Pyramidal tracts

The pyramidal tracts are a major pathway for voluntary motor signals. The pyramidal tracks carry
motor impulses from the cerebral cortex to the spinal cord.

Cerebral structures

Motor cortex:

- this is where motor signals primarily originate from.

- It is housed within the precentral gyrus of the frontal lobe towards the middle of the brain
and controls the movement of voluntary muscles.
- In the primary motor cortex, the neurons are somato-topically organized (neurons related to
similar regions are grouped together).

Subcortical structures:

Thalamus:

- This is a collection of grey matter organised into large nuclei e.g. ventral posteromedial
nucleus and the ventroposterolateral nucleus.
- Axons from the cortex or spinal cord synapse on cell bodies within the thalamus which then
relays the message onto another part of the CNS.

Basal ganglia:

This is a group of grey matter structures near the centre of the brain responsible for the control of
movement. Through direct and indirect pathways, these nuclei influence the activity of the motor
cortex and includes:

 Putamen- which is the most lateral of the basal ganglia found deep to the insular cortex.
 Globus pallidus- which is medial to the putamen and divided into an internal and external
part by a thin strip of white matter called the medial medullary lamina.
 Caudate nucleus- is divided into 3 segments, a head (which is near the genu of the corpus
callosum), a body (which passes over the thalamus) and a tail (which curves around the
thalamus to reach the amygdala).

Internal capsule:

This is a v-shaped structure consisting of:

- An anterior limb which separates the head of the caudate nucleus from the putamen and
Globus pallidus.
- A posterior limb which separated the thalamus from the putamen and Globus pallidus.
- Fibre tracts passing to or from the cerebral cortex.

Claustrum:

- This is a long strip of grey matter interrupting the white matter of the insula.
- The function is not completely understood, but research suggests that it may play a role in
consciousness.

Brain stem:

- Is large made up of axons passing through to another region of the nervous system.
 - The groups of axons travelling to the same place are called tracts and makes landmarks
which can be used to identify different regions of the brainstem when isolated in cross
section.
- Most of the cranial nerve nuclei are also located within the brainstem.

Midbrain:

- This is the most superior or rostral part if the brainstem and is continuous with the
thalamus, hypothalamus, epithalamus and subthalamus which collectively makes the
diencephalon.
- It is involved in vision, hearing and motor control as well as alertness, arousal and
temperature regulation.

Structures of the midbrain:

Cerebral peduncles aka crus cerebri:

- They are aligned nearly perpendicular to each other and forms the interpeduncular fossa.
- The cerebral peduncles are large collections of white matter fibre bundles including the:
 Corticospinal pathway
 Corticobulbar pathway
 Corticopontine pathway

Substantia Nigra

- This is a thin dark line of cell bodies running across the cerebral peduncles and the dark
colour is due to neuromelanin within the cell bodies.
- The neurons in the substantia nigra release dopamine to influence motor control.

The cerebral peduncles and substantia nigra are closer to the ventral part of the midbrain, and
dorsally there is the cerebral aqueduct.

Cerebral aqueduct:

- It receives CSF from the 3rd ventricle which then goes to the 4 th ventricle inferiorly.
- A small region of grey matter surrounds the cerebral aqueduct called the periaqueductal
grey.

Periaqueductal grey:

- This contains neurons which project to the raphe nuclei in the reticular system to modulate
pain.

Pons:

- The pons can be identified by the large bulge present on its ventral surface called the basal
pons.
- It houses several cranial nerve nuclei
- It also contains fibres of the ascending and descending white matter tracts.
Medulla oblongata:

- This is the most inferior portion of the brainstem and is continuous with the spinal cord.
- It is divided into two segments:

 Rostral medulla (rostral= beak/nose), named this way because it is closer to the nasal region
(superior part).
 Caudal medulla (inferior part) is continuous with the spinal cord.

On the ventral surface, there are bulges known as the pyramids of the medulla, however, the best
identifying structure to be used is the olivary nucleus which appears convoluted in cross section and
the neurons of which coordinates signals between the cerebellum and spinal cord.

Spinal cord:

- The spinal cord extends from the foramen magnum to the lumbar vertebrae.
- Numerous nerves project laterally on either side (spinal nerves) and contains fibres which
synapse with ascending and descending fibre tracts.
- The anterior root of the spinal nerves contains axons which synapse with fibres originating
from descending fibre tracts which controls movement and automatic functions (e.g.
sweating, heart rate).
- The posterior root contains axons that synapse with fibres within the spinal cord belonging
to ascending fibre tracts (transmits sensory information such as temperature, pain,
pressure).

