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Tytuł pozycji:

Pyramidal weakness: Is it time to retire the term?

Tytuł :
Pyramidal weakness: Is it time to retire the term?
Autorzy :
Castle-Kirszbaum M; Department of Neurosurgery, Monash Health, Melbourne, Australia.
Goldschlager T; Department of Neurosurgery, Monash Health, Melbourne, Australia.; Department of Surgery, Monash University, Melbourne, Australia.
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Źródło :
Clinical anatomy (New York, N.Y.) [Clin Anat] 2021 Apr; Vol. 34 (3), pp. 478-482. Date of Electronic Publication: 2020 Dec 31.
Typ publikacji :
Journal Article; Review
Język :
English
Imprint Name(s) :
Original Publication: New York : Alan R. Liss, Inc., [c1988-
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Contributed Indexing :
Keywords: corticospinal tract; false localizing signs; pyramidal weakness
Entry Date(s) :
Date Created: 20201221 Latest Revision: 20210304
Update Code :
20210309
DOI :
10.1002/ca.23715
PMID :
33347647
Czasopismo naukowe
Pyramidal weakness, that is, the weakness that preferentially spares the antigravity muscles, is considered an integral part of the upper motor neuron syndrome. Despite its name, pyramidal weakness has very little to do with the pyramidal tract, and preeminent texts on neurology, neuroanatomy, and clinical examination differ considerably in their descriptions and localization of this enigmatic finding. Evidence from human and nonhuman primate studies demonstrates that lesions confined only to the corticospinal (pyramidal) tract cause significant deficits in fine motor control of the hand, but do not cause posturing or patterned weakness of the extremities. Lesioning of the corticofugal fibers, particularly the corticoreticular and corticopontine tracts, leads to dysbalanced output from reticulospinal, and vestibulospinal systems, which along with changes in rubrospinal tract output balance, probably accounts for the pyramidal weakness pattern. Importantly, this would delineate that pyramidal weakness could only be incited by lesions above the brainstem. It has also been suggested that the inherently greater strength of the antigravity musculature is the substrate for pyramidal weakness, independent of any preferential motor innervation. These hypotheses require further testing in myometric studies with carefully selected participants.
(© 2020 American Association of Clinical Anatomists.)

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