Pyramidal insufficiency of ICD 10. The pyramidal system, symptoms that arise from its insufficiency and methods of studying this pathology. Symptoms and manifestations of pyramidal insufficiency

When determining the severity of paresis, difficulties often arise in assessing mild motor disorders (pyramidal insufficiency, less commonly mild paresis), in which the range of active and passive movements, muscle strength and tone are practically no different from the norm. In these cases, tests should be used to identify symptoms indicating the presence of pyramidal insufficiency (the most commonly used in clinical and [ ! ] medical and social expert practice).

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1 . Barre upper symptom. Method of induction: to identify it, the patient, who is in a vertical position, is asked to stretch out his arms, turn his palms down - the paretic limb lowers faster. In a modified test, the patient extends his arms forward, palms turned inward - on the affected side the hand pronates, the arm gradually lowers.

2 . Venderovich's symptom is characterized by a weakening of the strength of the adductor muscles of the IV - V fingers. With significant severity of the symptom, the fifth finger is constantly abducted. Invocation technique: the patient brings his fingers and presses them together. The doctor compresses the first interflank joints of the patient’s fourth and fifth fingers and then stretches them. Normally, this can be accomplished with a certain amount of effort. Slight abduction of the V or V and IV fingers indicates Venderovich's symptom, which is noted when the pyramidal tract is affected.

3 . Rusetsky's symptom (test) is characterized by incomplete extension of the hand with minor paresis in the limb. Summoning technique: the subject sits with his upper limbs extended in front of him, located at the same level, and, on command, extends his hands. On the side of pyramidal insufficiency, the angle between the forearm and hand will be greater than on the healthy limb.

4 . Gierlich's symptom. Invocation technique: in a vertical position, the arms are pressed to the body, bent at the elbow joints, supinated. There is limited supination on the affected side.

5 . Hand pronation test. Invocation technique: in a vertical position, the arms are extended forward, palms turned upward. On the side of the pyramidal insufficiency, pronation, slight flexion at the elbow joint, and descent are noted (the hand approaches the body not with the palmar surface, but with the back).

6 . Buddha phenomenon (or Panchenko's technique). Methodology: the patient raises his arms above his head, with his palms turned upward and the tips of his fingers coming together, [ ! ] but do not touch each other, and keeps his hands in that position. On the pyramidal insufficiency side, the arm soon pronates and also gradually descends.

In addition to the above tests, the following motor phenomena are noted:

Babinsky's pronation phenomenon - with passive supination of both lowered hands, the paretic one assumes a pronation position as soon as the examiner removes his hand; when the forearm is flexed, the pronation tendency increases and the affected arm approaches the shoulder with the back of the hand; with passive flexion of the forearm on the sore side, it is possible to obtain a sharper angle than on the healthy side; the patient's lowering of the passively bent forearm on the affected side occurs more slowly and jerkily; with passive extension of the fingers, the sore finger bends, while normally it extends; when walking, the synergistic pendulum-shaped swing of the arm on the affected side is weakened.

To diagnose pyramidal insufficiency in bottom limbs the following tests are used:

1 . Barre (pyramidal insufficiency, Mingazzini-Barre) lower symptom. Method of induction: to identify it, the patient lying on his stomach is asked to bend the lower limbs at the knee joints at a right angle and hold them in this position. The affected limb soon drops or begins to jerk. Mingazzini recommends the following technique: the patient lies on his back, the limbs are bent at the knee and hip joints at right angles and do not touch each other, the eyes are closed. In order to detect a milder degree of paresis, you can increase the static load by changing the angles in the hip and knee joints, or use a dynamic load, asking the patient to alternately bend and straighten the limbs at the knee joints. The paretic limb will lag behind the healthy one when moving up and will fall faster when moving down.

2 . Rusetsky-Andreeva test. Induction technique: the patient lies on his back, legs are bent at the hip joints at an angle of 90°, at the knee joints at an angle of 135°. There is a faster descent of the paretic leg.

3 . Leg swing test. Identification technique: the patient sits on the edge of the table, dangling his legs freely; they are raised to the level of the table and suddenly lowered - the healthy leg swings in a strictly longitudinal direction, the paretic limb describes the movement along an ellipse.

