & motor neurons of the
neck and upper limb muscles that are involved in regulation of the head & upper limb position during exposure to acceleratory movements
Superior colliculus
Medial T.S.T
Medial AHCs
Lateral TST
++++
Inferior colliculus
• Functions: Functions: • This tract mediates reflex turning of the head
in response to sudden visual or auditory stimuli.
MOTOR CORTEX
INTERNAL CAPSULE
BRAIN STEM
SPINAL CORD
Def.,• It is the damage of upper motor neuron in the
higher center or the descending motor tract.Causes1.Trauma2.Tumour3.Vascular disorders as thrombosis or hemorrhage.Sites: • Most common site of UMNL is the internal
capsule.
1. Contralateral paralysis (loss of only voluntary movements) of the distal ms of the limbs, lower facial ms and ms of the tongue.
2. Contralateral paresis (weakness i.e., the ms retains some movements) of the axial ms and upper facial ms.
• Axial ms are supplied by descending motor tracts other than CBS whereas ms of the upper face are ipsilaterally innervated by CBS tract.
3) Spasticity (increased ms tone) of the skeletal ms due to increased supraspinal facilitation to -motor neurons.
• A lesion at the level of internal capsule interrupts the descending inhibitory cortical fibers which feeds the inhibitory reticulospinal tract leaving the facilitatory vestibulospinal and reticulospinal to act.
• This spasticity is of the clasp-knife type
Inhibitory RF
Facilitatory RF and VST
4) Exaggerated tendon jerk & clonus: due to increased supraspinal facilitation.
5) Positive Babinski's sign
6) The paralyzed ms show no or minimal atrophy as the lower motor neuron is intact and the ms contracts reflexly.
7) Normal response of the paralyzed ms to electric stimulation
a) Faradic current produces clonic or tetanic contractions
b) Galvanic current produces contractions that occur only at closing (make) and opening (break)
of the circuits. CCC > ACC > AOC > COC
1) Contralateral hemianaesthesia i.e. loss of all sensations on the opposite side of the body
2) Contralateral homonymous hemianopia i.e., loss of vision in the two opposite halves of the field of vision
3) Bilateral diminution of hearing acuity. No complete loss of hearing as both ears are
bilaterally represented in both cortices.
Def.,• It is damage of the lower motor neurons (the
spinal AHCS and the cranial motor nuclei or their axons) resulting in skeletal ms paralysis
Causes1.Trauma2.Neuropathy
I) Structural changesIn Nerve (degeneration and regeneration In muscle (atrophy and increase Ach
receptorsII) Functional changes1.Flaccid paralysis 2.Fasciculation and fibrillation 3.Dennervation supersensitivity4.Reaction of degeneration
Wallerian degeneration
Retrograde degeneration
Regeneration Atrophy of muscles
A) Flaccid paralysis:Paralysis of denervated ms with loss of all types of
movements; "voluntary, postural and reflex".All reflexes are lost including stretch reflex
resulting in loss of ms tone and tendon jerk (flaccidity).
The extent of paralysis is usually limited to a small group of ms
B) Fasiculations and fibrillations:• Appears few days or weeks after denervation• Disappear when the motor nerve completely
degenerates or successful re-innervation of the ms occurs.
B) Fasiculations :• Synchronous visible contraction of the motor unit
(all ms fibers) supplied by the injured axon. • Result from spontaneous generation of action potential
(injury potentials) in distal segment of the injured axon
B) Fibrillations:• As degeneration of the injured axon continues,
the axon terminals are now separate from the main axon and hence, from each other.
• Injury potentials are still generated along the terminals leading to asynchronous contraction of the individual ms fibers attached to terminals.
• Invisible to the observer and detected only by electromyogram (EMG).
Fibrillations
C) Denervation supersensitivity:• Denervated ms becomes supersensitive to
acetylcholine.• This is due to increase in the number of A.Ch.
receptors which cover the entire surface of ms cell membrane.
D) Reaction of degeneration:• - This means abnormal response of the denervated
muscle to electric stimulation.• Reaction of degeneration (response of denervated
ms):• INCOMPLETE REACTION: • i) Faradic current produces no response. • The denervated muscle has a prolonged chronaxia. • The faradic current is faster than the excitation time
needed to produce a response.• ii) Galvanic current produces an abnormal response. • The response in general is weaker than normal and ACC
> CCC.
D) Reaction of degeneration:COMPLETE REACTION:• When the denervation is prolonged, the ms is
atrophied and fibrosed. • Thus, no response occurs to both faradic and
galvanic currents.
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