White matter tracts

Corticospinal tract:

- This tract carries axons from the motor cortex of the brain to the spinal cord where they
synapse with motor neurons.
- From the cerebral cortex, the corticospinal cortex fibres descend through the subcortical
white matter where they pass through the posterior limb of the internal capsule which is
situated between the thalamus and putamen. From here, the corticospinal fibres then
descend into the midbrain, where they travel within the cerebral peduncles and continue on
to the pons before gathering into discrete bundles forming the pyramids of the rostral
medulla.
- The fibres are somatotopically arranges with the more medial fibres belonging to the upper
extremity and the more lateral fibres being associated with the lower extremity.
- As the fibres reach the caudal medulla, the fibres separate into anterior and lateral divisions
at the pyramidal decussation.
Anterior corticospinal tract:

- The axons within the anterior corticospinal tract remains ipsilateral to the motor cortex they
originated from into the spinal cord.
- Before the fibres synapses with interneurons in the spinal cord, they cross over to the other
side of the body, anterior to the grey matter of the spinal cord.
- These fibres provide motor innervation to the back and proximal portions of the extremities,
and also play an important role in maintaining posture.

Lateral corticospinal tract:

- The axons of the lateral corticospinal tract crosses to the other side of the body in the
medulla at the pyramidal decussation.
- These fibres provide motor innervation to distal parts of the extremities e.g. hands.
- This tract is a relatively recent evolutionary development found only in mammals capable of
performing skilled voluntary movements.

Corticobulbar tract:

- The neurons of the corticobulbar tract control muscles of the head and neck. As these tracts
do not need to travel lower than the neck, the axons do not enter the spinal cord and
instead synapse onto the nuclei of cranial nerves 3,4,5,6,7,9,10,11 and 12 (3 to 12 except 8).
- These cranial nerves contain motor fibers for the eye muscles, face muscles, muscles of
mastication and some neck muscles.
- The corticobulbar tract is also called the cortico-nuclear tract and it has now been renamed
as the world “bulbar” refers to the medulla. However, not all fibers reach the medulla
therefore “cortical-nuclear” is more accurate as it refers to the cranial nerve nuclei.

Clinical:

- The two main pathways for the journey of motor signals are as follows:

1. Neural pathways contained in the central nervous system that is from the motor cortex of
the brain to the spinal cord and includes the pyramidal tracts.
2. From the spinal cord to target muscles, related to the peripheral nerves.

- Motor neurons within the CNS are referred to as upper motor neurons.
- Motor axons found in the peripheral nerves are referred to as lower motor neurons

Clinically, damage to the neurons or nerve fibers anywhere between the motor cortex and the
synapses is in the spinal cord and cause a disorder called upper motor neuron syndrome and this
could be due to lesions along those pathways caused by stroke, spinal cord injury or multiple
sclerosis etc.

Upper motor neuron symptoms differ from those of lower motor neuron syndrome and includes:

- Muscle weakness.
- Decreased motor control (fine/skilled movements).
- Spasticity (increased muscle tone).
- Exaggerated and sometimes repeating deep tendon reflexes known as hyperreflexia and
clonus respectively.
 - Positive Babinski sign, great toe extends or points upwards, while the remaining toes
demonstrate ‘fanning’. ( a normal Babinski sign demonstrates negative plantar, or toes are
flexed or point downwards).

Lower motor neuron symptoms:

- Paralysis.
- Decreased muscle tone.
- Depressed/hyperactive deep tendon reflexes.
- Muscle atrophy.

DESCENDING TRACTS
Motor neurons in the anterior grey columns of the spinal cord send axons innervating skeletal muscle
through the anterior roots of the spinal nerves.

These motor neurons are called lower motor neurons and constitute the final common pathway to the
muscles (Fig. 4-19).

Lower motor neurons are constantly receiving nervous impulses that descend from the medulla, pons,
midbrain, and cerebral cortex and those that enter along sensory fibres from the posterior roots.

Nerve fibres that descend in the white matter from different supraspinal nerve centres are segregated
into nerve bundles called the descending tracts.

These supraspinal neurons and their tracts are referred to as the upper motor neurons, and they
provide numerous separate pathways that can influence motor activity.

A summary of the main descending pathways In the spinal cord Is shown ln Table 4-4.

