PYRAMIDAL

TRACT
MELISSA C. CALILAO, M.D., D.P.P.S.
DEPARTMENT OF ANATOMY
UERMMMC COLLEGE OF MEDICINE

OBJECTIVES :
1. Enumerate the tracts that constitute the
pyramidal system.
2. Trace the pathway of the pyramidal tracts.
3. Locate the position of the lateral and anterior
corticospinal tracts in a section of the
spinal cord.
4. Differentiate an upper motor vs. a lower
motor neuron lesion.
5. Describe briefly the other descending tracts.

MOTOR SYSTEM
1.PYRAMIDAL SYSTEM
= the primary control of voluntary movement thru:
a. corticospinal
b. corticobulbar pathways
2. EXTRAPYRAMIDAL SYSTEM
a. Basal Ganglia (nuclei)
b. Cerebellum
supporting role in the production of wellcoordinated movements
= influence lower motor neurons indirectly
through modulation of the cerebral cortex &
brainstem

Cerebral cortex
Association areas

Premotor areas

Motor area

(Desire to move)

(program)

(commands)

BASAL GANGLIA
Initiation & Postural Adjustment

Posterior Lobe

CEREBELLUM
(Coordination)
Ant. Lobe
FNL

BRAINSTEM CENTERS
(Supraspinal Reflex Activity)

Vestibular Receptors
(Equilibrium)

LOWER MOTOR NEURONS

(Commands)

Intrafusal Stretch Receptors

Extrafusal Contractile Fibers
VOLUNTARY MUSCLES

TRACT

PYRAMIDAL TRACT
longest & largest
descending fiber tract
(human CNS)
concerned with voluntary,
discrete, skilled
movements; control of
muscles involved in
speech & vocalization

PYRAMIDAL TRACT
pass
through the
medullary
pyramids

PYRAMIDAL TRACT
CORTICOSPINAL TRACT
Lateral CST
Anterior or Ventral CST

CORTICOBULBAR TRACT

PYRAMIDAL TRACT
Fibers arise from the following areas:
1/3 of axons precentral gyrus
(BA 4) Primary Motor Cortex
* 10% or 3% of CST- Pyramidal Cells of Betz

of BETZ

ANTERIOR
HORN CELLS

PYRAMIDAL TRACT
Fibers arise from the following areas:
1/3 of axons precentral gyrus
(BA 4) Primary Motor Cortex

1/3 of axons postcentral gyrus

(BA 3,1,2) Primary Sensory Cortex
1/3 of axons Premotor/ Secondary
Motor Cortex (BA 6 )
& some from frontal
eye fields (BA 8)

SENSORIMOTOR CORTEX

MOTOR HOMUNCULUS
the body has a
somatotopic
representation
on the PRIMARY
MOTOR and
PREMOTOR
CORTEX

SUPPLEMENTARY MOTOR AREA

Descending Pathways:
Anatomical Organization
SERIES OF NEURONS:
1ST ORDER NEURON
- cell body in cerebral cortex

2ND ORDER NEURON

- internuncial neuron in anterior gray column of SC
- short axon

3RD ORDER NEURON (LMN or

FINAL COMMON PATHWAY)
- anterior gray column of SC
- axon innervates skeletal muscles through anterior
root of spinal nerve

Descending Pathways:
Anatomical Organization
SERIES OF NEURONS:
1ST ORDER NEURON
- cell body in cerebral cortex

2ND ORDER NEURON

- internuncial neuron in anterior gray column of SC
- short axon

3RD ORDER NEURON (LMN or FINAL COMMON

PATHWAY)
- anterior gray column of SC
- axon innervates skeletal muscles through anterior
root of spinal nerve
* Some axons of 1st order neurons terminate directly on 3rd
order neurons (as in reflex arcs)

PYRAMIDAL TRACT
CORTICOSPINAL TRACT
Lateral
Anterior or Ventral CST

CORTICOBULBAR TRACT

CORTICOSPINAL
TRACT

CEREBRAL CORTEX (origin)

- 1st order neuron

CORONA RADIATA

INTERNAL CAPSULE
(posterior limb)

CEREBRAL PEDUNCLES
(middle 3/5)

PONS
(break up into fascicles)

PYRAMIDS (upper medulla)

PYRAMIDAL DECUSSATION
(caudal medulla)

CORTICOSPINAL
TRACT

CEREBRAL CORTEX (origin)

- 1st order neuron

CORONA RADIATA

INTERNAL CAPSULE
(posterior limb)

CEREBRAL PEDUNCLES
(middle 3/5)

PONS
(break up into fascicles)

