HUMAN MOTOR SYSTEM

Pagan Pambudi, Sp.S

The Motor Cortex

The Pyramidal Tract

Pyramidal tract
Cortex corona radiata capsula interna ventral of brainstem decusatio pyramidalis tract corticospinalis lateralis cornu anterior peripheral nerve NMJ

UMN or LMN
UMN Upper Motor Neuron LMN Motor Neuron to NMJ

Where is the Lession

LMN vs UMN
UMN LMN

Atrophy Tone DTR Patological reflexes Fasikulasi

+ (disuse) Spastic Increase to clonus + -

+++ Flaccid Decrease/absent +

How to Examine Motor System

Inspection
Atrophy Fasiculation Spontaneous clonus

How to Examine Motor System

Motor Strength
5=N +4 = slightly below N 4 = some resistance 3 = against gravity 2 = joint movement 1 = muscle contraction 0 = no movement at all

PARESIS

PLEGIA

How to Examine Motor System

Motor Tone
Hipotonia Normal Hipertonia
Rigidity : Parkinsonism Spasticity: UMN syndrome

Deep Tendon Reflexes

DTR
Biceps Triceps Brachioradialis Patella Anke

Case 1
An old man, 70 yrs old, come to our ER with left weakness of his extremity, with MRC score both leg and arms =0, occurs suddenly, When he smile the face deviated to the right, the left side was fallen, there are lingual disarthria and when we ask the patient to protrude, the tonge deviate to the left. IS IT UMN OR LMN CASE AND WHERE IS THE LESION?

Case 2
15 yrs boy, with difficulty to walk, in the examination there is atrophy in tibialis anterior and he has a drop foot, the gastrocnemius was atrophic too, the achiles DTR is absent, Muscel strength of gastrocnemius and tibialis anterior are 2 on MRC scale, kuadriceps femoris and hamstring are normal, the boy has anestetic macula on his back UMN OR LMN /, where is the lesion ?

Case 3
A Woman 35 yrs old with complaint difficulty to walk for 3 month, on the examnation, there are weakness of both leg, spastic, and has clonus in both ankle and patella DTR, she complaint numbness till umbilicus and has difficulty to micturition. UMN or LMN Where is the lesion ?