Anatomical Organization

The descending pathway from the cerebral cortex is often made up of three neurons.

The first neuron, the first-order neuron, has its cell body in the cerebral cortex.

Its axon descends to synapse on the second-order neuron, an internuncial neuron (interneuron),
situated in the anterior grey column of the spinal cord.

The axon of the second-order neuron is short and synapses with the third-order neuron, which is the
lower motor neuron, in the anterior grey column.

The axon of the third-order neuron innervates the skeletal muscle through the anterior root and spinal
nerve.

In some instances, the axon of the first-order neuron terminates directly on the third-order neuron as
in reflex arcs.

Functions
Corticospinal tracts (Fig. 4-20) are the pathways concerned with voluntary, discrete, skilled
movements, especially those of the distal parts of the limbs.

Reticulospinal tracts may facilitate or inhibit the activity of the alpha and gamma motor neurons in the
anterior grey columns and may, therefore, facilitate or inhibit voluntary movement or reflex activity.

The tectospinal tract is concerned with reflex postural movements in response to visual stimuli.

Those fibres that are associated with the sympathetic neurons in the lateral grey column are concerned
with the pupillodilation reflex in response to darkness.

The rubrospinal tract acts on both the alpha and gamma motor neurons in the anterior grey columns
and facilitates the activity of flexor muscles and inhibits the activity of extensor or antigravity
muscles.
The vestibulospinal tract, by acting on the motor neurons in the anterior grey columns, facilitates the
activity of the extensor muscles, inhibits the activity of the flexor muscles, and is concerned with the
postural activity associated with balance.

The olivospinal tract may play a role in muscular activity, but some doubt its existence.

The descending autonomic fibres are concerned with the control of visceral activity.

Corticospinal Tracts

Fibres of the corticospinal tract arise as axons of pyramidal cells situated. in the fifth layer of the
cerebral cortex (Fig. 4-21). About a third of the fibres originate from the primary motor cortex (area
4). another third from the secondary motor cortex (area 6), and the final third from the parietal lobe
(areas 3, 1, and 2); thus, two thirds of the fibres arise from the precentral gyrus, and one third of the
fibres arise from the postcentral gyrus. These fibres do not control motor activity but influence
sensory input to the nervous system. Because electrical stimulation of different parts 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 this area of the cortex. Such a homunculus is shown in Figure 4-21. 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. Interestingly, most corticospinal fibres are myelinated and are relatively slow-
conducting, small fibres.

The descending fibres converge in the corona radiata and then pass through the posterior limb of the
internal capsule. Here, the fibres are organized so that those closest to the genu are concerned with
cervical portions of the body. while those situated more posteriorly are concerned with the lower
extremity. The tract then continues through the middle three fifths of the basis pedunculi of the
midbrain. Here, the fibres concerned with cervical portions of the body are situated medially, while
those concerned with the leg are placed laterally.

On entering the pons, the tract is broken into many bundles by the transverse pontocerebellar fibres
(see Figs. 5-19 to 5-22). In the medulla oblongata, the bundles become grouped together along the
anterior border to form a swelling known as the pyramid (hence the alternative name, pyramidal tract)
{see Figs. 5-11 and 5-12). At the junction of the medulla oblongata and the spinal cord, most of the
fibres cross the midline at the decussation of the pyramids (Fig. 4-21) and enter the lateral white
column of the spinal cord to form the lateral corticospinal tract (Fig. 4-20). The remaining fibres do
not cross in the decussation but descend in the anterior white column of the spinal cord as the anterior
corticospinal tract (Figs. 4-20 and 4-21). These fibres eventually cross the midline and terminate in
the anterior grey column of the spinal cord segments in the cervical and upper thoracic regions.

The lateral corticospinal tract descends the length of the spinal cord; its fibres terminate in the anterior
grey column of all the spinal cord segments.

Most corticospinal fibres synapse with internuncial neurons, which, in tum, synapse with alpha motor
neurons and some gamma motor neurons. Only the largest corticospinal fibres synapse directly with
the motor neurons.

The corticospinal tracts 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.

Branches

1. Branches are given off early in their descent and return to the cerebral cortex to inhibit activity in
adjacent regions of the cortex.