ADDITIONAL INFORMATION

book “Neurological symptoms, syndromes, symptom complexes and diseases” by E.I. Gusev, G.S. Burd, A.S. Nikiforov, 1999

Pyramidal insufficiency is a syndrome. In other words, a set of certain

symptoms. They are generated by disturbances in the pyramids, the anatomical sections of the medulla oblongata responsible for voluntary muscle contractions. It is through them that the signal passes from the cerebral cortex to the desired part of the spinal cord. Therefore, this section of the NS is called the pyramidal tract. Damaging factors such as tumors, inflammation, trauma, some infections and hemorrhages can disrupt impulse transmission along some part of this path and lead to movement disorders. Theoretically, a competent neurologist is able to determine exactly where the problem arose and prescribe adequate treatment. Almost more and more often, after an examination or computer study, based on implicit signs, or even complaints from the mother, the doctor diagnoses the baby with “pyramidal insufficiency” and recommends, at best, observation, and at worst, a standard set of medications “for everything” (“ Diakarb", "Eufillin", "Actovegin", etc.)

Is it dangerous?

Despite the fact that there is no diagnosis of pyramidal insufficiency, the syndrome itself can suggest serious damage to the nervous system. In particular, this may be paralysis or paresis (incomplete immobility). If the patency of central motor neurons is impaired, muscle spasticity or increased tone is observed (in the arms - flexor muscles, in the legs - extensors), hyperreflexia, and synkinesis. With incomplete damage to the pathway, for example, right-sided pyramidal insufficiency may occur, its manifestations: visual disturbances, nystagmus, decreased intelligence. However, not all children in whose medical records such an entry appears have noticeable deviations. In addition, for some of them everything returns to normal over time. Why? The fact is that in infants there are frequent cases of delayed myelination of nerve fibers. That is, the growth of neurons with a special membrane that improves conductivity occurs at a low rate due to hypoxia suffered by the child or diseases of the cardiopulmonary sphere. But at the same time, the diagnosis of “pyramidal insufficiency” may hide serious problems leading to persistent paresis and paralysis. It is especially dangerous if the lesion is visualized on ECHO diagnostics of the brain or computed tomography. The prognosis in this case is very serious.

Pyramidal insufficiency: treatment

Since the main manifestation of PN is hypertonicity of certain muscle groups, treatment is aimed at relieving it. A small child carries out his cognitive development through movements; if they are limited, then the whole process begins to proceed with a delay. The neurologist should prescribe drug treatment specifically for a specific disease, for example, obstetric paresis of the arm or neuritis of the facial nerve, as well as massage and physiotherapy. An integrated approach will help save your baby from these problems. As a rule, the diagnosis is removed by one year.

Pyramid insufficiency is one of the most controversial abnormalities. The disease in question occurs due to underdevelopment of areas of the brain that control the functioning of certain muscle groups. The patient may experience insufficiency in relation to certain muscle groups, for example, arms or legs, or several groups at the same time.

Next, you are invited to familiarize yourself with key information about pyramidal insufficiency in children under 1 year of age. You will learn how the disease manifests itself, what complications it can lead to, and whether there are methods to combat the pathology in question.

Determining the presence of pyramidal insufficiency in a child is quite simple. The disease manifests itself with the following symptoms:

The doctor can also make this diagnosis if the baby stands on tiptoes or curls his toes while walking.

In babies under 2-3 months of age, pyramidal insufficiency usually does not lead to any complications, because Representatives of this category have natural muscle hypertonicity. As the child develops, when he learns to take a vertical position, pyramidal insufficiency causes a lot of inconvenience, because the child, first of all, cannot fully stand.

In the process of diagnosing the disease, the doctor makes sure of the presence or absence of high tendon reflexes, delayed reduction of other reflexes and other associated pathologies.

To independently determine pyramidal insufficiency in an infant, you can do the following:

Often, pathologies affect the condition of the rectus femoris muscles: they either bend too much at the hip joints when bringing the legs to the stomach, or, when the child is in a supine position, they are difficult to straighten.

Many doctors do not regard the deviation in question as a disease. The presence of the word “deficit” in the diagnosis indicates that certain parts of the child’s brain are slightly behind in development.

In the human cerebral cortex there is a region that controls voluntary muscle contractions, i.e. intentionally committed by the “master”. And when a person tries to make any movement, a signal from the brain cells begins to flow through the processes of his nervous system to the corresponding part of the spinal cord. It is the part of the nervous system that occupies the path from cells in the cerebral cortex to the “destination” in the spinal cord that is called the pyramidal tract. In this case, the pyramids themselves refer to the parts of the medulla oblongata through which the nerve impulse moves.

