Neurological symptoms that arise due to damage to the pyramidal tract are called Pyramidal sign designated. In total, there are more than twelve different pathological reflexes that are considered to be pyramidal signs. They provide information about damage to the motor cortex or diseases such as multiple sclerosis or ALS.
What are the pyramid orbit signs?
Pyramidal trajectory signs are reflexes or involuntary, rhythmic muscle contractions that give an indication of damage to the pyramidal tract in adults.
The pyramidal tract is a large descending nerve tract. It pulls from the so-called motor cortex (precentral gyrus) into the body periphery and innervates the alpha motor neurons there. The motor cortex is also known as the motor cortex and is found in the brain. He is responsible for controlling voluntary movements. It sends its signals to the alpha motor neurons via the pyramid orbit. These innervate the skeletal muscles and are therefore responsible for the muscle contractions.
In infants, on the other hand, the pyramidal trajectory signs are physiological, i.e. part of normal development, since the pyramidal trajectories are not yet fully developed in them. Most of the pyramidal trajectories are found on the lower extremities, while there are only a few pyramidal trajectories on the upper extremities.
Function & task
The different pyramid orbit signs are used to diagnose pyramidal orbit damage. The Babinski reflex is triggered by vigorously wiping the outer edge of the sole of the foot from the heels towards the little toe. When damaged, the big toe lifts towards the instep and the little toes move down and out.
Something similar can be observed with the Gordon reflex. The effect corresponds to the effect with the Babinski reflex. However, it is triggered by wiping the edge of the shin from the knee towards the ankle.
The Oppenheim reflex also shows damage to the pyramidal tract by pulling the big toe and spreading the other toes. The Oppenheim reflex is triggered by brushing the outer edge of the foot. The Clauss sign is performed by the therapist bending the knee against the patient's resistance. This also shows the tightening of the big toe in combination with the splaying of the little toes.
Even with the Strümpell sign, the patient's knee is bent against resistance. In this case, however, if the pyramidal tract is damaged, a supination, i.e. an elevation of the inner edge of the foot with simultaneous lowering of the outer edge of the foot, becomes apparent. The Strümpell sign is also known as the tibialis phenomenon.
The Rossolimo reflex, the Piotrowki reflex and the dorsal reflex can be summarized under the term plantar muscle reflexes. Plantar muscle reflexes are self-reflexes of the muscles of the soles of the feet, which are intensified when the pyramidal tract is damaged. In the Rossolimo reflex, plantar flexion, i.e. flexion of the foot or toes in the direction of the sole of the foot, can be triggered by a blow on the muscles of the sole of the foot. The same result is triggered with the Piotrowski reflex by a blow on the anterior tibial muscle (Musculus tibialis anterior). In the dorsal reflex, plantar flexion also occurs after a blow on the back of the foot.
The pyramidal trajectory signs of the upper extremity include the Gordon finger spreading sign, the Trömner reflex and the Wartenberg reflex. In the case of the Gordon finger splay, the fingers are spread by pressure on the pea bone (os pisiforme), a small carpal bone. In the Trömner reflex, the fingers bend under pathological conditions by hitting the palm side of the distal phalanx of the middle finger. If the thumb hits against resistance when bending the index, middle and ring fingers, this is called a positive Wartenberg reflex.
The Gordon finger splay sign, the Trömner reflex, the Gordon reflex, the Rossolimo reflex, the Pitotrowski reflex and the dorsal reflex are among the unsafe pyramidal signs. This means that even if one of these pathological reflexes can be triggered, the pyramidal pathway does not necessarily have to be damaged.
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If multiple sclerosis is suspected, the pyramidal orbit signs are always checked. In multiple sclerosis, the body's own defense cells attack cells in the nervous system and cause inflammation. The so-called glial cells are attacked. These form a kind of insulating layer around nerve fibers so that the transmission of stimuli can take place much faster. This so-called myelin layer is damaged by the inflammation. One speaks here of demarking.
Foci of demyelinating are found in multiple sclerosis in both the central nervous system and the peripheral nervous system. Typical symptoms of multiple sclerosis are visual disturbances such as double vision or blurred vision, easy fatigue, paralysis, spasticity and slurred speech. However, the symptoms can also be very unclear, so that positive pyramidal signs can provide initial indications of the disease.
The pyramidal orbit signs are also positive if the motor cortex is damaged. The most common cause of damage to the motor cortex is a cerebral infarction in the area of the middle cerebral artery (arteria cerebri media). The motor cortex can also be impaired if the anterior cerebral artery is blocked. Other causes of damage to the brain area are cerebral haemorrhage, inflammation, tumors or injury.
A rather rare disease in which the motor neurons in the brain perish is spastic spinal paralysis. The disease is inherited and manifests itself as increasing spastic paralysis in the lower extremities. Urination disorders, eye diseases, dementia, deafness and epilepsy can also occur in spastic spinal paralysis. In addition to significantly increased self-reflexes, positive pyramidal signs can also be observed in the neurological examination.
Positive signs of the pyramidal tract can also be found in ALS, amyotrophic lateral sclerosis. The disease is caused by irreversible damage to motor neurons. The degeneration leads to paralysis, muscle wasting and spasticity. Those affected can no longer walk properly and suffer from speech and swallowing disorders. After diagnosis, patients usually die within three to five years. Amyotrophic lateral sclerosis is incurable.
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