Upper Motor Neuron

Lower Motor Neuron

David Brewer DVM, DACVIM (Neurology)

Objectives
• Fundamental differences between the UMN
and LMN systems
• Typical symptoms seen with dysfunction
• Role in neurolocalization

• Cases examples
UMN? LMN? Who Cares?
• Localization

4
 Definitions
• UMN- The neurons of the brain that
control motor activity of the body

5
 Definitions

• UMN- Cell bodies are

located in the cerebrum
and brainstem
• Entire UMN is confined
to CNS

6
 Definitions
• LMN- the neurons that directly innervate
the muscles.

7
 Definitions
• LMN- Cell bodies are located in the ventral
gray horn of the spinal cord

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Functions
• UMN
• ‘Tells’ the LMN what to do
• Stimulate or inhibit the
LMN
• Initiation of voluntary
movement
• Maintenance of muscle
tone and support against
gravity
• Regulation of posture

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Functions
• LMN-
• Receives inputs from
the UMN
• Connects the CNS
with the muscles
• Spinal reflexes

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 Dysfunction of the UMN
• Paretic (weakness) to paralysis
• Gait: (if still walking)
• Long strided
UMN
• Crossing Ataxia
• Scuffing
• Loss of inhibition:
• Spasticity
• Hyperreflexia / hypertonia /
abnormal reflexes
• Abnormal postures (brain lesion)
• Ex. opisthotonus

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Dysfunction of the UMN
• Gait Generation
▪ Dogs/cats- brainstem
▪ People- cerebrum
Romy
Romy
Romy
Romy
Tonic Gamma Loop Mechanism2
Loss of Inhibition

1.Gravity (pleximeter)
stimulates muscle spindle

2. Firing along Ia afferent

1 3. Stimulation of alpha motor
neuron and muscle
3 contraction

** Must be controlled by
UMN system
Crossed Extensor Reflex
 Dysfunction of the LMN
• Paretic (weakness) to paralysis
• Gait: (if still walking)
• Short-strided
• Choppy
• Lame
• Hypotonia
• Hyporeflexive
• Rapid muscle
atrophy

20
Postural Reactions
• Both UMN and LMN
lesions can cause
abnormal postural
reactions
• More so with UMN
• Depends on severity
Goal: Neurolocalization
• How do we use UMN and LMN
symptoms to help localize a lesion?

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Goal: Neurolocalization
• The location of the lesion along the neuroaxis
will determine which limbs are affected
▪ UMN symptoms will be present in limbs
downstream from a CNS lesion
▪ LMN symptoms will only be present if the
motor nerve or the intumescence is
affected
24
Goal: Neurolocalization
• Symptoms can be isolated to one limb or
generalized to all limbs.
• Not every symptom needs to be present to
localize a region
 Diffuse
Brain C1-C5 C6-T2 T3-L3 L4-S3
LMN

TL UMN UMN LMN Normal Normal LMN

PL UMN UMN UMN UMN LMN LMN

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UMN or LMN Bladder?

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 Diffuse
Brain C1-C5 C6-T2 T3-L3 L4-S3
LMN

TL UMN UMN LMN Normal Normal LMN

PL /
UMN UMN UMN UMN LMN LMN
Bladder

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 Bladder
• UMN Bladder
▪ Seen with lesions cranial
to L4
▪ Loss of inhibition causes
excess tone on the
urethral sphincters
▪ Large difficult to express
▪ Overflow incontinence
UMN Bladder Treatment
• Relax Internal Urethral Sphincter
▪ Alpha-adrengeric antagonist
▪ Ex. Phenoxybenzamine or Prazosin

• Relax External Urethral Sphincter

▪ Skeletal muscle relaxant
▪ Ex. Diazepam
Bladder
• LMN Bladder
▪ Seen with lesions caudal
to L4
▪ Hypotonia of the
urethral sphincters
▪ Fills partially
▪ Continuous dribbling
▪ Easy to express
LMN Bladder Treatment
• Promote Bladder Contraction
▪ Stimulate muscarinic receptors
• Ex. Bethanechol
Technically Speaking
• LMN is referencing
just the nerve

• What about the

muscle or the
junction between the
nerve and muscle?
Neuromuscular System
• LMN (Neuropathy)
• Muscle (Myopathy)
• NMJ (Junctionopathy)
Neuromuscular System
Myopathy Neuropathy NMJ

