E xtrapyramidal System

A collection of nerve fibres connecting two masses of grey matter within the central nervous system is
referred to as a tract, system or pathway. They are often referred to as fasciculi (bundles) or lemnisci
(ribbons).

Tracts may be ascending or descending, and are usually named after the masses of grey matter they
interconnect. Therefore, a pathway that originates in the cerebral cortex and descends to terminate in the
spinal cord is referred to as a corticospinal tract, while a tract ascending from the spinal cord to the
thalamus is called the spinothalamic tract.

The extrapyramidal pathway or system is an important part of the motor system of the body and can also
be described as the descending motor pathway, whose fibres pass through the tegmentum rather than the
medullary pyramid. The extrapyramidal pathway is actively involved in the initiation and selective activation
of movements, along with their coordination.

Major contribution in the extrapyramidal motor system are the nuclei of the basal ganglia. Other structures
which are involved include substantia nigra, red nucleus, subthalamic nucleus, mesencephalic reticular
formation and the cerebellum. The extrapyramidal system is also often described as the motor-modulation
system.

The term “extrapyramidal” is to distinguish between the effects of basal ganglia diseases and those of
damage to the “pyramidal” system, even though there is an intertwine of a functional relationship between
the two systems. Extrapyramidal system is polysynaptic in nature with many synapses within the
brainstem.

Gray matter - ventral view

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C omponents !

Most of the descending pathways running from the cerebrum, cerebellum and brainstem towards
the spinal cord, without coursing through the pyramids of the medulla, are considered part of the
extrapyramidal system. Such tracts include:

Parts of the rubrospinal tracts

Tectospinal tracts

Reticulospinal tracts (lateral and medial)

Lateral and medial vestibulospinal tracts

R ubrospinal tracts

Fibres originating from the red nucleus

(which lies in the upper part of the midbrain)
course to the spinal cord, as rubrospinal
tracts, but decussate to the opposite side in
the lower part of the tegmentum of the
midbrain. Such crossing fibres constitute
what is referred to as the ventral tegmental
decussation. The extrapyramidal part of the
rubrospinal tracts descend through the pons
and medulla to enter the lateral funiculus of Midbrain - medial view

the spinal cord, where they terminate by

lying immediately anterior to the lateral
corticospinal tract (pyramidal tract).

T ectospinal tracts
Another collection of extrapyramidal tracts originates from the superior colliculus. These tracts are
referred to as the tectospinal tracts and cross in the posterior tegmental decussation of the midbrain.
Fibres of the tract synapse with motor neurons of the cervical muscles and mediate reflex postural
movements. They follow the same course of the rubrospinal tracts by passing through the pons and
medulla but terminate in the anterior funiculus of the spinal cord.

R eticulospinal tracts

The lateral reticulospinal tracts, which

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originate in the ventrolateral part of the
reticular formation of the pons, cross to the
opposite side in the medulla and run inferiorly
in the lateral funiculus of the spinal cord. This
pathway is associated with motor functions
and in the control of pain perception.
In the medial parts of the reticular formations of the pons and
medulla, arise the medial reticulospinal tracts. Pontine fibres
of these tracts travel in the anterior funiculus and are mainly
uncrossed. Medullary fibres travel in the anterior and lateral
funiculus as crossed and uncrossed. This tract is mainly
concerned with posture.

V estibulospinal tracts Pons - lateral left view

The medial and lateral vestibulospinal tracts

originate in the medial vestibular and lateral
vestibular nucleus respectively. The lateral
vestibulospinal tracts, are particularly
important for the balancing of movements.
They lie in relation to the ventral grey
column of the spinal cord in the anterior
funiculus, where they terminate without
crossing as they course through the
medulla.
Medial vestibular nucleus - ventral
On the other hand, most of the fibres of the medial
view
vestibulospinal tract decussate as the tracts descend
through the medulla to terminate in the anterior funiculus
within the cervical region of the spinal cord. Thier axons
inhibit motor neurons of neck axial muscles.

" Clinical relevance !

Damage to the extrapyramidal system leads to different forms of movement and cognitive
disorders. The majority of such movement disorders are classically described as dyskinesia.
Different types of dyskinesia include myoclonus, tics, chorea, athetosis and tremors. Injury to the
pyramidal system induces paralysis, whereas extrapyramidal tract disorders result in involuntary

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 movements, muscle rigidity and immobility without paralysis. In some cases, both pyramidal and
extrapyramidal systems are affected, such as spastic-athetoid cerebral palsy. Disorders which
are seen with many types of extrapyramidal disease are:

Parkinson’s disease, which is linked to dopamine deficiency in the striatum of basal ganglia. It is
characterised by rigidity (increased muscle tone), bradykinesia (slowing of movements) and
tremors.

Non-spastic cerebral palsy, which could be dyskinetic or ataxic. It is caused by damage to the
nerve cells outside the pyramidal tracts in the basal ganglia or in the cerebellum.

Huntington’s disease, which is a choreiform disorder. It is caused by the degenerative process

in the striatum.

Extrapyramidal symptoms including acute and tardive dyskinesias and dystonic reactions are
sometimes serious side effects of antipsychotic and other drugs.

References:

Standring S. (2008) Gray’s Anatomy: The Anatomical Basis of Clinical Practice. Churchill
Livingstone Elsevier 40th Edition, p. 228 – 291.
H. P Academy: The human brain. HumanPhysiology.Academy 2014-2015. (accessed 12/12/2015).
Singh: Textbook of Neuroanatomy, 2nd edition, (2010) p. 60 – 65.
P. Gupta: Extrapyramidal tracts and disorders (accessed 12/12/2015).
K. T. Patton: Anatomy and Physiology, 9th edition (2013), p. 467 – 469.

Author, Review and Layout:

Benjamin Aghoghovwia
Uruj Zehra
Catarina Chaves

Illustrators:

Gray matter - ventral view - Rebecca Betts

Midbrain - medial view - Paul Kim
Pons - lateral left view - Paul Kim
Medial vestibular nucleus - ventral view - Paul Kim

© Unless stated otherwise, all content, including illustrations are exclusive property of Kenhub GmbH, and are
protected by German and international copyright laws. All rights reserved.

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# Related diagrams and images

B rainstem

T halamus

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