Extrapyramidal

From WikiMD's Wellness Encyclopedia

Extra means outside. (Lat.) extra = outside, and pyramidal (q.v.), hence descending nerve tracts that do not traverse the pyramids of the medulla.

Extrapyramidal Resources
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General features

Posterior grey column	Marginal nucleus Substantia gelatinosa of Rolando Nucleus proprius Rexed lamina V Rexed lamina VI
Lateral grey column	Intermediolateral nucleus Posterior thoracic nucleus
Anterior grey column	Interneuron Alpha motor neuron Onuf's nucleus Gamma motor neuron
Other	Rexed laminae Central gelatinous substance Gray commissure

Sensory

Posterior	Posterior column-medial lemniscus pathway Gracile Cuneate
Lateral	Spinocerebellar dorsal ventral Spinothalamic lateral anterior Posterolateral Spinotectal
Anterior	Spinoreticular tract Spino-olivary tract

Motor

Lateral	Corticospinal Lateral Extrapyramidal Rubrospinal Raphespinal Reticulospinal Hypothalamospinal
Anterior	Corticospinal Anterior Extrapyramidal Vestibulospinal Reticulospinal Tectospinal Raphespinal Olivospinal

Both

Anterior white commissure

External features

Ventral
- Anterior median fissure
- Anterolateral sulcus
Dorsal
- Posterior median sulcus
- Posterolateral sulcus

Brain and spinal cord: neural tracts and fasciculi

Sensory

1°:	Pacinian corpuscle/Meissner's corpuscle → Posterior column (Gracile fasciculus/Cuneate fasciculus) → Gracile nucleus/Cuneate nucleus
2°:	→ sensory decussation/arcuate fibers (Posterior external arcuate fibers, Internal arcuate fibers) → Medial lemniscus/Trigeminal lemniscus → Thalamus (VPL, VPM)
3°:	→ Posterior limb of internal capsule → Postcentral gyrus

Anterolateral/
pain

Fast/lateral	1° (Free nerve ending → A delta fiber) → 2° (Anterior white commissure → Lateral and Anterior Spinothalamic tract → Spinal lemniscus → VPL of Thalamus) → 3° (Postcentral gyrus) → 4° (Posterior parietal cortex) 2° (Spinomesencephalic tract → Superior colliculus of Midbrain tectum)
Slow/medial	1° (Group C nerve fiber → Spinoreticular tract → Reticular formation) → 2° (MD of Thalamus) → 3° (Cingulate cortex)

Motor

flexion: Primary motor cortex → Posterior limb of internal capsule → Decussation of pyramids → Corticospinal tract (Lateral, Anterior) → Neuromuscular junction

flexion:	Primary motor cortex → Genu of internal capsule → Corticobulbar tract → Facial motor nucleus → Facial muscles
flexion:	Red nucleus → Rubrospinal tract
extension:	Vestibulocerebellum → Vestibular nuclei → Vestibulospinal tract
extension:	Vestibulocerebellum → Reticular formation → Reticulospinal tract
Midbrain tectum → Tectospinal tract → muscles of neck

direct:	1° (Motor cortex → Striatum) → 2° (GPi) → 3° (Lenticular fasciculus/Ansa lenticularis → Thalamic fasciculus → VL of Thalamus) → 4° (Thalamocortical radiations → Supplementary motor area) → 5° (Motor cortex)
indirect:	1° (Motor cortex → Striatum) → 2° (GPe) → 3° (Subthalamic fasciculus → Subthalamic nucleus) → 4° (Subthalamic fasciculus → GPi) → 5° (Lenticular fasciculus/Ansa lenticularis → Thalamic fasciculus → VL of Thalamus) → 6° (Thalamocortical radiations → Supplementary motor area) → 7° (Motor cortex)
nigrostriatal pathway:	Pars compacta → Striatum

Afferent

Vestibular nuclei → Vestibulocerebellar tract → ICP → Cerebellum → Granule cell

Pontine nuclei → Pontocerebellar fibers → MCP → Deep cerebellar nuclei → Granule cell

Inferior olivary nucleus → Olivocerebellar tract → ICP → Hemisphere → Purkinje cell → Deep cerebellar nuclei

Efferent

Dentate nucleus in Lateral hemisphere/pontocerebellum → SCP → Dentatothalamic tract → Thalamus (VL) → Motor cortex

Interposed nucleus in Intermediate hemisphere/spinocerebellum → SCP → Reticular formation, or → Cerebellothalamic tract → Red nucleus → Thalamus (VL) → Motor cortex

Fastigial nucleus in Flocculonodular lobe/vestibulocerebellum → Vestibulocerebellar tract → Vestibular nuclei

Bidirectional:
Spinocerebellar

Unconscious proprioception	lower limb → 1° (muscle spindles → DRG) → 2° (Posterior thoracic nucleus → Dorsal/posterior spinocerebellar tract → ICP → Cerebellar vermis) upper limb → 1° (muscle spindles → DRG) → 2° (Accessory cuneate nucleus → Cuneocerebellar tract → ICP → Anterior lobe of cerebellum)
Reflex arc	lower limb → 1° (Golgi tendon organ) → 2° (Ventral/anterior spinocerebellar tract→ SCP → Cerebellar vermis) upper limb → 1° (Golgi tendon organ) → 2° (Rostral spinocerebellar tract → ICP → Cerebellum)

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Contributors: Prab R. Tumpati, MD