Upper motor neuron lesion

Upper motor neuron lesion
The motor tract.

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2] Luke Rusowicz-Orazem, B.S.

Overview

An upper motor neuron lesion is a lesion of the neural pathway above the anterior horn cell or motor nuclei of the cranial nerves. This is in contrast to a lower motor neuron lesion, which affects nerve fibers traveling from the anterior horn of the spinal cord to the relevant muscle(s).

Causes

Life Threatening Causes

• Cerebral palsy
• Cerebrovascular accident
• Cervical myelopathy
• Multiple sclerosis
• Spinal cord injury
• Stroke 
• Traumatic brain injury

Common Causes

• Cerebral palsy,
• Cerebrovascular accident,
• Cervical myelopathy,
• Cervical spondylosis,
• Friedreich ataxia,
• Juvenile primary lateral sclerosis,
• Konzo,
• Motor neuron disease,
• Multiple sclerosis,
• Pseudobulbar palsy,
• Spastic paralysis,
• Spina bifida,
• Spinal cord injury,
• Subacute combined degeneration of the cord,
• Syringomyelia,
• Traumatic brain injury,
• Weber syndrome,
• X-linked sideroblastic ataxia,

Causes by Organ System

Cardiovascular	Cerebrovascular accident, Stroke
Chemical/Poisoning	Lathyrus poisoning
Dental	No underlying causes
Dermatologic	No underlying causes
Drug Side Effect	Pellagra
Ear Nose Throat	No underlying causes
Endocrine	Adult polyglucosan body disease
Environmental	No underlying causes
Gastroenterologic	Adult polyglucosan body disease
Genetic	No underlying causes
Hematologic	Leukoencephalopathy , Pernicious anemia, Progressive multifocal leucoencephalopathy
Iatrogenic	No underlying causes
Infectious Disease	Quaternary syphilis
Musculoskeletal/Orthopedic	Cervical myelopathy, Cervical spondylosis, Friedreich ataxia, Juvenile primary lateral sclerosis, Spastic paralysis, Spinal cord injury, Subacute combined degeneration of the cord, X-linked sideroblastic ataxia
Neurologic	Cerebral palsy, Cerebrovascular accident, Cervical myelopathy, Cervical spondylosis, Friedreich ataxia, Juvenile primary lateral sclerosis, Konzo, Motor neuron disease, Multiple sclerosis, Pseudobulbar palsy, Spastic paralysis, Spina bifida, Spinal cord injury, Subacute combined degeneration of the cord, Syringomyelia, Traumatic brain injury, Weber syndrome, X-linked sideroblastic ataxia
Nutritional/Metabolic	Vitamin b12 deficiency
Obstetric/Gynecologic	No underlying causes
Oncologic	No underlying causes
Ophthalmologic	No underlying causes
Overdose/Toxicity	No underlying causes
Psychiatric	No underlying causes
Pulmonary	No underlying causes
Renal/Electrolyte	No underlying causes
Rheumatology/Immunology/Allergy	No underlying causes
Sexual	Quaternary syphilis
Trauma	Traumatic brain injury
Urologic	No underlying causes
Miscellaneous	No underlying causes

Causes in Alphabetical Order

• Adult polyglucosan body disease
• Cerebral palsy
• Cerebrovascular accident
• Cervical myelopathy
• Cervical spondylosis
• Friedreich ataxia
• Juvenile primary lateral sclerosis
• Konzo
• Lathyrus poisoning
• Leukoencephalopathy
• Motor neuron disease
• Multiple sclerosis
• Pellagra
• Pernicious anemia
• Progressive multifocal leucoencephalopathy
• Pseudobulbar palsy
• Quaternary syphilis
• Spastic paralysis
• Spina bifida
• Spinal cord injury
• Stroke 
• Subacute combined degeneration of the cord
• Syringomyelia
• Traumatic brain injury
• Vitamin b12 deficiency
• Weber syndrome
• X-linked sideroblastic ataxia

Symptoms

• Spastic increase in tone in the extensor muscles (lower limbs) or flexor muscles (upper limbs)
• Clasp-knife response where initial resistance to movement is followed by relaxation
• Weakness in the flexors (lower limbs) or extensors (upper limbs), but no muscle wasting
• Brisk tendon jerk reflexes
• Babinski sign positive, where the big toe is raised rather than curled downwards on stimulation of the sole of the foot

Corticospinal/pyramidal tract

These are the neural tracts which descend in the spinal cord, in the lateral columns, carrying signals for voluntary movement of skeletal muscle. These nerve fibres usually originate in the cerebral cortex, then gather in the internal capsule before crossing over to the opposite side (decussation) in the medulla oblongata and proceeding down the spinal cord to meet lower motor neurons in the anterior horn.

See also

• Upper motor neuron

External links

• http://www.med.yale.edu/caim/cnerves/cn7/cn7_13.html
• http://www.lib.mcg.edu/edu/eshuphysio/program/section8/8ch3/s8ch3_34.htm

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