Muscle mass/tone Normal to ↓ ↓ Normal

Gait Paresis Paresis Paresis may be episodic

Postural Reactions Normal

↓ Normal

Reflexes Normal
↓ Normal
Case Example 1
• Middle-age German Shepherd
• CC: Wobbly in the pelvic limbs
37
 Diffuse
Brain C1-C5 C6-T2 T3-L3 L4-S3
LMN

TL UMN UMN LMN Normal Normal LMN

PL /
UMN UMN UMN UMN LMN LMN
Bladder

38
Differentials
• C6-T2 myelopathy
▪ Degenerative - IVDD
▪ Anomalous – Wobbler’s syndrome
▪ Metabolic - ??
▪ Neoplastic- Extradural or intramedullary
▪ Inflammatory- Immune-mediated or infectious
▪ Traumatic / Toxic- Contusion
▪ Vascular- FCE
Diagnostics
Diagnosis
• C6-T2 myelopathy

▪ Anomalous – Wobbler’s syndrome

Treatment and Outcome
• Treatment
▪ Owner elected conservative management

• Outcome
▪ Fair to good response to prednisone and life
long gabapentin
Case Example 2
• Young Bichon
• CC: Down in pelvic limbs
44
 Diffuse
Brain C1-C5 C6-T2 T3-L3 L4-S3
LMN

TL UMN UMN LMN Normal Normal LMN

PL /
UMN UMN UMN UMN LMN LMN
Bladder

45
Differentials
• T3-L3 myelopathy
▪ Degenerative - IVDD
▪ Anomalous – Malformation, cyst
▪ Metabolic - ??
▪ Neoplastic- Extradural or intramedullary
▪ Inflammatory- Immune-mediated or infectious
▪ Traumatic- Contusion
▪ Vascular- FCE
Diagnostics
Diagnosis
• T3-L3 myelopathy
▪ Degenerative - IVDD
Treatment and Outcome
• Treatment
▪ Hemilaminectomy

• Outcome
▪ Normal at 6 weeks post surgery
Case Example 3
• Young adult Giant Schnauzer
• CC: Down in all 4
53
 Diffuse
Brain C1-C5 C6-T2 T3-L3 L4-S3
LMN

TL UMN UMN LMN Normal Normal LMN

PL /
UMN UMN UMN UMN LMN LMN
Bladder

54
Differentials
• Diffuse LMN Disease
▪ Degenerative – Hereditary?, Storage diseases
▪ Anomalous – ?
▪ Metabolic – Endocrine (DM, cortisol, thyroid)
▪ Neoplastic- Lymphoma, paraneoplastic
▪ Inflammatory- Polyradiculoneuritis, infectious – protozoal,
(botulism)
▪ Traumatic / Toxic- (Tick paralysis)
▪ Vascular- ?
Diagnostics
Diagnostics
• CBC – Normal
• Chem – Normal
• Urinalysis – Normal
• 3 view chest radiographs – Normal
• Abdominal Ultrasound – Normal
• Baseline cortisol and T4 – Normal
Additional Diagnostics
• Electrodiagnostics
▪ Electromyography
▪ Motor Nerve Conduction Velocity
▪ F-Waves
• +/- Muscle nerve biopsy
Updated Differentials
• Diffuse LMN Disease
▪ Degenerative – Hereditary?, Storage diseases

▪ Neoplastic- Lymphoma, paraneoplastic

▪ Inflammatory- Polyradiculoneuritis, infectious – protozoal,
(botulism)
▪ Traumatic / Toxic- (Tick paralysis)
Treatment and Outcome
• Treatment
▪ Frontline application

• Outcome
▪ ~2 weeks later – 90%
▪ ~4 weeks later – 100%
Presumptive Diagnosis
• Diffuse LMN Disease

▪ Inflammatory- Polyradiculoneuritis,
Case Example 4
• 2 yr old Newfoundland
• CC: Unable to walk
Case Example 4
 Take Home Points
• UMN disease should have distinctly different signs
from LMN disease

• Cervical spinal cord disease and diffuse LMN disease can sometimes be
confused without thorough examination

• Diseases that affect the neuromuscular system can look very similar

• Gait evaluation is probably the most important aspect of the exam

• Acute localization is key!

QUESTIONS?