Voluntary Motion

Tracts
KAZAN STATE MEDICAL UNIVERSITY
  1. Descending Tracts
 2. Corticospinal Tract
 3. Lateral Corticospinal Tract
 4. Anterior Corticospinal Tract
Outline  5. Functions of Corticospinal Tract
 6. Clinical Significance
 7. References and other resources
Descending
(Efferent)
Tracts
• Descending pathway are considered with,

SOMATIC &

VISCERAL Motor activities.

• Somatic motor pathway of brain and spinal cord are divided into two
types.

• These tracts are functionally different. Clinically these tracts are

considered together because lesions within the cortex always almost
involve both of them.
• Both these system control the motor activities of body through lower motor
neurons (LMN).

• Have their cells of origin in the cerebral cortex (or) in the brainstem.

• It is otherwise called as motor pathway.

• Conventionally, the term pyramidal tract refers specifically to a group of corticospinal
fibres (corticospinal tract) which occupies the pyramid of the Medulla Oblengata,
however clinically. or
(the pyramidal tracts derive their name from the medullary pyramids of the
medulla oblengata, which they pass through).

• This is the longest tract starting from the motor cortex and reaching up to the last
segment of the spinal cord & carry motor impulses from cortex to the spinal
cord.

• This is the main Voluntary motor pathway.

• 80% - 90% of the fibres in the pyramidal system are small diameter is 1µm
diameter.
• It consists of two neurons, the upper and lower motor neurons. Previously
mentioned that the pyramidal tract are control the motor activities of body
through Lower motor neuron (LMN).
• It is present in the higher animals and man where cerebrum has
developed.
• All the pyramidal fibres,
 55% end in the Cervical
 20% in the Thoracic
 25% in the Lumbosacral Region
• Pyramidal tract are considered with,

Corticospinal tract

Corticonuclear tract
 Corticospinal tracts - Supplies the musculature of the axial &
Extremity.
 Corticobulbar tracts - Supplies the musculature of the head &
neck.
• Corticonuclear fibres otherwise called as Corticobulbar tract.
• That Motor Cranial Nuclei (Particularly 4, 7, 12)
• This is a pathway that begins in the cerebral cortex and ends in the brain stem.
• Bulbar means pertaining to the brainstem where all motor cranial nuclei are
located.
• Throughout the brainstem, the corticobulbar fibres are crossing to reach the
motor cranial nuclei of the opposite side
Corticospinal
Tract
• The corticospinal tract are not the sole pathway for serving voluntary movement.
Rather, they form the pathway that confers speed and agility to voluntary
movements and is thus used in performing rapid skilled movements.
• Many of the simple, basic voluntary movements are mediated by other descending
tracts.
• The corticospinal tract are the pathway concerned with voluntary, discrete, skilled
movements, especially those of the distal part of the limbs.
• Corticospinal tract has approximately 1 Million nerve fibres with an avarage
conduction velocity of approximately 60m/s using glutamate as their transmitter
substance.
 GROWTH OF CORTICOSPINAL TRACT
IN FETUS:
• 1st corticospinal axons, less than 0.5 microns in diameter.
• MYELINATION:-
The myelination of the pyramidal fibres is incomplete at birth &
gradually progresses in Cranio-caudal (from head to feet)
direction and thereby progressively gaining functionality.
Most of the myelination complete by 2 years of the age (that’s why
under 2 years baby have babinski sign negative).
 Myelination commences between postnatal days 10-12.
 Myelinate largerly during the 1st & 2nd years after birth.
It progressively slowly in Carnio-caudal direction upto 12the year of
the age.
• The rate of extension of corticospinal axons are not constant.
On the day after birth, labelled corticospinal axons have crossed in the pyramidal
decussating and extended into the dorsal column of the upper cervical spinal
cord level.

