A system of practical medicine. By American authors. Vol. 5 : $b Diseases of the nervous system
Science
A system of practical medicine. By American authors. Vol. 5 : $b Diseases of the nervous system
Medicine -- Practice
From this level the fibres of the internal capsule again diverge, as
fasciculi whose physiological independence has been well determined,
going dorsad and frontad to certain gyri of the cerebral cortex where
their fibres join ganglion-cells. Three large fasciculi and
corresponding cortical areas are recognized as constituting the
pyramidal tract, strictly speaking: (1) A fasciculus which extends
frontad to the base of the second frontal gyrus where it coalesces
with the precentral, the centre and fasciculus for movements of the
facial muscles of the opposite side; (2) a fasciculus which extends to
the precentral and postcentral gyri, more especially in their middle
part, constituting the centre and fasciculus for movements of the arm
and hand; (3) another fasciculus which goes dorso-mesad, almost
vertically in the brain, to join the ends of the pre- and postcentral
gyri at the top of the hemisphere, and their continuation upon its
mesal aspect known as the paracentral lobule, centre and fasciculus
for movements of the opposite foot and leg. Besides these three great
cortical areas and their connected fasciculi of nerve-fibres, which go
to make up the pyramidal tract, we recognize (4) a cortical centre for
speech movement of the tongue and lips in the base of the left third
frontal gyrus over the fissure of Sylvius (Broca's speech-centre),
with a connected white fasciculus which passes into the elbow of the
internal {87} capsule, and can be traced (by means of secondary
degeneration) into the inner part of the base of the crus and into the
pons, but not to the pyramid. Another probable centre (5), for coarse
lingual movements and for the various movements of deglutition, is in
the folds of the insula, its fasciculus not joining the pyramid.
[Illustration: FIG. 9. Longitudinal (sagittal) Section through the
Brain, to show the distribution of the fasciculi of the internal
capsule. Fasciculi of motor tract in dotted lines, to fronto-parietal
convolutions. Fasciculi of sensory tract in full lines, to
temporo-parieto-occipital convolutions: _N. C._, nucleus caudatus;
_N. L._, nucleus lentiformis; _T.O._, thalamus opticus. 1, level of
crus cerebri; 2, level of pons; 3, level of oblongata. (This diagram
is to be used in conjunction with Fig. 7.)]
The location of two other motor centres—one for the movement of the
eyeballs in or near the gyrus angularis, and one for vocal laryngeal
movements in the base of the right third frontal gyrus (homologous to
the speech-centre in the left hemisphere), is problematical, or at
least not well enough established to be recognized in a practical
treatise.
Recent experimental researches have shown that to electrical
excitation at least the fasciculi for the tongue, face, arm, and leg
yield the same distinct reaction (isolated muscular contractions) as
do their respective centres or cortical areas; perhaps they are more
excitable.
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