Upper Motor Neurones (UMN) vs Lower

Motor Neurone (LMN) Lesions

1

BY BURHAN AHMED
IN CLINICAL MEDICINE
30 APR, 2011 AT 2:58 PM

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 nerves
are called lower motor neurons (LMN). Axons of these cells give rise to the peripheral
motor nerves. These are lowest in position in the motor system and recieve all the inputs
from higher centers like medulla, pons, mid-brain and cerebral cortex and transmit the same
to the target organs. All impulses for motor activity are to be funelled into them and these
are also called final common pathway.

Signs of Upper Motor Neuron Lesions (UMNL)

1. Paralysis or weakness of movements of the affected side but gross movements may be
produced. No muscle atrophy is seen initially but later on some disuse atrophy may occur.
2. Babinski 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.
3. Loss of performance of fine-skilled voluntary movements especially at the distal end of the
limbs.
4. Superficial abdominal reflexes and cremasteric reflex are absent.
5. Spasticity or hypertonicity of the muscles.
6. Clasp-knife reaction: initial higher resistance to movement is followed by a lesser
resistance
7. Exaggerated deep tendon reflexes and clonus may be present.

Signs of Lower Motor Neuron Lesions (LMNL)

1. Flaccid paralysis of muscles supplied.

2. Atrophy of muscles supplied.
3. Loss of reflexes of muscles supplied.
4. Muscles fasciculation (contraction of a group of fibers) due to irritation of the motor
neurons seen with naked eye.
5. Muscle fibrillation (contraction of individual fibers) detected only by EMG
6. Muscle contracture (shortening of paralyzed muscles)
7. Presence of muscle wasting
8. Reaction of degeneration: When the LMN is cut, a muscle will no longer respond to
interrupted electrical stimulation 7 days after nerve section, although it will still respond to
direct current. After 10 days, response to direct current also ceases.

Mnemonic for Medical Students

Mnemonic for basis of difference: STORM Baby
Also remember: In a Lower motor neuron lesion everything lowers
Basis of Difference
(STORM Baby)

UMNL

LMNL

S = Strength

Lowers

Lowers

T = Tone

Increases (spastic)

Decreases (flaccid)

O = Others

Superficial reflexes
absentClonus

R = Reflexes = DTR or
Deep tendon reflexes

Increased

Decreased

M = Muscle Mass

Slight loss only

Decreases / Atrophy

Baby = Babinski Sign

Positive (toe up)

Negative (toe down)

FasciculationsFibrillations
Reaction of degeneration