Postnatal day-3
Corticospinal tract reach the thoracic segments

Postnatal day-6
It reach Lumbar segments

Postnatal day-9
It reach the sacral segments
FIBERS OF THE CORTICOSPINAL
TRACT:
• Are usually 90% between 1 – 4 micro in diameter.
• Are usually 67% myelinated.
• With diameters greater than 20 micra, represent 4% of the tract’s population.
These are the axons of the Giant cells of Betz (these Betz cells are found in
the precentral gyrus and in the anterior paracentral lobule).
• Betz cells are pyramidal cell neurons located within the 5th layer of the
primary motor cortex. They are some of the largest in the central nervous
system, sometimes reaching 100 µm in diameter and send their axons down
the corticospinal tracts to the anterior horn cells of the spinal cord. They
are named after Ukrainian scientist Vladimir Betz, who described them in
his work published in 1874.
(Functions of the Betz cells are see further more in the functions of the
corticospinal tract)*.
• The Archicortex consists of the hippocampus, which is a three-layered
cortex.
• The Neocortex represents the great majority of the cerebral cortex. It has six
layers and contains between 10 and 14 billion neurons.

TYPES OF CORTEX:
Archicortex
Paleocortex
Neocortex
• Corticospinal tract are considered with,

Lateral Corticospinal tract

Anterior Corticospinal tract

Physiologically, the anterior pathways are old, whereas the lateral

pathways are new.
ORIGIN OF CORTICOSPINAL
TRACT:
• Fibres of the corticospinal tract arise as axons of pyramidal cells situated in the 5th
layer of the cerebral cortex.
1/3rd of the fibres originate primary motor cortex (Area 4).
1/3rd originate from the Secondary motor cortex (Area 6).
1/3rd originate from the Primary Somato sensory cortex (postcentral
gyrus)
(Area 3, 1 and 2).

These fibres do not control motor activity but influence sensory input to
the nervous system.
 PRIMARY MOTOR CORTEX
(Precentral gyrus)

PRIMARY
SOMATOSENSORY
CORTEX
(Post central gyrus)
SECONDARY MOTOR CORTEX

SUPPLEMENTAL MOTOR AREA PRE FRONTAL CORTEX

PRE MOTOR AREA

•Electrical stimulation of different part of the
precentral gyrus produces movements of
different parts of the opposite side of the body,
we can represent the parts of the body in the
areas of the cortex, Such a Homunculus.

•Note that the region controlling the face is situated

inferiorly and the region controlling the lower limb is
situated superiorly and on the medial surface of the
hemisphere.

•The Homunculus is a distorted picture of the body,

with the various parts having a size proportional to
the area of the cerebral cortex devoted to their
control. It is intresting to find that the majority of the
corticospinal fibres are myelinated and are relatively
slow-conducting small fibres.
 COURSE OF THE
CORTICOSPINAL TRACT:

• These descending fibres converge in the

Corona radiata to reach Internal
capsule. (Located between the
Thalamus and the basal ganglia)

• IN THE INTERNAL CAPSULE:

 then pass through the posterior limb of
the Internal capsule.
 Where they occupy in the genu and the
anterior 2/3rd of the posterior limb.
INTERNAL CAPSULE INTERNAL CAPSULE
The motor fibres passes through the
posterior limb of the internal capsule
where they are organized in the
sequence of “fibres of UPPER
EXTREMITY, TRUNK, LOWER
EXTREMITY”.
This is clinically important, as the internal
capsule is particularly susceptible to
compression from haemorrhagic
bleeds, known as a ‘capsular
stroke‘. Such an event could cause a
lesion of the descending tracts.
CAUDATE
NUCLEUS PUTAMEN
GLOBUS
PALLIDUS THALAMUS
IN THE MIDBRAIN:
The tract then continues through the
middle 3/5th of the (Crus cerebri of
Cerebral peduncle) or basis
pedunculi of the midbrain ventral to
the substantia nigra.

The middle fifth carries the pyramidal

tract and medial frontopontine and lateral
temporopontine fibres.
IN THE PONS:
And then passes through the base
(Basilar part) of the pons.
In the pons the corticospinal tracts are
become scattered.
 IN MEDULLA OBLONGATA:
While coming out of the pons, the
scattered corticospinal fibres are
reunited and enter the medulla as a
thick bundle.

