HUMAN MOTOR SYSTEM

HUMAN MOTOR SYSTEMPagan Pambudi, Sp.SThe Motor Cortex

The Pyramidal Tract

Pyramidal tractCortex corona radiata capsula interna ventral of brainstem decusatio pyramidalis tract corticospinalis lateralis cornu anterior peripheral nerve NMJ

UMN or LMNUMN Upper Motor NeuronLMN Motor Neuron to NMJ

Where is the Lession

LMN vs UMNUMNLMNAtrophy+ (disuse) +++ToneSpasticFlaccidDTRIncrease to clonusDecrease/absentPatological reflexes+-Fasikulasi-+How to Examine Motor SystemInspectionAtrophyFasiculationSpontaneous clonus

How to Examine Motor SystemMotor Strength5 = N+4 = slightly below N4 = some resistance3 = against gravity2 = joint movement1 = muscle contraction0 = no movement at all

PARESISPLEGIAHow to Examine Motor SystemMotor ToneHipotoniaNormalHipertoniaRigidity : ParkinsonismSpasticity: UMN syndrome

Deep Tendon ReflexesDTRBicepsTricepsBrachioradialisPatellaAnkeCase 1An old man, 70 yrs old, come to our ER with left weakness of his extremity, with MRC score both leg and arms =0, occurs suddenly, When he smile the face deviated to the right, the left side was fallen, there are lingual disarthria and when we ask the patient to protrude, the tonge deviate to the left.IS IT UMN OR LMN CASE AND WHERE IS THE LESION?Case 215 yrs boy, with difficulty to walk, in the examination there is atrophy in tibialis anterior and he has a drop foot, the gastrocnemius was atrophic too, the achiles DTR is absent, Muscel strength of gastrocnemius and tibialis anterior are 2 on MRC scale, kuadriceps femoris and hamstring are normal, the boy has anestetic macula on his backUMN OR LMN /, where is the lesion ?Case 3A Woman 35 yrs old with complaint difficulty to walk for 3 month, on the examnation, there are weakness of both leg, spastic, and has clonus in both ankle and patella DTR, she complaint numbness till umbilicus and has difficulty to micturition.UMN or LMNWhere is the lesion ?