Lesions of Upper Motor Neurons and Lower Motor Neurons

Upper and Lower Motor Neurons

All the neurons contributing to the pyramidal and extrapyramidal systems should be called upper motor neurons (UMN). The anterior horn cells and the related neurons in the motor nuclei of some cranial ner es are called lower motor neurons (LMN). Axons of these cells gi e rise to the peripheral motor ner es. These are lowest in position in the motor system and recie e all the inputs from higher centers li!e medulla" pons" mid#brain and cerebral cortex and transmit the same to the target organs. All impulses for motor acti ity are to be funelled into them and these are also called final common pathway. $igns of Upper Motor Neuron Lesions (UMNL) %. &aralysis or wea!ness of mo ements of the affected side but gross mo ements may be produced. No muscle atrophy is seen initially but later on some disuse atrophy may occur.

'. (abins!i sign is present) The great toe becomes dorsiflexed and the other toes fan outward in response to sensory stimulation along the lateral aspect of the sole of the foot. The normal response is plantar flexion of all the toes.

(abins!i *eflex +. Loss of performance of fine#s!illed oluntary mo ements especially at the distal end of the limbs.

,. $uperficial abdominal reflexes and cremasteric reflex are absent.

-. $pasticity or hypertonicity of the muscles.

.. /lasp#!nife reaction) initial higher resistance to mo ement is followed by a lesser resistance

0. 1xaggerated deep tendon reflexes and clonus may be present. $igns of Lower Motor Neuron Lesions (LMNL) %. 2laccid paralysis of muscles supplied.

'. Atrophy of muscles supplied.

+. Loss of reflexes of muscles supplied.

,. Muscles fasciculation (contraction of a group of fibers) due to irritation of the motor neurons 3 seen with na!ed eye.

-. Muscle fibrillation (contraction of indi idual fibers) 3 detected only by 1M4

.. Muscle contracture (shortening of paraly5ed muscles)

0. &resence of muscle wasting

6. *eaction of degeneration) 7hen the LMN is cut" a muscle will no longer respond to interrupted electrical stimulation 0 days after ner e section" although it will still respond to direct current. After %8 days" response to direct current also ceases.

Mnemonic for Medical $tudents

Upper Motor Neuron Lesion vs Lower Motor Neuron Lesion : Difference or comparison between upper motor neuron lesion (UMNL) and lower motor neuron lesion (LMNL) Mnemonic for basis of difference) $T9*M (aby Also remember) :n a Lower motor neuron lesion e erything lowers (asis of ;ifference ($T9*M (aby) $ < $trength T < Tone 9 < 9thers UMNL Lowers :ncreases (spastic) $uperficial reflexes absent /lonus * < *eflexes < ;T* or :ncreased ;eep tendon reflexes M < Muscle Mass $light loss only (aby < (abins!i $ign &ositi e (toe up) &opularity) %6> LMNL Lowers ;ecreases (flaccid) 2asciculations 2ibrillations *eaction of degeneration ;ecreased ;ecreases = Atrophy Negati e (toe down)

Understanding Upper and Lower Motor? Neuron Lesion $igns

An upper motor neuron connects the primary motor cortex of the precentralgyrus of a cerebral hemisphere with a synaptic junction to a lower motor neuron cell body (often located )in the ventral horn of the spinal cord

A lower motor neuron travel then from the ventral horn of the spinal cord, out the ventral root through the spinal nerve (to either or dorsal rami) and then to a named nerve (ex: musculocutaneousnerve) to a specific group of now innervated muscles (the musc. cutaneousnerve supplies the biceps brachiimuscle))ventral

Upper s Lower Motor Neuron Lesions

:nspection M9$TL@ $11N :N $&:NAL /9*; :NAU*@ Muscle (ul!

Loss of muscle bul! in LMN and late in UMN $ymmetry

Muscle 4irth

2asciculations

present in LMN" none in UMN

Muscle Tone flexion=extension" pronation=supination of Boint through its *9M

Cypotonia

o o

flaccidity LMN lesions" spinal shoc!" cerebellar lesions

Cypertonia

$pasticity

# UMN lesion. &yramidal tract in ol ed limb mo es" then catches" and then goes past catch (clasp#!nife) o test by rapidly supinating forearm *igidity o UMN lesions" extrapyrimidal tract lesion o increased tone throughout *9M (cog#wheeling" lead#pipe) o circumducting the wrist

&ower

UMN
o o

flexors D extensors in upper limbs extensors D flexors in lower limbs

LMN reduced power in specific motor neuron distribution deltoids # arm abduction # /- /. (axillary) biceps # elbow flexion # /- /. (musculocutaneous) triceps # elbow extension # /. /0 /6 (radial) thumb flexion # /. /0 (median) wrist extensors # /0 /6 (radial) interossei of hand # finger abduction=adduction # /6 T% (ulnar) hip flexion # L% L' L+ (femoral) hip adduction # L' L+ L, (obturator) hip abduction # L, L- $% (superior gluteal) !nee extension # L' L+ L, (femoral) !nee flexion # L- $% $' (sciatic) an!le dorsiflexion # L, L- (deep peroneal) an!le plantar flexion # $% $' (tibial) foot in ersion # L, L- (posterior tibial) foot e ersion # L- $% (superficial peroneal)
o

compare between L and * 4*A;1 o 8 nil o % flic!er of mo ement o ' mo ement cannot o ercome gra ity o + mo ement cannot o ercome any resistance o , mo ement is wea!er than normal o - normal

$pecial Tests

&ronator ;rift ha e the patient stand with eyes closed and arms held straight out and hands supinated E F patient cannot maintain this position o muscle wea!ness (pronation and outward drift) o UMN lesion (pronation and downward drift) standing problemes

2ine 2inger Mo ements as! patient to touch each finger to crease of thumb (show patient how) and speed it up loo! for right and left differences" slow if UMN lesion

/lonus

An!le or &atellaer clonus in UMN Lesion

*eflexes ;eep Tendon *eflexes

biceps tendon (/-#.) brachioradialis tendon (/-#.) triceps tendon (/.#6) !nee Ber! (L'#,) Achilles tendon ($%#') hyperacti e an!le Ber! F examine for clonus at !nee and

an!le absent F use reinforcements (teeth clenching for UL" Aendrassi!Gs maneu er for LL)

UMN F hyperreflexia" but may be flaccid LMN F diminished reflexes

4rading

8 nil % low normal ' normal + high normal

, clonus (sustained D + beats) note if reinforcements used (teeth clenching" hand grips)

(abins!iGs reflex (L-#$%) E F dorsiflexion of the big toe with=without fanning of the other toes (UMN lesion)