The bundles are become grouped

together in the upper part of medulla
& along the anterior border to form
a swelling known as the pyramid or
Medulla Oblongatary Pyramids
Great Motor
(Cervicomedullary Junction)
(hence the alternative name Decussation
pyramidal tract).
Pyramid of the Olivary Nuclei
Medulla Oblangata
Pyramid of the Medulla
Oblangata

Olivary Nuclei
• The majority of the fibres cross (Decussate) to the opposite side
& enter the lateral white column as the Lateral
Corticospinal Tract of spinal cord.
• The remaining fibres about do not cross in the decussation &
enter the anterior white column as Anterior corticospinal
tract of spinal cord.
LATERAL
CORTICO
SPINAL
TRACT
In the lower part of medulla(junction between the medulla oblongata
and the spinal cord) the majority of the fibres (75-90%) cross to the
opposite side & descend in the spinal cord occupying the posterior part of
lateral white column as the Lateral Corticospinal Tract of spinal
cord.
 It extend throughout the spinal cord.
At each segment some fibres leave the tract, turn inward and end round
the anterior grey horn cells (Motor neurons) either directly or through
interneuron's.
 They are also called as “CROSSED CORTICOSPINAL TRACT”.
• The Lateral Corticospinal
Tract (Betz cells fibres)
descend in the Lateral
funiculus of the spinal cord
to terminate mainly in the
lumbosacral region of the
spinal cord.
 TERMINATION OF THE
LATERAL CORTICOSPINAL
TRACT:

• It terminates via
Interneurons on ventral horn
motor neurons and sensory
neurons of the dorsal horn
till the lumbosacral region of
the spinal cord.
ANTERIOR
CORTICOSPI
NAL TRACT
The remaining fibres about (10-25%) do not cross in the decussation &
enter the anterior white column near the median fissure and descend
down as Anterior corticospinal tract of spinal cord.
 They are also called as “UNCROSSED CORTICOSPINAL
TRACT”.

As a rule, the direct pyramidal tract does not crossed beyond the Lower
cervical (or) Mid thoracic region.
• The Anterior Corticospinal
Tract descend in the Anterior
funiculus of the spinal cord
to terminate mainly in the
anterior horn grey matter of
the cervical and upper thoracic
spinal cord levels.
Near their termination, fibres of the
anterior corticospinal tract cross the
midline (decussate to the opposite side)
to end round the anterior horn cells of
the opposite side & instead synapse
directly with lower motorneurons.
 FUNCTIONS OF
THE
CORTICOSPINAL
TRACT
 Thought of the Movement in Prefrontal cortex
(Example: Flexion of Biceps)

ORIGIN: (BETZ cells)

~Primary motor cortex
6
- pre motor cortex
~Secondary motor cortex - Supplemental
Area
This is the
~Primary Somatosensory cortex
planned
motor
2 movements
What type of
3 movement
4
can be
perform?

Basal Ganglia
(Blue print of the Cerebellum 6
movement)
Special checking
mechanism:
~Low/high/perfect 5
intensity of the
movement

Muscle Pontine nuclei

Receptors 5 Spinal cord 5 (Conveying the information)
(Proprioception)
Continue
~Primary motor cortex
-pre motor cortex
~Secondary motor cortex -pre frontal cortex
-Supplemental Area
~Primary Somatosensory cortex

Corona radiata

Internal Capsule
(Special white matter)

Crus Cerebri of the Cerebro peduncle

Fibres are scattered

(leg/arm/trunk)

Pontine Nuclei
Continue
Scattered fibres are reunited

Lower part of meduul oblengata

(Pyramidal decussation)

Lateral Corticospinal tract Anterior Corticospinal tract

Lateral Funiculus Anterior Funiculus

Synapse with the same side cell bodies Synapse (via Anterior commusure) with
of Ventral or Anterior grey horn the opposite side cell bodies of Venral or
Anterior grey horn

Stimulate the
Stimulate Muscle Spindles
Extrafeusal fibres Alpha motor Gamma motor
(Maintain the
(Maintain the neuron neuron
length and Tone)
contractions)
1) The corticospinal tract has many functions which include the,
 Control of afferent inputs:–
(These fibres that originate from the sensory cortex (somatosensory cortex)
terminate in the dorsal horn of the spinal cord where they synapse with
interneurns that receive input from somatosensory receptors and are thought
to regulate information pheripheral receptors within the spinal cord).