PYRAMIDS (upper medulla)

PYRAMIDAL DECUSSATION
(caudal medulla)

PYRAMIDAL TRACT

 75 - 90%
crossed
LATERAL CST
terminate: ant. gray
column of all spinal
cord segments

10 - 15%
uncrossed
ANTERIOR CST
eventually cross
before terminating
on anterior horn
cells in cervical &
upper thoracic
regions

Termination of
PYRAMIDAL TRACT FIBERS

Cervical spinal cord level

Thoracic level
Lumbar / Sacral level

55%
20%
25%

The cortisospinal tracts are NOT the

sole pathway for serving voluntary
movement rather they form the
pathway that confers SPEED and
AGILITY to voluntary movements. They
are believed to control the prime mover
muscles while the other descending
tracts are important in controlling
simple basic movements.

UPPER MOTOR NEURON

VS.

LOWER MOTOR NEURON PARALYSIS

UMN

LMN

POINTS TO REMEMBER:
The pyramidal tract is used commonly by
physicians and refer SPECIFICALLY to the
CORTICOSPINAL TRACT.
The pyramidal tracts normally tend to INCREASE
muscle tone while the extrapyramidal tracts
INHIBIT muscle tone.
In clinical practice, it is rare to have an organic
lesion that is restricted only to the pyramidal or
only to the extrapyramidal tracts. Usually BOTH
sets of tracts are affected to a variable extent
producing both groups of clinical signs.

UPPER MOTOR
NEURON

LOWER MOTOR
NEURON

Paresis

Complete paralysis

NO muscle atrophy

WITH muscle atrophy

Spasticity

Flaccidity

Hyperreflexia

Arreflexia

Clonus

NO clonus

Babinski

NO Babinski

loss of certain superficial

reflexes:
a. Superficial abdominal
b. Cremasteric reflex

UPPER MOTOR
NEURON

LOWER MOTOR
NEURON

Paresis

Complete paralysis

NO muscle atrophy

WITH muscle atrophy

Spasticity

Flaccidity

Hyperreflexia

Arreflexia

Clonus

NO clonus

Babinski (Extensor Plantar Reflex)

NO Babinski

loss of certain superficial

reflexes:
a. Superficial abdominal
b. Cremasteric reflex

CORTICOBULBAR TRACT
Arise from FACE region of primary
motor cortex (BA 4), BA 6 and
BA 3,1 & 2
Project : motor nuclei of CNs
III,IV,V,VI,VII,IX,X,XI & XII
: parts of reticular formation
(corticoreticular fibers)
in pons & medulla
: sensory relay nuclei (gracilis,
cuneatus, sensory trigeminal
nuclei, & nucleus of solitary
fasciculus)
Projections are BILATERAL innervations
from BOTH contra & ipsilateral cortex

CORTICOBULBAR TRACT
Project : motor nuclei of CNs
III,IV,V,VI,VII,IX,X,XI & XII
: parts of reticular formation
(corticoreticular fibers)
in pons & medulla
: sensory relay nuclei (gracilis,
cuneatus, sensory trigeminal
nuclei, & nucleus of solitary
fasciculus)

Projections are BILATERAL :

innervations from BOTH
contra & ipsilateral cortex

FACIAL
MOTOR
NUCLEUS

The shaded areas of the face show the distribution of facial muscles
paralyzed after a supranuclear lesion of the corticobulbar tract &
after a lower motor neuron lesion of the facial nerve

FACIAL
MOTOR
NUCLEUS

CENTRAL FACIAL
PARALYSIS
* UMN LESION

FACIAL
MOTOR
NUCLEUS

PERIPHERAL FACIAL
PARALYSIS
(BELLS PALSY)
* LMN LESION

BELLS PALSY (Peripheral Facial Paralysis)

PRACTICE # 1 :
CASE SCENARIO: A post-stroke patient
with inability to move the left half of the
face but can still wrinkle both
eyebrows.
TYPE OF LESION?
WHERE IS THE LESION?

PRACTICE # 2 :
CASE SCENARIO: A patient upon
waking up in the morning is unable to
move the entire RIGHT half of his face.
PHHx: had chicken pox 2 weeks prior
TYPE OF LESION?
DIAGNOSIS?
WHERE IS THE LESION?
PROGNOSIS?

FACIAL
MOTOR
NUCLEUS
CENTRAL FACIAL
PARALYSIS
* UMN LESION
PERIPHERAL FACIAL
PARALYSIS
(BELLS PALSY)
* LMN LESION

HYPOGLOSSAL
NUCLEUS

Corticobulbar
projections
are largely
CONTRALATERAL

LEFT

RIGHT

PRACTICE # 3 :
CASE SCENARIO: The resident noted
that the tongue of a post-stroke patient
is atrophied and deviated to the LEFT.
TYPE OF LESION?
WHERE IS THE LESION?

