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distribution of bers in the rostral pons is much the same as in the cerebral peduncle; in the caudal pons this distinction is less well de ned In man, a lack of systematic study leaves the precise somatotopic organization of corticospinal bers in the pons uncertain A point of some uncertainty has been the course of bers that descend through the lower pons and upper medulla and then ascend again to innervate the facial motor nucleus on the opposite side Such a connection must exist to explain occasional instances of facial palsy from brainstem lesions caudal to the midpons A discussion of the various hypothesized sites of this pathway, including a recurrent bundle attached to the name of Pick, can be found in the report by Terao and colleagues They conclude from imaging studies that corticobulbar bers destined for the facial nucleus descend in the ventromedial pons to the level of the upper medulla, where they decussate and then ascend again; but there is considerable variability between individuals in this con guration The descending pontine bundles, now devoid of their corticopontine bers, reunite to form the medullary pyramid The brachial-crural pattern may persist in the pyramids and is certainly reconstituted in the lateral columns of the spinal cord (Fig 8-3), but it should be emphasized that the topographic separation of motor bers at cervical, thoracic, lumbar, and sacral levels is not as discrete as usually shown in schematic diagrams of the spinal cord The corticospinal tracts and other upper motor neurons terminate mainly in relation to nerve cells in the intermediate zone of spinal gray matter (internuncial neurons), from which motor impulses are then transmitted to the anterior horn cells Only 10 to 20 percent of corticospinal bers (presumably the thick, rapidly conducting axons derived from Betz cells) establish direct synaptic connections with the large motor neurons of the anterior horns.

The motor area of the cerebral cortex is de ned physiologically as the region of electrically excitable cortex from which isolated movements can be evoked by stimuli of minimal intensity (Fig 3-3) The muscle groups of the contralateral face, arm, trunk, and leg are represented in the primary motor cortex (area 4), those of the face being in the most inferior part of the precentral gyrus on the lateral surface of the cerebral hemisphere and those of the leg in the paracentral lobule on the medial surface of the cerebral hemisphere The parts of the body capable of the most delicate movements have, in general, the largest cortical representation, as displayed in the motor homunculus diagram shown in Fig 3-4 Area 6, the premotor area, is also electrically excitable but requires more intense stimuli than area 4 to evoke movements Stimulation of its caudal aspect (area 6aa) produces responses that are similar to those elicited from area 4 These responses are probably effected by transmission of impulses from area 6a to area 4 (since they cannot be obtained after ablation of area 4) Stimulation of the rostral premotor area (area 6ab) elicits more general movement patterns, predominantly of proximal limb musculature The latter movements are effected via pathways other than those derived from area 4 (hence, extrapyramidal ) Very strong stimuli elicit movements from a wide area of premotor frontal and parietal cortex, and the same movements may be obtained from several widely

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Windows Explorer displays the drive and folder structure in the left pane and the selected folder s (or drive s) contents on the right; you can display the contents of a folder by clicking the folder s icon As you can see in Figure 8-7, the Mike s Document folder contains two subfolders and two files To view the contents of a subfolder, click the + sign to the left of the main folder The subfolders will be displayed in the folder structure on the left You can now view the contents of these subfolders by clicking them

Server architecture, platform specifications, and hardware details High availability (HA), disaster recovery (DR) architecture of the current system, and application-level service agreements Components used in DR and HA These are third-party proprietary technologies, active/passive or active/active HA, and failover times Network diagrams depicting applications, external storage, and systems connectivity Network throughput, latency, and bandwidth requirements for all connections going in and out of the source systems

of importance in clinical work, especially in relation to certain stroke syndromes As the descending axons subserving limb and facial movements emerge from the cortical motor strip, they maintain the anatomic speci city of the overlying cortex; therefore a discrete cortical-subcortical lesion will result in a restricted weakness of the hand and arm or the foot and leg More caudally, the descending motor bers converge and are collected in the posterior limb of the internal capsule, so that even a small lesion there may cause a pure motor hemiplegia, in which the face, arm, hand, leg and foot are affected to more or less the same degree (page 682) The axons subserving facial movement are situated rostrally in the posterior limb of the capsule, those for hand and arm in the central portion, and those for the foot and leg caudally (see Brodal) This topographic distribution is more or less maintained in the cerebral peduncle, where the corticospinal bers occupy approximately the middle of the peduncle, the bers destined to innervate the facial nuclei lying most medially More caudally, in the basis pontis (base, or ventral part of the pons), the descending motor tracts separate into bundles that are interspersed with masses of pontocerebellar neurons and their cerebellopetal bers A degree of somatotopic organization can be recognized here as well, exempli ed by selective weakness of the face and hand with dysarthria, or of the leg, which may occur with pontine lacunar infarctions Anatomic studies in nonhuman primates indicate that arm-leg

Figure 22-7 Photograph of the lateral surface of the human brain (Reproduced by permission from Carpenter MB, Sutin J: Human Neuroanatomy, 8th ed Baltimore, Williams & Wilkins, 1982)

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FIGURE 8-7

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