 Spinal reflexes:–
(the 1st order afferent sensory fibres transmitting sensory information from the
muscle spindles also from synapses with the inhibitory interneurons (that
synapse with the Lateral corticospinal tract) to mediate reflex activity.

 Motor neuron activity.

 MOTOR NEURON ACTIVITY
LATERAL CORTICOSPINAL
TRACT
This mediates the execution
of rapid, skilled, voluntary
and Fine movements of the
distal musculature of upper
and lower limbs.
i.e., The intrinsic and
extrinsic muscles of the
hand and foot, especially
the muscles of the hand.
ANTERIOR CORTICOSPINAL
TRACT
Control of Axial muscles
(Neck, Shoulder, and Trunk)
 proximal upper limb (girdle)
musculature.
And they are associated with
the maintenance of upright
posture.
 Betz cells are capable of faster nerve impulse transmission to
the spinal cord. The rapid conduction rate is 70m/sec.
 CLINICAL
SIGNIFICANCE
INTRODUCTIO
N:
1) The resulting deficiencies associated with lesions to the respective tracts
will depend on the location of the lesions.
 A lesion proximal to the decussation of the pathway will result in a
contralateral defect.
 In contrast, a lesion distal to the decussation will result in
ipsilateral
signs and symptoms.
• Injury to the corticospinal tract caudal to the decussation may present with
varying types of paresis or paralysis of the upper and lower limbs.
 Unilateral lesions present with ipsilateral hemiparesis, hemiplegia
or
Monoplegia.
 While bilateral lesions may result quadriplegia, or bilateral
2) The lesion types are deviding into two.

Upper Motor Neuron Lesion

Lower Motor Neuron Lesion

1) UPPER MOTOR NEURON
LESIONS:
• The pyramidal tracts are susceptible to damage, because they extend almost
the whole length of the central nervous system. As mentioned previously,
they particularly vulnerable as they pass through the internal capsule – a
common site of cerebrovascular accidents (CVA) - (haemorrhagic bleeds,
known as a ‘capsular stroke‘).
(Additionally, lesions of the cortex (cortical lesions) or within the internal
capsule (capsular lesions) may present with both corticospinal and
corticobulbar findings. That is, contralateral muscle weakness in addition to
cranial nerve abnormalities.)
• If there is only a unilateral lesion(upper to the decussation) of the left or right
corticospinal tract, symptoms will appear on the contralateral side of the body.
• (Corticospinal tract syndrome)
• The Cardinal signs of an upper motor neurone lesion are:
1) Hypertonia – an increased muscle tone
2) Hyperreflexia – increased muscle reflexes
3) Clonus – involuntary, rhythmic muscle contractions (an
oscillatory motor response to muscle stretching)
4) Babinski sign – extension of the hallux in response to blunt
stimulation of the sole of the foot.
5) Muscle weakness.
• When the Babinski reflex is present in a child older than 2 years or in an
adult, it is often a sign of a central nervous system disorder. The central
nervous system includes the brain and spinal cord. Disorders may
include:
 Amyotrophic lateral sclerosis (Lou Gehrig disease)
 Brain tumor or injury
Meningitis (infection of the membranes covering the brain and
spinal cord)
 Multiple sclerosis
 Spinal cord injury, defect, or tumor
 Stroke.
1. THE BABINSKI SIGN:
The normal response in an adult to stroking the sole of the
foot is flexion of the big toe, and often the other toes. Following
damage to descending upper motor neuron pathways,
however, this stimulus elicits extension of the big toe and a
fanning of the other toes.
A similar response occurs in human infants before the
maturation of the corticospinal pathway and presumably
indicates incomplete upper motor neuron control of local
motor neuron circuitry.
2. SAPSTICITY (Hypertonia):
 Spasticity is increased muscle tone.
Spasticity is probably caused by the removal of inhibitory influences
exerted by the cortex. It predominates in the Antigravity muscles.
 Spasticity is also eliminated by sectioning the dorsal roots.
The form and intensity of spasticity may vary markedly, depending on
the extend and site of the Central Nervous System(CNS) system damage.
 It is typically manifested as increased resistance to passive movements.
3. SPINAL REFLEXES (Hyperreflexia):
Spasticity is also eliminated by sectioning the dorsal roots, suggesting
that it represents an abnormal increase in the gain of the spinal
cord reflex due to loss of descending inhibition.
4. HYPOREFLEXIA OF SUPERFICIAL REFLEXES:
The initial stage of lesion, the superficial reflexes are Areflexia
or
Hyporeflexia. That mechanism of diminishment of superficial reflexes
is not well understood.
Further signs are the decreased vigor (and increased threshold) of
superficial reflexes such as the,
 Corneal reflex,
Superficial abdominal reflex (tensing of abdominal muscles in
response to stroking the overlying skin), and
 The cremasteric reflex in males (elevation of the scrotum in
response
to stroking the inner aspect of the thigh).
5. A loss of the ability to perform fine movements:
 If the lesion involves the descending pathways that control the lower
 motor neurons to the upper limbs, the ability to execute fine movements (such as independent
movements of the fingers) is lost.
6. MUSCLE WEAKNESS:
Weakness may range in severity from mild paresis to total paralysis, depending
on the extent of the lesion.
Types of weakness or paralysis:
1. Hemiplegia/paresis
2. Monoplegia/paresis
3. Paraplegia/paresis
4. Triplegia/paresis
5. Tetraplegia (or) Quadriplegia/paresis
 Types of Weakness Definition Common causes

