Spinothalamic tract:

Transmits pain and temperature sensations to

the thalamus and then to the cerebrum
Super cial sensations
Tested by pin prick and cotton piece
Give either sensory level or peripheral neuritis
Sensory a ection till the anterior superior iliac
spine or inguinal ligament in the lower limb or
shoulder girdle in the upper limb is peripheral
neuropathy

Spinocerebellar tract:
Transmits proprioception sensations to the
cerebellum.
Joint position and vibration sense tested by
tuning fork
In the posterior column
If damaged in the spinal cord or peripheral
nerves will cause sensory ataxia tested by loss
of vibration sense and joint position sene and
Romberg test

Corticospinal tract:
Conscious control of skeletal muscles.
Pyramidal tract
Upper motor neurone
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 If a ected will cause UMNL manifested by
hypertonia, hyperre exia, planters upwards,
pyramidal shape of weakness = distal weaker
than proximal, extensors more weaker than
exors except in the lower limbs and abductors
weaker than adductors

Anterior horn cells:

Lower motor neurone
It may be a ected in some diseases like viral
diseases eg polio virus or LMN subtypes of
MND like spinal muscular atrophy
Its a ection will lead to LMND in the for of
wasting, weakness ( distal more than proximal,
extensors weaker than exors, abductors
weaker than adductors), facciculations,
hypotonia, hypore exia.

Spastic paraparesis without

sensory a ection
1. Hereditary spastic paraparesis
2. Tropical spastic paraparesis
3. Parasagital meningioma
4. Cerebral palsy
5. MS| Stroke bilateral
6. MND
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Spastic paraparesis with complete
sensory level
1. Trauma
2. Tumor
3. Transverse myelitis (acute)
4. TB
5. Disc prolapse

Spastic paraparesis with posterior

sensory a ection
1. Trauma
2. Tumor
3. TB
4. Tabes dorsalis
5. MS
6. SCD

Spastic paraparesis with

super cial sensation a ection
1. Anterior cord syndrome

Mixed signs
• Signs of LMNL in the form of
• Signs of UMNL in the form of
• Signs of cerebellar a ection in the form of
• Signs of loss of sensation
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 Neurology brain maps in UMNL
UMNL + Peripheral neuropathy + posterior column +Cerebellum =
HSCD
UMNL + peripheral neuropathy + Posterior column = SCD
UMNL + sensory level + posterior column = Complete cord cut
UMNL + Posterior column + Cerebellum =MS or Stroke
UMNL + PC = Tapopariesis + Ts = Tumours, Trauma , TB
Cerebellum only = MS or Stroke
UMNL in LL +LMNL in UL = MND/ Cervical myelopathy
UMNL + LMNL + Dissociated sensory loss = Syringomyelia, Stroke
with peripheral neuropathy,
UMNL monoparesis + Ipsilaterl posterior column + contralateral
super cial sensory level = BROWN SQUARED SYNDROME =
HEMISECTION OF THE CORD = spastic monoparesis

Neurology brain maps in LMNL

LMNL +loss of sup & deep sensation (sensory ataxia) up to the
anterior superior iliac spine +
intact cerebellum = PN
LMNL +intact sup deep sensation & intact
cerebellum=pure motor neuropathy
hypotonia + impaired coordination + intact sensation
cerebellum
LMNL + distal Ms intact +unable to perform co ordination
bez of weakness + intact sensation = proximal myopathy
UMNL in LL +LMNL in UL = MND/ Cervical myelopathy

Pure motor LMNL

1. Demylenating PN ((GBS - CIPD - Porphyria
lead poisoning -HSMN (CHARCOT-MARY- TOOTH)- Dapson
2. Anterior horn cell (MND) = spinal muscular atrophy
3. Polio
4. Myotonia Dystrophica, MG - quada equina
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 Cerebellum (SHIP NDRA)

Staccato speech
Hypotonia
Intension tremor
Post pointing
Nystagmus
Dysdiadokinesia
Rebound phenomenon
Ataxic gait
+ve Heel chin test.

LMND
Wasting
Fasciculations
Hypotonia
Hypore exia: Hypo or are exia, down going planters or
Equivocal
Weakness: E > F, Abd > Add ( same as UMNL )= PN

Add > Abd = (Frog) > Proximal myopathy

E > F (THIS is every where in UMNL and LMNL) the

only exception is UMNL in LL - F>E
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Hypotonia Does not always mean LMNL but
Hypertonia and Hyperre exia always mean UMNL
ex.Hypotonia with normal re exes or
pendularre exes = Cerebellar
Hypotonia with Hyperre exia › UMNL+ cerebellar
(MS, FA, Stroke )

Wasting of the muscle is mostly present in LMND

but if it is found with UMND it is called disuse
atrophy.

