In neuroanatomy, the medullary pyramids are paired white matter structures of the

brainstem The brainstem (or brain stem) is the posterior stalk-like part of the brain that connects the cerebrum with the spinal cord. In the human brain the brainstem is composed of the midbrain, the pons, and the medulla oblongata. The midbrain is cont ...

medulla oblongata The medulla oblongata or simply medulla is a long stem-like structure which makes up the lower part of the brainstem. It is anterior and partially inferior to the cerebellum. It is a cone-shaped neuronal mass responsible for autonomic (involun ...

that contain motor fibers of the corticospinal and corticobulbar tracts – known together as the pyramidal tracts. The lower limit of the pyramids is marked when the fibers cross (

decussate Decussation is used in biological contexts to describe a crossing (due to the shape of the Roman numeral for ten, an uppercase 'X' (), ). In Latin anatomical terms, the form is used, e.g. . Similarly, the anatomical term chiasma is named aft ...

Structure

The ventral portion of the

contains the medullary pyramids. These two ridge-like structures travel along the length of the medulla oblongata and are bordered medially by the anterior median fissure. They each have an anterolateral sulcus along their lateral borders, where the hypoglossal nerve emerges from. Also at the side of each pyramid there is a pronounced bulge known as an

olive The olive, botanical name ''Olea europaea'', meaning 'European olive' in Latin, is a species of small tree or shrub in the family Oleaceae, found traditionally in the Mediterranean Basin. When in shrub form, it is known as ''Olea europaea'' ...

. Fibers of the posterior column, which transmit

sensory Sensory may refer to: Biology * Sensory ecology, how organisms obtain information about their environment * Sensory neuron, nerve cell responsible for transmitting information about external stimuli * Sensory perception, the process of acquiri ...

and proprioceptive information, are located behind the pyramids on the medulla oblongata. The medullary pyramids contain motor fibers that are known as the corticobulbar and corticospinal tracts. The corticospinal tracts are on the anterior surface of the pyramids. These tracts transport motor signals that originated in the precentral gyrus and travelled through the internal capsule to the medulla oblongata and pyramids. Extrapyramidal tracts are those motor tracts that do not traverse the medullary pyramids. At the pyramids' most caudal end, the corticospinal axons

(or cross over) the midline and continue down the spinal cord on the contralateral side. The fibers that decussated will go down the lateral corticospinal tract while the fibers that did not decussate will travel down the anterior corticospinal tract. Nearly 90 percent of the fibers decussate and travel down the lateral corticospinal tract while the other 10 percent travels down the anterior corticospinal tract.

Decussation

The two pyramids contain the motor fibers that pass from the brain to the

and spinal cord. These are the corticobulbar and corticospinal fibers that make up the pyramidal tracts. About 90% of these fibers leave the pyramids in successive bundles and

(cross over) in the

anterior median fissure of the medulla oblongata The anterior median fissure (ventral or ventromedian fissure) contains a fold of pia mater, and extends along the entire length of the medulla oblongata: It ends at the lower border of the pons in a small triangular expansion, termed the foramen ...

as the ''pyramidal decussation'' or ''motor decussation''. Having crossed over at the middle line, they pass down in the posterior part of the lateral funiculus as the lateral corticospinal tract. The other 10% of the fibers stay uncrossed in the anterior corticospinal tract. The pyramidal decussation marks the border between the spinal cord and the medulla oblongata.

Function

The medullary pyramids contain the motor fibers of the pyramidal tracts – the corticospinal and corticobulbar tracts.

Clinical significance

Whiplash as a result of a car accident can lead to brainstem injuries that affect the pyramids at the medulla oblongata. These pyramid injuries are usually a result of a dislocation at the occiput or spinal level C1. Injuries to the pyramids of the medulla oblongata can also be caused by the quick hyperextension of the neck (cervical region of the spine). Hyperextension of the neck can pull and tear the pyramids, leading to a variety of symptoms such as weakness in all four limbs, difficulty swallowing, and difficulty speaking. A bilateral infarction in the pyramids of the medulla can result in motor quadriplegia. This is rare, however, as there have only been four cases of this reported.

Additional images

File:Gray679.png, Medulla oblongata and pons. Anterior surface. (Pyramid visible at center.) File:Gray684.png, Sketch of the brainstem, with the pyramidal tract visible in red, and pyramidal decussation labeled at lower right. File:Gray688.png, Section of the medulla oblongata at the level of the decussation of the pyramids.

References

Saladin, Kenneth (2012). Anatomy & Physiology: The Unity of Form and Function, Sixth Edition. New York: McGraw-Hill.

External links

Diagram at csus.edu

Whiplash Injuries: The Cervical Acceleration/Deceleration Syndrome book

Neurology Journal article

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