Pyramidal syndrome refers to all motor disorders caused by damage to the pyramidal pathway. The pyramidal pathway, also called the pyramidal tract or cortico-spinal pathway, is the support of voluntary motor skills: it transmits motor control from the central nervous system from the cortex to the spinal cord. This syndrome results in a set of motor deficit making it difficult, if not impossible, to daily actions such as walking and dressing, as well as spasticity. Physiotherapy allows the patient to fight, to a certain extent, against the deterioration of his motor capacities.

The symptoms associated with pyramidal syndrome depend on the location of the lesions of the pyramidal tract. The main function of the pyramidal path is to provide motor skills through the will. Its impairment leads to paralysis or paresis (partial or transient paralysis) of the muscles of the body, for example making walking difficult (limping) or even impossible.

The pyramidal route also has the function of inhibiting muscle tone (muscle contraction) and reflexes (tendon). Its impairment therefore leads to an exaggeration of muscle contractions (hypertonia) and reflexes (spasticity). A person whose corticospinal tract has been damaged has a clonus, which is a series of rapid, reflex muscle contractions.

The plantar skin reflex, often called Babinski’s sign, is the only specific sign of pyramidal damage. : to stimulation of the sole of the foot, the affected person responds by extending the big toe in a slow and “majestic” manner, instead of flexing the toes by reflex.

Constructive apraxia can also be associated with pyramidal syndrome, preventing the sufferer from coordinating their movements to perform complex tasks such as dressing or speaking. Pyramidal syndrome also results in a loss of the individual’s ability to perform fine movements, especially with the fingers.

The pyramidal syndrome results from a localized lesion at any level of the cortico-spinal pathway: the involvement of the cerebral cortex causes a contralateral partial hemiplegia; damage to the internal capsule causes massive hemiplegia; involvement of the brainstem causes contralateral hemiplegia when the lesion is above the facial nucleus and global hemiplegia if the lesion is located below the facial nucleus.

A cerebrovascular accident (CVA), a cerebral hemorrhage, traumatic lesions, a tumor (benign or malignant), multiple sclerosis, or a generalized epileptic seizure, are all causes of damage to the corticosteroid pathway. spinal cord and therefore risk factors for the appearance of a pyramidal syndrome.

Treatment varies depending on the location of the nerve damage and its cause. Several drugs are used to treat muscle spasticity. This is also treated with intramuscular injections of botulinum toxin. This toxin produced from the bacterium Clostridium botulinum inhibits the release of the neurotransmitter acetylcholine and causes muscle fibers to relax. The rehabilitation by physiotherapy (or physiotherapy) of the muscles affected by paresis is at the heart of the treatment.