UMNL
Disuse dystrophy
3 TONE: Hypertonia, Clasp knife , Clonus

3 Hyperre exia: upgoing Planter, Pathology re exes

3 POWER
Distal >Proximal
Flexor > Extensor
Abductors > Adductor,

Note: Hypotonia Does not always mean LMNL but Hypertonia and
Hyperre exia always mean UMNL
ex. Hypotonia with normal re exes or pendular re exes and
impaired coordination = cerebellar Hypotonia with Hyperre exia

UMNL + cerebellar (MS, FA, Stroke )

If the sensory loss extend to the trunk

But below mastoid ( sensory level)
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DD of UMNL + trunk sensory level
Cord compressions
Trauma
Tumors
MS
Spinal cord lesion
TB
Brucella
Transverse Myelitis
Vascular

Spastic Paraparesis Causes:

With sensory level, Focal spinal cord = Trauma, Tumours, TB,
Transverse Myelitis, Vascular
With intact sensation > MS, MND,
Parasagittal meningioma,
Tropical and hereditary spastic Paraparesis,
Cerebral palsy
With Cerebellar a ection > MS, HSCD ( FA)
With PN = HSCD , SCD
With Mix UMNL and LMNL = MND (if no sensory ), Cervical
Myelopathy ( DC), Syringomyelia (Super cial sentations)
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Lower limb Bilateral spastic paralysis without
sensory level:
Motor Neuron Disease
Hereditary Spastic Paraplegia
Tropical Spastic Paraplegia
Parasagittal meningioma
Bilateral Stroke
Cervical Myelopathy

Lower limb Bilateral spastic paralysis with

sensory level:
Spinal Cord Compression
Transverse Myelitis
Cervical Myelopathy

Lower limb Unilateral spastic paralysis

Stroke
Brown-Sequard syndrome (BSS)

Spastic paralysis with Cerebellar signs

Spinocerebellar ataxia
Fredericks ataxia
Multiple Sclerosis

Spastic paralysis with dissociative sensory loss

Subacute Combined Degeneration of the Spinal Cord
(defect in posterior column)
Syringomyelia (pin prick= pain and temperature is lost)
Flaccid paralysis
Guillain barre syndrome
Chronic In ammatory Demyelinating Polyneuropathy (CIDP)
Motor peripheral neuropathy
Mixed peripheral neuropathy
Cauda Equina
Poliomyelitis
Charcot-Marie-Tooth disease
Becker's muscle atrophy
Facial Scapular Humeral Muscular Dystrophy

Rigidity and tremors = Parkinsonian (examine

for plus signs)
Cerebellar signs = Cerebellar syndrome
Median nerve injury (LOAF muscles)
Ulnar nerve injury (Claw hand)
Radial nerve injury (hand drop)

Cranial nerves
Marcus Gunn pupil
Argyll Robertson pupil
Isolated Ill nerve palsy
Bell's palsy
Ramsey Hunt Syndrome
Weber syndrome
Benedikt syndrome
Tolosa hunt syndrome
Moebius syndrome
Gradenigo syndrome
Wallenberg syndrome
Cerebello-pontine angle tumor
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 A lower motor neuron lesion (LMNL) is a lesion
which a ects nerve bers traveling from the ventral horn or
anterior grey column of the spinal cord to the relevant muscle(s)
One major characteristic used to identify a LMNL is accid
paralysis

These changes vary depending on the site and the extent of the
lesion, and may include:
Muscle paresis or paralysis
Fibrillations
Fasciculations
Hypotonia or atonia
Hypore exia
The extensor Babinski re ex is usually absent.

Causes include:
Most common causes of lower motor neuron injuries are trauma
to peripheral nerves that serve the axons
A virus that selectively attacks ventral horn cells.
Guillain-Barré syndrome
C. botulism
Polio
Cauda equina syndrome
Amyotrophic lateral sclerosis.

Viruses causing neurological diseases:

Poliovirus
Herpes virus
Human T cell lymphotropic virus 1 HTLV1 = TROPICAL SPASTIC
PARAPLEGIA
HIV
EPSTEIN BARR VIRUS
Cytomegalovirus
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 Spinal cord diseases
Traumatic
Disc prolapse
Spondylitis
Spondylosis
Spondylolisthiasis
Fracture vertebrae (osteoporosis)
Hematoma
Spinal stenosis
Meningeocele

Tumors
Neuro broma
Meningioma

Infections
TB
Syphilis ( Tabes dorsalis)
Brucellosis
Lyme disease
Botulism
Abscess

Viruses causing neurological diseases:

Poliovirus
Herpes virus
Human T cell lymphotropic virus 1 HTLV1 = TROPICAL SPASTIC
PARAPLEGIA
HIV
EPSTEIN BARR VIRUS
Cytomegalovirus
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 De ciency
Vitamin B12 (Subacute combined degeneration of the spinal cord)
Vitamin B6
Vitamin E
Copper de ciency

Toxicity
Chemotherapy
Radiation therapy

Vascular
A-V malformation
Vasculitis
Stroke
Hypercoagulable conditions like antiphospholipid syndrome

Autoimmune
Transverse Myelitis
Paraneoplastic
Postviral infections
MS
Progressive muscular atrophy
Sarcoidosis
Connective tissue diseases
SLE
Sjogren related myelopathy

Syringomyelia
traumatic or congenital like Arnold Chiary syndrome

Degenerative
MND
Radiation therapy

Hereditary
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Kinnedy’s disease
Hereditary spastic paraplegia