Cranial Motor Neuron; Eye

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
• 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
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
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
• Lower motor lesion affects the a-
motor neuron (w/in lamina IX of
the ventral grey horn)
• Whole face will be affected
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
• Ipsilateral upper and lower facial
Hypoglossal nucleus

• Corticobulbar Tract
• Initial loss of contralateral input
• After a few weeks of recovery, ipsilateral
input compensates for loss of contralateral
• Motor Cortex (same affects as
corticobulbar tract)
• Ex: Lesion on right cortex
• Left side of tongue is weak (contralateral to
• 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
• 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

• 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
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
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 •
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
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 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