Cranial Motor Neuron; Eye

Movements
3/31
Corticobulbar Tract
• Pathway runs from motor cortex to the
medullary pyramids
• Within the medulla, the tracts synapse
on respective nuclei (ex: hypoglossal
nucleus, facial nucleus, motor nucleus
of V)
• Innervates cranial motor nuclei
bilaterally
• EXCEPTION: lower facial nuclei and cranial
nerve XII (unilaterally innervated)
• Both the lower part of cranial nerve VII and
XII are innervated by the contralateral cortex.
• Among those nuclei that are bilaterally
innervated a slightly stronger connection
contralaterally than ipsilaterally is
observed
Corticobulbar Tract
• Controls muscles of the face, head
and neck
• Order of neuron
• 1st neuron – upper motor neuron
• From motor cortex (lower precentral gyrus)
to the medulla
• The level of the medulla the 1st order
neuron ends at depends on which cranial
nerve it synapses on
• 2nd neuron – lower motor neuron
• Cranial nerve
• Lesions
• Upper motor lesion affects the
corticobulbar tract
• Lower motor lesion affects the a-motor
neuron (w/in lamina IX of the ventral grey
horn)
Innervation of Face
• Upper Face: bilateral innervation
• Lower Face: unilateral innervation
from the contralateral side

• Upper motor lesion affects the
corticobulbar tract
• Upper face will be normal
• Lower face will be affected
contralaterally
• Lower motor lesion affects the a-
motor neuron (w/in lamina IX of
the ventral grey horn)
• Whole face will be affected
unilaterally
Facial Paralysis vs Facial Palsy
• Facial paralysis
• Lesion of corticobulbar tract
• Contralateral lower facial paralysis
• No upper facial paralysis b/c upper
face is bilaterally innervated
• Facial (Bell’s) Palsy
• Lesion of facial motor nucleus of
CN VII
• Ipsilateral upper and lower facial
paralysis
Hypoglossal nucleus

Lesions
• Corticobulbar Tract
• Initial loss of contralateral input
• After a few weeks of recovery, ipsilateral
input compensates for loss of contralateral
input
• Motor Cortex (same affects as
corticobulbar tract)
• Ex: Lesion on right cortex
• Left side of tongue is weak (contralateral to
lesion)
• When patient sticks out tongue, tongue will
go to the left
• Genu (same affects as motor cortex &
corticobulbar tract)
• Hypoglossal Nucleus
• Loss on ipsilateral side
Uvula
• Bilaterally innervated by CN X
• Lesion of corticobulbar tract
• Uvula is pulled ipsilaterally
• Lesion of CN X
• Uvula is pulled contralaterally
• Ex: right CN X lesion
• Right side of uvula is weak because of
loss of innervation
• Left side of uvula still maintains its
innervation, so its muscle contracts
• Uvula is pulled to the left side
• Corticobulbar = corticonuclear
Spinal Accessory Nerve
• Nerve innervations to all striated
muscles are all innervated
ipsilateral.

• Sternocleidomastoid
• Right muscle contracts to allow you
to look to the left
• Corticobulbar motor neurons that
innervates this muscle is on the
ipsilateral Good representation
of trapezius

• Trapezius innervation

• Corticobulbar motor neurons is
contralateral Good representation
of
sternocleidomastoid
innervation
Lesions Review
Corticospinal Tract Cranial N.
(Upper motor) (Lower motor)
Face Lower face, contralaterally (VII)
(Facial Paralysis) Whole face, unilaterally (Facial
[Bell’s] Palsy)
Tongue • Loss of contralateral input (XII)
• Tongue goes to opposite side • Loss of ipsilateral input
of the lesion (weak side) • Tongue goes to the same side
of lesion
Uvula • Loss of contralateral input (X)
• Uvula goes to the same side of • Loss of ipsilateral input
lesion • Uvula goes to the opposite
side of lesion

• Remember
• Corticobulbar tract innervates cranial motor nuclei bilaterally, EXCEPT lower facial
nucleus and cranial nucleus of XII
• Lesions of genu or motor cortex present the same way as a lesion to corticospinal tract
Cranial Motor Neuron; Eye
Movements
Neuro Lab 3/31
Eye Movement
• Nystagmus: eyes move rapidly and
• Motor unit to extra-ocular muscle has uncontrollably
a low ratio (1 axon innervates very few • Circulating btw saccade & smooth pursuit
muscle fibers) • Vestibular nystagmus
• Caused by dysfunction of the vestibular
part of the inner ear, the nerve, the
vestibular nucleus within the brainstem, or
• Saccade (rapid eye movement) parts of the cerebellum that transmit
signals to the vestibular nucleus
• Voluntarily change your gaze
• Situation: Spin your patient around in a
• Smooth pursuit (slow eye movement) circle, stop them, and look at their eyes
• Unconscious reflexes that makes the • https://www.youtube.com/watch?v=faRSU
TOQHns
image you see, stay on the fovea (ex:
following a birds flight w/ your eyes) • Optokenetic nystagmus
• Innate and complex ocular motor reflex
that allows us to adequately follow moving
objects when we keep our head steady
• Situation: Tell your patient to keep their
head still and watch as you spin the wheel
of fortune
• https://www.youtube.com/watch?v=LInm9
cZcHyk
Horizontal Gaze
• Paramedian pontine reticular
formation (PPRF)
• Right PPRF stimulates both eyes to
look to the right
• Frontal eye field/cortex
• When activated, eyes saccade to
contralateral side
• Superior colliculus: unconscious
eye movement
Internuclear Opthalamoplegia
• Internuclear Opthalamoplegia (INO)
• One or both MLFs are lesioned, leads to
impairment of eye adduction

• MLF unilateral lesion
• Cannot adduct ipsilateral eye
• Ex: Right MLF lesion
• Both eyes can still tract movement to the
right
• Right eye cannot tract movement to the left
(cannot adduct)
• Left eye can still tract movement to the left
• MLF bilateral lesion
• No adduction for both eyes
Eye Manifestation of Lesions Anomalies

Looking Straight Looking Right Looking Left

Both eyes looks
to the right