Cranial Motor Neuron; Eye

Movements
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Corticobulbar Tract
Pathway runs from motor cortex to the
medullary pyramids
Within the medulla, the tracts synapse
on respective nuclei (ex: hypoglossal
nucleus, facial nucleus, motor nucleus
of V)
Innervates cranial motor nuclei
bilaterally
EXCEPTION: lower facial nuclei and cranial
nerve XII (unilaterally innervated)
Both the lower part of cranial nerve VII and
XII are innervated by the contralateral cortex.
Among those nuclei that are bilaterally
innervated a slightly stronger connection
contralaterally than ipsilaterally is
observed
Corticobulbar Tract
Controls muscles of the face, head
and neck
Order of neuron
1st neuron upper motor neuron
From motor cortex (lower precentral gyrus)
to the medulla
The level of the medulla the 1st order
neuron ends at depends on which cranial
nerve it synapses on
2nd neuron lower motor neuron
Cranial nerve
Lesions
Upper motor lesion affects the
corticobulbar tract
Lower motor lesion affects the a-motor
neuron (w/in lamina IX of the ventral grey
horn)
Innervation of Face
Upper Face: bilateral innervation
Lower Face: unilateral innervation
from the contralateral side

Upper motor lesion affects the

corticobulbar tract
Upper face will be normal
Lower face will be affected
contralaterally
Lower motor lesion affects the a-
motor neuron (w/in lamina IX of
the ventral grey horn)
Whole face will be affected
unilaterally
Facial Paralysis vs Facial Palsy
Facial paralysis
Lesion of corticobulbar tract
Contralateral lower facial paralysis
No upper facial paralysis b/c upper
face is bilaterally innervated
Facial (Bells) Palsy
Lesion of facial motor nucleus of
CN VII
Ipsilateral upper and lower facial
paralysis
Hypoglossal nucleus

Lesions
Corticobulbar Tract
Initial loss of contralateral input
After a few weeks of recovery, ipsilateral
input compensates for loss of contralateral
input
Motor Cortex (same affects as
corticobulbar tract)
Ex: Lesion on right cortex
Left side of tongue is weak (contralateral to
lesion)
When patient sticks out tongue, tongue will
go to the left
Genu (same affects as motor cortex &
corticobulbar tract)
Hypoglossal Nucleus
Loss on ipsilateral side
 Uvula
Bilaterally innervated by CN X
Lesion of corticobulbar tract
Uvula is pulled ipsilaterally
Lesion of CN X
Uvula is pulled contralaterally
Ex: right CN X lesion
Right side of uvula is weak because of
loss of innervation
Left side of uvula still maintains its
innervation, so its muscle contracts
Uvula is pulled to the left side
Corticobulbar = corticonuclear
Spinal Accessory Nerve
Nerve innervations to all striated
muscles are all innervated
ipsilateral.

Sternocleidomastoid
Right muscle contracts to allow you
to look to the left
Corticobulbar motor neurons that
innervates this muscle is on the
ipsilateral Good representation
of trapezius

Trapezius innervation

Corticobulbar motor neurons is

contralateral Good representation
of
sternocleidomastoid
innervation
Lesions Review
Corticospinal Tract Cranial N.
(Upper motor) (Lower motor)
Face Lower face, contralaterally (VII)
(Facial Paralysis) Whole face, unilaterally (Facial
[Bells] Palsy)
Tongue Loss of contralateral input (XII)
Tongue goes to opposite side Loss of ipsilateral input
of the lesion (weak side) Tongue goes to the same side
of lesion
Uvula Loss of contralateral input (X)
Uvula goes to the same side of Loss of ipsilateral input
lesion Uvula goes to the opposite
side of lesion

Remember
Corticobulbar tract innervates cranial motor nuclei bilaterally, EXCEPT lower facial
nucleus and cranial nucleus of XII
Lesions of genu or motor cortex present the same way as a lesion to corticospinal tract
Cranial Motor Neuron; Eye
Movements
Neuro Lab 3/31
Eye Movement
Motor unit to extra-ocular muscle has
a low ratio (1 axon innervates very few
muscle fibers)
Saccade (rapid eye movement)
Voluntarily change your gaze
Smooth pursuit (slow eye movement)
Unconscious reflexes that makes the
image you see, stay on the fovea (ex:
following a birds flight w/ your eyes)
Nystagmus: eyes move rapidly and
uncontrollably
Circulating btw saccade & smooth pursuit
Vestibular nystagmus
Caused by dysfunction of the vestibular
part of the inner ear, the nerve, the
vestibular nucleus within the brainstem, or
parts of the cerebellum that transmit
signals to the vestibular nucleus
Situation: Spin your patient around in a
circle, stop them, and look at their eyes
https://www.youtube.com/watch?v=faRSU
TOQHns
Optokenetic nystagmus
Innate and complex ocular motor reflex
that allows us to adequately follow moving
objects when we keep our head steady
Situation: Tell your patient to keep their
head still and watch as you spin the wheel
of fortune
https://www.youtube.com/watch?v=LInm9
cZcHyk
 Horizontal Gaze
Paramedian pontine reticular
formation (PPRF)
Right PPRF stimulates both eyes to
look to the right
Frontal eye field/cortex
When activated, eyes saccade to
contralateral side
Superior colliculus: unconscious
eye movement
Internuclear Opthalamoplegia
Internuclear Opthalamoplegia (INO)
One or both MLFs are lesioned, leads to
impairment of eye adduction

MLF unilateral lesion

Cannot adduct ipsilateral eye
Ex: Right MLF lesion
Both eyes can still tract movement to the
right
Right eye cannot tract movement to the left
(cannot adduct)
Left eye can still tract movement to the left
MLF bilateral lesion
No adduction for both eyes
Eye Manifestation of Lesions Anomalies

Looking Straight Looking Right Looking Left

Both eyes looks

to the right