2. Pyramidal tract lesion

Question 1

Pyramidal tract term

Answer 1

Upper motor neuron, corticospinal system

Question 2

Causes

Answer 2

Stroke, MS, traumatic brain injury, cerebral palsy

Acute: Immediate & total –> hemiplegia (e.g. internal capsule infarct)
Slow progessive: Hemiparesis (e.g. hemisphere glioma)

Lesions below decussation in the medulla, same side. Below, contralateral.

Question 3

Symptoms

Answer 3

Mus. weak.
- Weak. in flexors of lower limbs
- Weak. in extensors of upper limbs
Reduced skilled fine move.
Initially flaccid --> spasticity
Babinski, Chaddock, Oppenheim sign
Hyperreflexia (increased deep tendon reflex)
Hypertonia (velocity dependent)
Pyramidal drift (w/eyes closed, upper limbs stretched out w/palms down --> the affected limb drifts downards and and the palm up)
Dyssenergic move.

Question 4

Possible affected areas (lesions)

Answer 4

CNS: Cortex, brainstem, corticospinal tracts, spinal cord

Question 5

Treatment

Answer 5

Rehabilitation, baclofen, diazepam, dantrolene, clonazepam, phenol injections
- Effectiveness of meds: Varies in ppl and locations

Question 6

Diagnosis

Answer 6

Physical exam., CT, MRI