Primary motor cortex (precentral gyrus, Brodmann area 4)

Receptor or cortex · Betz cells UMN

Layer V pyramidal cells of the precentral gyrus, including the giant Betz cells, give rise to roughly half of corticospinal axons; the rest arise from premotor and supplementary motor areas and from the postcentral somatosensory cortex. The motor homunculus places the leg on the medial surface (anterior cerebral artery territory) and the face and arm on the lateral convexity (middle cerebral artery territory).

Detail

Cell type
Layer V pyramidal cells (Betz cells are the largest)
Contribution
About half of corticospinal fibres from M1; remainder from premotor, supplementary motor and somatosensory cortex
Blood supply
Leg area: anterior cerebral artery; face and arm area: middle cerebral artery

When it goes wrong

Middle cerebral artery territory infarct

Contralateral UMN weakness of the face and arm more than the leg, with aphasia (dominant hemisphere) or neglect (non-dominant)

Anterior cerebral artery territory infarct

Contralateral leg weakness more than arm, often with urinary incontinence and abulia

Focal motor (Jacksonian) seizure

Clonic jerking that marches along the homunculus, for example thumb to hand to face, followed by transient Todd's paresis

Practise this structure

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