New pathways uncovered to the map of 'pyramidal weakness'
Matthew Szmidel's literature review explores the use of the phrase 'pyramidal weakness'
A literature review published by Monash Final year Medical student Matthew Szmidel investigates the pattern of muscle weakness observed in patients with central nervous system (CNS) lesions and explores the use of the phrase 'pyramidal weakness' over time.
Pyramidal weakness has historically implied a pattern of weakness involving the upper limb extensor and lower limb flexor muscles. Neurology trainees study this concept to determine the location of brain and spinal cord lesions when examining patients.
There is a varied understanding of ‘pyramidal weakness’ across time; this phrase should also infer a pattern of distal muscle weakness. This understanding will enable neurology trainees to improve the localisation of CNS lesions by considering additional muscle weakness patterns.
Think of 'pyramidal weakness' as a map neurologists have long relied on to pinpoint brain and spinal cord lesions. This map highlights weakness in specific muscle groups including the triceps and hamstrings, guiding the diagnosis of disease. But imagine explorers discovering new pathways — they've uncovered that weakness in the hands and feet are not accounted for on the old map, but may act as a guide to the location of brain and spinal cord lesions.
While the old map remains valuable, integrating it with these new findings highlights overlooked pathways in the neurological landscape. When examining patients with a distal weakness pattern, clinicians may consider the presence of CNS lesions, which is contrary to clinical teaching.
This research by Matthew Szmidel in collaboration with Prof Thanh Phan and Prof Henry Ma may impact patients presenting with undiagnosed brain and spinal cord lesions. It highlights an aspect of medicine that is contrary to what is written in current day neurology textbooks.
Speaking of his research, Matthew said, "Our research could promote earlier identification of brain and spinal cord lesions by prompting clinicians to consider additional muscle weakness patterns. Potentially leading to timelier medical interventions and better outcomes for patients."
Mathew presented his research at the Australian and New Zealand Association of Neurologists (ANZAN) conference in Adelaide in May 2024.
Reference:
Use of the phrase ‘pyramidal weakness’ within the past 100 years. Matthew Szmidel, Henry Ma and Thanh Phan BMJ Neurology Open Volume 6, Issue 1
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