Paralysis/Weakness of muscles of the arm, Lesion at the Internal capsule,

Hemiplegia/Hemiparesis leg &sometimes face on one side of the cerebral hemispheres, pontine
body. bleed, rarely a high spinal cord
injury .

Paralysis/Weakness of all the muscles of the Lesion at the cerebral

Monoplegia/Moparesis hemisphere and spinal cord &
limbs, either Upper extremity & Lower
extremity. peripheral Neuropathy.

Paraplegia/Paraparesis Paralysis of muscles in both legs Spinal cord lesions &

Peripheral Neuropathy.

Hemiplegia paresis combined with High cervical spinal cord lesion

Triplegia/Triparesis paralysis of one limb on the opposite side or multiple lesion.
of the body.

Lesion: high cervical spinal cord,

Paralysis/Weakness of all four brainstem or Cerebral Hemispheres,
Tetraplegia/tetraparesis and Acute polyneuropathy,
limbs.
Radiculopathy, Myopathy
 PARTS ARTERIAL SUPPLY

Motor cortex 1) Anterior cerebral artery

1) Leg area 2) Middle cerebral artery
2) Face, Trunk & Arm areas

Internal capsule Branches of middle cerebral artery

Midbrain (Crus cerebri) Posterior cerebral artery

Pons Pontine branches of basilar artery

Medulla Oblangata Anterior spinal branches of vertibral artery

Spinal cord Segmental branches of Anterior & posterior spinal artery

 1. B.D.Chourasia (Human Anatomy)
2. Sembulingam (Medical Physiology)
3. A.K.Jain (Textbook of Physiology)
4. James D.Fix (NeuroAnatomy)

5. Christoper M.Fredericks (Pathophysiology of the motor

system)
6. Eric R.Kandel (Principles of neural science)
7. Snell’s (Clinical NeuroAnatomy)
References 8. Vichram Singh (Clinical NeuroAnatomy)
9. Harold Ellis (Clinical Anatomy)
10. Bear MF, Connors BW, Paradiso. (Brain and
Neuroscience).
11. Stiner CM, Barber PA, Petoe M, Anwar S, (Functional
potential in chronic stroke patients depends on
corticospinal tract integrity).Dale Purves, George J
Augustine, David Fitzpatrick, Lawrence C Katz,
Anthony-Samuel LaMantia, James O McNamara, and S
Mark Williams (Neuroscience-2nd edition).

12.Karen J.Jones (Neuro Assessment a Clinical Guide)

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