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Corticospinal Decussation Pyramids — FRCA Primary MCQ

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HardPhysiology - NeurophysiologyCorticospinal Decussation PyramidsFRCA Primary

Most fibres forming the lateral corticospinal tract cross the midline at which site?

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Correct answer: DThe pyramidal decussation at the cervicomedullary junction

The best answer is “The pyramidal decussation at the cervicomedullary junction”. Approximately 80–90% of corticospinal fibres decussate in the caudal medulla at the pyramidal decussation and descend as the lateral corticospinal tract. A smaller anterior corticospinal component remains uncrossed initially and may cross near its spinal target. The internal capsule and brainstem pathways precede, rather than perform, the principal decussation.

Reference: Royal College of Anaesthetists, Primary FRCA Syllabus 2021: https://www.rcoa.ac.uk/sites/default/files/documents/2026-01/Primary-FRCA-Syllabus.pdf