PYRAMID SYSTEM.
CENTRAL AND PERIPHERAL
PARALYSIS.
There are two main types of movements: involuntary and voluntary.
Involuntary movements include simple automatic movements carried out due to
the segmental apparatus of the spinal cord and the brainstem by the type of a
simple reflex act. Arbitrary purposeful movements are acts of human motor
behavior. Special voluntary movements are carried out with the leading
participation of the cerebral cortex, as well as the extrapyramidal system and
the segmental apparatus of the spinal cord. In humans and higher animals, the
exercise of arbitrary movements is associated with the pyramid system. In this
case, the pulse from the cerebral cortex to the muscle is carried out along a
chain consisting of two neurons: central and peripheral.
Pyramidal tract
1) Tr.corticospinalis. The bodies of the first neurons are giant pyramidal Betz cells located in
the upper two-thirds of the gyrus precentralis. Their axons pass through the anterior part
of the posterior leg of the inner capsule and transit through the middle third of the legs
of the brain, the bridge, the medulla oblongata. In the bridge, the fibers of the path are
loosened, and in the medulla oblongata they gather into a compact bundle, forming
protruding rollers, pyramides.
At the border with the spinal cord, part of the fibers crosses, decussatio pyramidum, and
in the form of tr.corticospinalis lateralis descends into the lateral ropes, and ends in the
motor nuclei of the anterior horns of its side. The uncrossed (smaller) part,
tr.corticospinalis anterior, goes along its side in the anterior cords of the cervical-
thoracic region, makes a segmental intersection and ends in the motor nuclei of the
anterior horns of its own and the opposite side.
Here lie the bodies of the second neurons. Axons of the anterior pyramidal pathway
conduct impulses to the muscles of the trunk, and the lateral pathway - to the muscles
of the extremities.
2) Tr.corticonuclearis. The first neurons are giant pyramidal cells in the lower part of the
precentral gyrus. Their axons pass through the knee of the inner capsule and transit
through the middle third of the legs of the brain (medial tr.corticospinalis), the bridge
and the medulla oblongata. Here the axons end at the somatic motor nuclei of the
cranial nerves of their own and the opposite side (except for the nucleus of the hyoid
nerve, n.hypoglossus, and the lower part of the nucleus of the facial nerve, n.facialis).At
this level, the tr.corticonuclearis separates from the general pyramidal pathway.
The somatic motor nuclei of the cranial nerves contain the bodies of the second
neurons. Their axons as part of the peripheral cranial nerves go to the muscles of the
neck, face and head.
The pyramidal motor system, also called the pyramidal tract or
the corticospinal tract, start in the motor center of the
cerebral cortex. There are upper and lower motor neurons in
the corticospinal tract. The motor impulses originate in the giant
pyramidal cells or Betz cells of the motor area; i.e., precentral
gyrus of cerebral cortex. These are the upper motor neurons
(UMN) of the corticospinal tract. The axons of these cells pass
in the depth of the cerebral cortex to the corona radiata and
then to the internal capsule, passing through the posterior
branch of internal capsule and continuing to descend in the
midbrain and the medulla oblongata. In the lower part of the
medulla oblongata, 90–95% of these fibers decussate (pass to
the opposite side) and descend in the white matter of the lateral
funiculus of the spinal cord on the opposite side. The remaining
5–10% pass to the same side. Fibers for the extremities (limbs)
pass 100% to the opposite side. The fibers of the corticospinal
tract terminate at different levels in the anterior horn of the grey
matter of the spinal cord. Here, the lower motor neurons (LMN)
of the corticospinal cord are located. Peripheral
motor nerves carry the motor impulses from the anterior horn to
the voluntary muscles
Diagram of switching the
pyramidal pathway in the
spinal cord.
1 - posterior cord; 2 - posterior column; 3 - lateral cord; 4 - anterior corticospinal pathway; 5 - large
motor neurons of the anterior column; 5 - insertion neurons of the anterior column; 7 - insertion
neurons of the posterior column; 8 - lateral cortical-spinal pathway.
