Szmidel Matthew, Ma Henry, Phan Thanh
Neurology, Monash Medical Centre, Clayton, Victoria, Australia.
School of Clinical Sciences, Department of Medicine, Monash University, Clayton, Victoria, Australia.
BMJ Neurol Open. 2024 May 28;6(1):e000580. doi: 10.1136/bmjno-2023-000580. eCollection 2024.
The concept of 'pyramidal weakness' denotes that neurological examination findings can be localised to the central nervous system (CNS), and implying a specific pattern of motor weakness involving upper limb extensors and lower limb flexors. However, other weakness patterns have been observed in CNS lesions. We aim to investigate the pattern of weakness observed in CNS lesions and explore the use of the phrase 'pyramidal weakness' over time. We searched Medline, PubMed, and Google Scholar up to January 1st, 2022, using keywords such as 'distal weakness,' 'upper limb flexion,' 'lower limb extension,' 'pyramidal weakness,' and related terms. The inclusion criteria were papers relating to brain or spinal cord lesions and terms inferring their presence or the description of a motor weakness pattern. We identified 117 studies since 1889, of which 29.9% of publications described weakness in upper limb extensors and lower limb flexors, and 26.5% reported distal weakness. We found an early reference to 'pyramidal weakness' in 1922 in the context of unilateral weakness in encephalitis with no description of the upper limb extensor and lower limb flexor pattern. Since 1988, 'pyramidal weakness' has become associated with weakness in upper limb extensors and lower limb flexors. The phrase 'pyramidal weakness', used in its current format, has been more frequent since the 1980s. Distal weakness and upper limb extensor and lower limb flexor weakness have been associated with CNS lesions.
“锥体束征性肌无力”这一概念表明，神经学检查结果可定位于中枢神经系统（CNS），并意味着存在一种涉及上肢伸肌和下肢屈肌的特定运动性肌无力模式。然而，在中枢神经系统病变中也观察到了其他肌无力模式。我们旨在研究中枢神经系统病变中观察到的肌无力模式，并探讨“锥体束征性肌无力”这一表述随时间的使用情况。我们检索了截至2022年1月1日的Medline、PubMed和谷歌学术，使用了“远端肌无力”“上肢屈曲”“下肢伸展”“锥体束征性肌无力”等关键词及相关术语。纳入标准为与脑或脊髓病变相关的论文以及推断其存在或描述运动性肌无力模式的术语。我们确定了自1889年以来的117项研究，其中29.9%的出版物描述了上肢伸肌和下肢屈肌的肌无力情况，26.5%报告了远端肌无力。我们发现1922年在脑炎单侧肌无力的背景下首次提及“锥体束征性肌无力”，但未描述上肢伸肌和下肢屈肌模式。自1988年以来，“锥体束征性肌无力”已与上肢伸肌和下肢屈肌的肌无力相关联。以当前形式使用的“锥体束征性肌无力”这一表述自20世纪80年代以来更为常见。远端肌无力以及上肢伸肌和下肢屈肌无力与中枢神经系统病变有关。
