The precentral corticospinal tract (PreCST) connects the precentral gyrus with the spinal cord. Superiorly, the PreCST sweeps anteriorly deep to the superior and middle frontal gyri, posterior to the SMA CST, and lateral to the caudate and dorsal cingulum. Inferiorly, PreCST funnels into the posterior limb of the internal capsule, lateral to the thalamic nuclei and medial to the putaminal projections. Inferior to the thalamus, the PreCST is on the anterolateral aspect of the midbrain, in the lateral part of the cerebral peduncle. The tract is more medial in the pons and decussates across the midline in the lower medulla, descending into the lateral spinal cord in the lateral funiculus.