The main syndromes of motor
disorders in the defeat of the
pyramidal pathway
Localization of the lesion:
I — right anterior central
gyrus; (I is the motor zone
of the right inner capsule;
III - midbrain; focus on the
right;
IV- bridge of the brain, the
focus on the right;
V medulla oblongata,
focus on the right;
VI - VIII - the intersection of
the pyramids;
IX - a half lesion of the
spinal cord on the right in
the lower thoracic region:
1 - cortical-nuclear
pathway: 2-3 - cortical-
spinal
What is paralysis?
Paralysis (греч.
παράλυση - relaxation)
— the absence of
voluntary movements
caused by damage to
the motor centers of
the spinal cord and /
or brain, the
pathways of the
central or peripheral
nervous system, in
particular, the
pyramidal pathway.
Classification
Depending on the volume of restricted movements:
Plegia – complete absence of arbitrary movements
Paresis is a limitation of the volume of movement
and a decrease in strength.
Classification
Depending on the number of affected limbs, paralysis can be called
Monoplegia/monoparesis - one limb is affected on one side.
Paraplegia/paraparesis - two limbs of the same species are affected.
Triplegia/triparesis - three limbs are affected.
Tetraplegia/tetraparesis is a lesion of all limbs.
Hemiplegia/hemiparesis is a lesion of half of the trunk.
Cross hemiplegia/hemiparesis - paralysis/paresis of the arm on one
side - legs on the opposite.
Classification
By the level of motor neurone
damage:
Central, or spastic, paralysis develops
due to disorders of the cortical-
spinal pathway.
In the case of damage to the
peripheral motor neuron,
peripheral, or sluggish, paralysis is
formed.
There are also:
Organic paralysis - develops as a
result of organic changes in the
structure of the central and
peripheral motor neuron, arising
under the influence of various
pathological processes.
Functional paralysis is associated with
the impact of psychogenic factors
that lead to neurodynamic
disorders of the central nervous
system.
Classification
There are two scales for assessing the severity of paralysis —
paresis) - according to the degree of decrease in muscle strength
and according to the degree of severity of paralysis (paresis),
which are the opposite of each other:
0 points of "muscle strength" — no arbitrary movements. Paralysis.
1 point — barely noticeable muscle contractions, no movement in
the joints.
2 points — the volume of movements in the joint is significantly
reduced, movements are possible without overcoming gravity
(along the plane).
3 points — a significant reduction in the volume of movements in
the joint, the muscles are able to overcome gravity, friction (in fact,
this means the possibility of tearing the limb from the surface).
4 points — a slight decrease in muscle strength, with a full volume
of movement.
5 points — normal muscle strength, full range of movements.
Causes of paralysis
The causes of paralysis can also be
divided into organic, infectious and toxic.
Organic causes include:Malignant
neoplasms;Vascular lesions;Metabolic
disorders;Intoxication;Eating
disorders;Infections;Injuries;Multiple
sclerosis;
Infectious causes include:
Meningitis;
Poliomyelitis;
Viral encephalitis;
Tuberculosis;Syphilis.
Peripheral paralysis
Peripheral paralysis
(flaccid) occurs when the second
peripheral motor neuron is
affected in any part of it. It is
typical for him: Muscle
hypotension - a drop in muscle
tone,
Areflexia - the extinction of
reflexes,
Muscle atrophy is a nutritional
disorder. When the peripheral
nerve or plexus is affected, which
contain both motor and sensory
fibers, sensitivity disorders are
also detected,
Fibrillar and fascicular twitching,
Electrical excitability disorder is a
degeneration reaction caused by
peripheral neuron damage and a
developing degenerative lesion in
the muscles (death of muscle fiber
with their replacement by fat and
connective tissue).
Central paralysis
Central paralysis occurs when
the central motor neurons are
affected. They are
characterized by:
hypertonicity (increased muscle
tone), for example, the
phenomenon of a "folding
knife". The muscles are tense,
tight to the touch. The tone is
increased by the spastic type.
