Pyramidal signs

Pyramidal signs indicate that the pyramidal tract is affected in some region. Pyramidal tract dysfunction can lead to clinical presentations like spasticity, weakness, slowing of rapid alternating movements, hyperreflexia, and Babinski sign.[1]

A presence of these phenomena is nearly always connected with hyperreflexia and some authors think that we can not count them as a pathological reactions at all. Their existence on lower extremity is more serious that on the upper ones. The most often reason of irritative phenomena is some lesion of a central motoneuron, but if there is an asymmetry, we should also think about diagnose of amyotrophic lateral sclerosis.

These phenomena normally occur till the age of 2, when the myelinization is finished. So we don't diagnose them as a pathology in children.

Pathophysiology

The upper motor neurons from the central nervous system travel through the pyramidal tracts (i.e., corticospinal tracts), connecting the brain and spinal cord and help in controlling voluntary movement of muscles.[2]

Irritative phenomena on the upper extremity
Babinski sign

The irritative phenomena are present if there is visible flection of the thumb, which goes to opposition:

  • Hoffmann's sign – We twang to the middle finger of a patient by our second finger from the top. (see video)
  • Tromner's sign - We twang to the middle finger of a patient by our second finger from the underside. (see video)
  • Juster's sign – We prick a patient by something sharp into hypothenar.

Irritative phenomena on the lower extremity

Extension

The extension phenomena are present if a big toe goes up after the irritation:

  • Babinski reflex:
  • Roche's sign

We stimulate in same style as before but on the external part of the foot.

  • Chaddock's phenomen:

Reaction on sharp irritation on the outer ankle.

  • Vitek's sign:

Repeatedly scrape the fingertip of big toe.

  • Oppenheim's phenomen:

We irritate the periosteum of tibia by our knuckles. (see video)

  • Schäffer's phenomen:

We kneads the Achilles tendon.

  • Gordon's phenomen:

We kneads musculus triceps surae.

Flexion

These phenomena are present if the fingers of the foot are going into the flection position:

  • Rossolimo – Reaction on percussion of all fingertips. (see video)

Clinical significance

Parkinsonian-Pyramidal syndrome (PPS) are a combination of both pyramidal and parkinsonian signs that manifest in various neurodegenerative diseases.[3]

See also

References
  1. Grant, Gerald A.; Xu, Linda; Ellenbogen, Richard G. (2018). "3 - Clinical Evaluation of the Nervous System". Principles of Neurological Surgery (Fourth ed.). doi:10.1016/B978-0-323-43140-8.00003-2. ISBN 978-0-323-43140-8.
  2. Rogers, Laura; Wong, Eric. "Cerebral palsy". www.pathophys.org. McMaster Pathophysiology Review. Retrieved 9 September 2020.
  3. Tranchant, Christine; Koob, Meriam; Anheim, Mathieu (June 2017). "Parkinsonian-Pyramidal syndromes: A systematic review". Parkinsonism & Related Disorders. 39: 4–16. doi:10.1016/j.parkreldis.2017.02.025. PMID 28256436.

Further reading
  • Nevšímaová, Růžička, Tichý (2005), Neurologie (book), yes (1st ed.), ISBN 80-7262-160-2CS1 maint: multiple names: authors list (link)
  • Jedlička, Keller (2005), Speciální neurologie (book), yes (1st ed.), ISBN 80-7262-312-5
  • Ambler (2011), Základy neurologie (book) (7th ed.), ISBN 978-80-7262-707-3
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