PRACTICE # 4 :
CASE SCENARIO: The resident noted
that the tongue of a post-stroke patient
is NOT atrophied and deviated to the
LEFT.
TYPE OF LESION?
WHERE IS THE LESION?

OTHER DESCENDING TRACTS

I. MIDBRAIN
A. Tectospinal and Tectobulbar
B. Rubrospinal tract
C. Interstitiospinal tract

II. PONS/MEDULLA
A. Vestibulospinal tracts
1. LATERAL VESTIBULOSPINAL
2. MEDIAL VESTIBULOSPINAL
B. Reticulospinal tracts
1. PONTINE RETICULOSPINAL TRACT
2. MEDULLARY RETICULOSPINAL TRACT

OTHER DESCENDING TRACTS

I. MIDBRAIN
A. Tectospinal and
Tectobulbar
ORIGIN: superior colliculus
FIBERS: cross in dorsal tegmental
decussation (midbrain)
- incorporated > MLF
(medullary level)

OTHER DESCENDING TRACTS:

Tectospinal and Tectobulbar

TERMINATE:
anterior gray column
(Rexed laminae VI,VII & VIII)
in upper cervical segments
of the spinal cord

FUNCTION:
mediate reflex postural
movements in response
to visual & auditory stimuli
(head turning and eye
movements)

OTHER DESCENDING
TRACTS: MIDBRAIN

B. Rubrospinal tract
ORIGIN: red nucleus (level of
superior colliculus)
FIBERS: cross immediately in
the ventral tegmental
decussation > descend
down (brainstem) > enter
lateral funiculus of SC

TERMINATE: internuncial
neurons (anterior gray
column)
FUNCTION: influence tone
control in flexor muscle
groups

OTHER DESCENDING TRACTS: MIDBRAIN

C. Interstitiospinal tract
- origin: interstitial
nucleus of CAJAL
- uncrossed
- forms part of MLF
- terminate: anterior
horn of upper cervical
levels of the SC in
laminae VII and VIII
- function: modulates
reflex postural movements
in response to visual &
vestibular stimuli

OTHER DESCENDING TRACTS

II. PONS/MEDULLA
A. Vestibulospinal tract

1.LATERAL VESTIBULOSPINAL
ORIGIN: lateral vestibular nucleus
> descends in anterolateral funiculus
and terminates in Rexed laminae VII
& VIII on alpha and gamma motor
neurons from cervical & lumbosacral
levels
AFFERENTS: vestibular nerve and
cerebellum
FUNCTION: for maintenance of upright
posture and balance (excites
extensor motor neurons innervating
neck, back, forelimb and hindlimb
muscles)
*UNCROSSED

OTHER DESCENDING TRACTS

2. MEDIAL VESTIBULOSOPINAL
ORIGIN: medial vestibular nucleus >
descends in MLF > anterior funiculus
of SC (as far as midthoracic level)
terminates in same laminae as lateral
vestibulospinal tract (Rexed laminae
VII & VIII)
AFFERENTS: primary vestibular
& cerebellar
FUNCTION: maintains upright posture
(excites neck & back
motor neurons)
* BOTH CROSSED AND UNCROSSED

OTHER DESCENDING TRACTS

B. Reticulospinal tracts
1. PONTINE (MEDIAL)
RETICULOSPINAL TRACT
- almost entirely IPSILATERAL
- descends chiefly in anterior
funiculus of SC (all cord levels,
laminae VII & VIII)
- facilitatory to extensor
motor neurons

2. MEDULLARY (LATERAL)
RETICULOSPINAL TRACT
- fibers project BILATERALLY
to spinal levels
- descend both IPSI/CONTRA
in lateral funiculus of SC (all
cord levels, laminae VII & IX)
- inhibitory to extensor
motor neurons

OTHER DESCENDING TRACTS

Medullary Reticulospinal
Tract :
- provide a pathway by
which the hypothalamus
can control the
sympathetic outflow &
sacral parasympathetic
outflow

Thank you

REFERENCES :
1. Gilman and Newman. Manter and
Gatzs Essentials of Clinical
Neuroanatomy and Neurophysiology,
10th ed., 2003
2. Snell. Clinical Neuroanatomy for
Medical Students, 7th ed., 2010
3. Lansang et al., Modules in
Neuroanatomy