The Wernick-Mann pose is
typical – the arm is brought to
the trunk, bent and pierced at
the elbow, bent at the hand
and fingers, the leg is unbent
at the hip, at the knee, slightly
brought and bent at the foot.
The gait of the "mower" is
characteristic: the patient
describes a semicircle with his
foot, so as not to "cling" with
the toe of the "elongated" leg
to the floor.
hyperreflexia (increased intensity of
deep reflexes), especially
demonstrative in unilateral lesions;
the appearance of clonuses (convulsive
muscle contractions in response to
exposure), for example, foot clonus —
when a patient lying on his back with
an affected leg bent at the hip and
knee joints, the doctor performs a back
extension of the foot, while the flexor
muscles begin to contract involuntarily
rhythmically, the rhythm can persist
for a long time or almost immediately
fade away.
the appearance of pathological
synkinesias (friendly movements), for
example, when a patient arbitrarily
squeezes a healthy hand into a fist,
does not involuntarily repeat this
movement with a sick hand, but with
less force;
defensive reflexes; the presence of
pathological reflexes (Babinsky,
Bekhterev, Astvatsaturov, etc.);
Symptoms of oral
automatism
The palmar-chin reflex is caused by irritation
of the palm. In response, there is a
contraction of the chin muscles.
Labial proboscis reflex is caused by
percussion or stroke irritation of the lips. In
response, there is a protrusion of the lips.
The sucking reflex is obtained as a result
of touching the lips or their stroke
irritation: in response, sucking
movements with the lips are observed.
The nasolabial reflex is caused by
tapping the back of the nose with a
hammer. The response is to contract the
circular muscle of the mouth (pulling the
lips forward).
The distance-oral reflex is caused by the
approach of a hammer to the patient's
mouth: even before the blow, a
"proboscis" stretching of the lips
forward occurs.
Hand reflexes
Hand reflexes are
characterized by the
fact that with various
methods of their
evocation, reflex flexion
of the fingers of the
hand occurs — they
"bow".
Rossolimo reflex - the
investigator strikes a
short staccato blow with
his fingertips on the tips
of the II-V fingers of the
patient's hand (the
hand in the palm-down
position). In response,
there is a rhythmic
flexion of the fingertips.
The Bekhterev-Jacobson-Weasel reflex is the
flexion of the fingers of the hand in response to
a hammer blow on the awl-shaped process or
with percussion of the back surface of the wrist.
The Zhukovsky reflex - the researcher strikes
the palm at the base of the fingers with a
hammer. In response, there is a rhythmic
flexion of the fingertips.
Foot reflexes
Foot reflexes they are divided into extensor and flexor. Extensor foot
reflexes :
Babinsky's symptom is caused by holding the handle of a
neurological hammer, the blunt end of the needle along the outer
edge of the sole. In response, there is an extension of the thumb or a
fan-shaped divergence of the toes. In children under 1.5 years of
age, Babinsky's symptom is physiological and is normally caused.
Oppenheim's symptom is caused by holding
the back surface of the middle phalanx of the
II and III fingers on the anterior surface of
the lower leg of the subject. In response,
there is a reflex extension of the big toe.
Gordon's symptom is caused by compression of the
calf muscle of the leg of the subject. In response,
there is a reflex extension of the big toe.
Schaeffer's symptom is caused by compression of
the Achilles tendon. In response, there is a reflex
extension of the big toe.
Flexion foot reflexes are characterized by the fact that the fingers
"nod" and "bow" at various ways of irritating them.
Rossolimo symptom - the examiner with his fingertips strikes a
short blow on the tips of the II-V fingers from the plantar side of
the foot of the examinee. In response, there is a reflex flexion of
the fingers.
Zhukovsky's symptom is caused by a hammer blow
in the middle of the sole at the base of the fingers.
In response, there is a reflex flexion of the fingers.
The symptom of Bekhterev I is caused by a hammer
blow on the back of the foot in the area of the IV- V
metatarsal bones. In response, there is a reflex
flexion of the fingers.