2. Branches pass to the caudate and lentiform nuclei, the red nuclei, and the olivary nuclei and the
reticular formation. These branches keep the subcortical regions informed about the cortical motor
activity. Once alerted, the subcortical regions may react and send their own nervous impulses to the
alpha and gamma motor neurons by other descending pathways.
Extrapyramidal tracts

Reticulospinal Tracts

 In the midbrain, pons, and medulla oblongata, there are groups of scattered nerve cells and
nerve fibres that are collectively known as the reticular formation.

 Neurons in the pons sends mostly uncrossed axons, down into the spinal cord forming the
pontine reticulospinal tract (Fig. 4-22). These fibres descend through the anterior white
column.

 Similar neurons in the medulla sends crossed and uncrossed axons, to the spinal cord forming
the medullary reticulospinal tract. These fibres descend through the lateral white column.

 Both sets of reticulospinal fibres enter the anterior grey columns of the spinal cord and may
facilitate or inhibit alpha and gamma motor neuron activity. Alpha motor neurons supply
ordinary (extrafusal) fibres of striated skeletal muscle. Gamma motor neurons which are
smaller, are less numerous and supply the intrafusal fibres of the neuromuscular spindles.

 Therefore, the reticulospinal tracts influence voluntary movements and reflex activity.

 It is believed that the reticulospinal fibres are also include the descending autonomic fibres
and it provides a pathway where the hypothalamus can control the sympathetic outflow and
the sacral parasympathetic outflow.
Tectospinal Tract

 These fibres arise from nerve cells in the superior colliculus of the midbrain {Fig. 4-23).

 Most of the fibres cross the midline soon after their origin and descend through the brainstem
close to the medial longitudinal fasciculus.

 This tract descends through the anterior white column of the spinal cord close to the anterior
median fissure (Fig. 4-20).

 Most of the fibres terminate in the anterior grey column in the upper cervical segments of the
spinal cord as they synapse with interneurons.

 These fibres are associated with reflex postural movements in response to visual stimuli.

Rubrospinal Tract

 In the tegmentum of the midbrain at the level of the superior colliculus lies the red nucleus
(Fig. 4-24) and from this nucleus, the neurons project axons which cross the midline at the
level of the nucleus and descend as the rubrospinal tract through the pons and medulla
oblongata, which then enters the lateral white column of the spinal cord (Fig. 420).
  The fibres terminate by synapsing with internuncial neurons in the anterior grey column of
the cord.

 The cerebral cortex and the cerebellum send afferent impulses to the neurons of the red
nucleus.

 This is believed to be an important indirect pathway by which the cerebral cortex and the
cerebellum can influence alpha and gamma motor neuron activity.

 The tract facilitates the activity of the flexor muscles and inhibits the activity of the extensor
or antigravity muscles.

Rubrospinal and tectospinal pathway

Vestibulospinal Tract

 The vestibular nuclei are situated in the pons and medulla oblongata beneath the floor of the
fourth ventricle (Fig. 425).

 Afferent fibres from the cerebellum and afferent fibres from the inner ear travel through the
vestibular nerve to the vestibular nuclei.

 Neurons of the lateral vestibular nucleus give rise to the axons that form the vestibulospinal
tract.

 The tract descends uncrossed through the medulla and length of the spinal cord in the anterior
white column (Fig. 420).

 The fibres then terminate by synapsing with internuncial neurons of the anterior grey column
of the spinal cord.

 The inner ear and the cerebellum, by means of this tract, facilitate the activity of the extensor
muscles and inhibit the activity of the flexor muscles in association with the maintenance of
balance.
Olivospinal Tract
  The olivospinal tract is believed to arise from the inferior olivary nucleus and descends in the
lateral white column of the spinal cord (Fig. 4-26), where it influences the activity of the
motor neurons in the anterior grey column. However, many now doubt that it exists.

Descending Autonomic Fibres

  The higher centres of the CNS associated with the control of autonomic activity are situated
in the cerebral cortex, hypothalamus, amygdaloid complex, and reticular formation.

 Although distinct tracts have not been recognized, investigation of spinal cord lesions has
demonstrated that descending autonomic tracts do exist and probably form part of the
reticulospinal tract.

 The fibres arise from neurons in the higher centres and cross the midline in the brainstem.

 They are believed to descend in the lateral white column of the spinal cord and terminate by
synapsing on the autonomic motor cells in the lateral grey columns in the thoracic and upper
lumbar (sympathetic outflow) and mid-sacral (parasympathetic) levels of the spinal cord.

So in this image, we can see the pontine reticulospinal tract in red which arises from the pontine
reticular formation