INDIVIDUAL ASSIGNMENT

Basic Human Neuroscience

1 year / 2 Semester / 2020 / FMUI 2020
st nd

Mohamad Arbian Karim

2006489400 – Group B

Paraparesis

Introduction

Paraparesis is a partial loss of voluntary motor function in the pelvic limbs, it is

similar with with paraplegia which is the complete loss of voluntary motor function in
the pelvic limbs.1 It can also be said that paraparesis is the weakness affecting both
lower extremities, and paraplegia is the paralysis of the lower extremities.
Paraparesis can be caused by peripheral nerve or muscle disease, but it can also be
caused by lesions in the corticospinal tract, usually at the spinal cord level. 2 In this
LTM, I will be discussing about the main types of paraparesis and how it occurs in
the nervous system caused by lesions in the spinal cord.

Topics Discussion

A. The Upper Motor Neuron Lesion

Before we talk about the types of paraparesis, we must know how

paraparesis occurs in our body. In order to understand this, we must
understand the upper motor neuron and the corticospinal tract. The primary
motor activity for our somatic system from our neck until the feet is controlled
by the corticospinal tract. The corticospinal tract is a major spinal pathway
used in voluntary movements. The tract starts in the primary motor cortex
where the soma of pyramidal neurons are placed within corticol layer V. The
internal capsule, cerebral peduncles, and ventral pons is where the axons for
these neurons travel in bundles. They are put in the ventral position inside
the medulla as the pyramids. A lot of the axons will cross the midline at the
pyramidal decussation between the brainstem and the spinal cord to form the
lateral corticospinal tract. Because of this crossover, the right side of the brain
will control the left side of the spinal cord and vice versa. The anterior
corticospinal tract will be formed by a small number of axons that remain on
the ipsilateral side. Axons from both the anterior and lateral corticospinal tract
will move into the gray matter of the ventral horn and create a synapse with
the lower motor neurons.
The lower motor neurons will exit the spinal cord to contract the muscle while
the anterior corticospinal tract will assist with axial muscle motor control. The
primary pathway for sending motor information to the body is the lateral
corticospinal tract. If there is damage to the lateral corticospinal tract, this will
result in paresis or weakening of the motor strength, ipsilateral paralysis or
the inability to move, and hypertonia or increased tone. The lateral
corticospinal tract can suffer damage in a various ways. The most common
types of injury are central cord syndrome, Brown-Sequard syndrome, and
anterior spinal cord syndrome.

Fig.1 Corticospinal tract lesion locations (A) Normal spinal cord cross section. (B) Area affected by central cord
syndrome (C) Area affected by anterior cord syndrome (D) area affected by Brown-Sequard syndrome

Van Wittenberghe IC, Peterson DC. Corticospinal Tract Lesion. [Updated 2020 Aug 30] [Internet]. Treasure Island
(FL): StatPearls Publishing; 2021 Jan [2021 Apr 6]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK542201/

The extent of trauma needs to be evaluated for any spinal cord lesion.
Cervical immobilization should be performed if there are any injury involving
the cervical segment to prevent further injury to the cord. A complete
examination of all primary functions of the spinal cord should be included.
These primary functions include motor, primary touch, light touch, autonomic
function, pain, proprioception, and temperature. Touching the patient at
different dermatome regions of the body using blunt or sharp objects can
used as an assessment of sensory function for primary touch and pain.
Examine muscle tone and spasticity for extensors and flexors of the arms and
legs to assess corticospinal tract function. Have the patient move different
groups of muscles with and without resistance to test for motor strength and
 function. Use a finger to nose test, rapid alternating movements test, or
Romberg test to assess for proprioception. Examine their gate for motor
ability and coordination if the patient is ambulatory or can walk. The bowel
and bladder can be affected if the injury occurs at the lower lumbar region. In
these cases, the rectal tone can be assessed to determine the severity of
autonomic compromise.3
B. Types of Paraparesis

There are two main causes for paraparesis,

Summary

The

References

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