Children with this disease often walk on their toes, which causes an incorrect distribution of the center of gravity. The human spine is subject to uneven pressure. The muscles, as well as the joints of the knees and hips, are in constant tension. As a result, if the situation drags on for several years, the child may develop problems with the back, legs, or even joints.

Often, pyramidal insufficiency leads to such a complication as spinal osteochondrosis, which manifests itself as curvature of posture, more severe pain in the back, and sometimes herniated intervertebral discs. Patients often experience headaches and discomfort in the neck area.

In most cases, doctors, having examined a child with manifestations of pyramidal insufficiency, claim that no pathologies were found during X-ray examinations, MRI, ultrasound and other diagnostic measures, the baby is completely healthy and there is nothing to worry about. Treatment prescribed by such specialists is usually limited to massage sessions, vitamin complexes and sedatives, which in most cases do not give any significant result.

It is important to understand that any developmental delays, especially if they affect the brain, do not just arise and definitely do not go away without leaving a trace. If there is a late response to adverse symptoms and lack of necessary treatment, the consequences can be much more serious.

In general, pyramidal insufficiency belongs to the category of functional diseases, therefore, the possibility of eliminating its external manifestations is present. The disadvantage of the previously mentioned general massage is the fact that during such procedures the problematic muscles are not fixed, and without this it is impossible to achieve positive results.

A special emendic massage shows a good effect in the treatment of pyramidal insufficiency, during which children's muscles naturally get rid of swelling. As a result of the procedure, an accelerated release of body cells from harmful metabolic products is noted, the function of nerve cells and the brain is normalized, failures in their interaction are eliminated, which allows the patient’s body to fully develop and rapidly catch up.

After a course of massage, little patients become more active and cheerful, and some of them even outperform their peers in development. Regular preventive sessions prevent the occurrence of curvatures and other problems with the spine, the appearance of pain in the neck and back, and the formation of hernias.

For greater effectiveness of therapeutic massage, many experts recommend starting it with the use of paraffin therapy methods. During this preparatory procedure, the patient's skin is covered with paraffin melted to a liquid state. Don’t worry, it’s absolutely safe for the child – there won’t be any burns due to the special physical properties of the substance. Under the influence of molten paraffin, among other things, there is an improvement in blood flow and joint function, which makes massage procedures much more effective and beneficial.

In general, the treatment option, as well as the need for any additional measures in general, is determined by a specialist individually after assessing the condition of a particular patient.

React in a timely manner to unfavorable changes in your child’s condition, follow the recommendations of specialists and be healthy!

Video - Pyramidal insufficiency in children under 1 year of age

Pyramidal (pyramidal) insufficiency is a collection of symptoms associated with disorders of the nervous system. Basically, pyramidal insufficiency syndrome occurs in children under one year old and adults who have suffered from diseases of the cardiovascular system or have cancer.

Despite the fact that this disease is not on the international list of diagnoses, medical workers still make this diagnosis, also known as a ballerina symptom, walking on tiptoes, equinus, or paresis.

Why pyramidal?

The medulla oblongata is one of five sections of the brain. It connects the brain to the spinal cord and is responsible for performing simple and complex reflexes.

The medulla oblongata consists of a large number of anatomical cells - pyramids, hence the name - pyramidal. And if at least one part of the pyramidal cells fails, then a violation of coordination of movements will appear.

Development of the disorder

Features of the development of pyramidal insufficiency depend on the changes and level of damage to the nervous system (NS).

As for (paresis) or peripheral, it is formed when a neuron and its process in the spinal cord are damaged. Muscle tone decreases, until the muscle completely immobilizes. Reflexes decline or disappear completely, after which hypotrophy of the innervated area occurs.

Clinical paralysis (paresis) in the lower extremities - tremor and tension appear in the legs, tone increases, gait becomes different. The leg is unbent with difficulty, the foot is placed on the toe, and the impression of steppage (“rooster gait”) is created.

Clinical paralysis (paresis) of the upper limbs - in order to lift something, enormous effort is required due to increased muscle tone. Malnutrition or atrophy begins to develop.

Causes of the disease in adults:

• inflammation in the brain (,);
• changes in hemodynamics in the brain (,);
• , which cause disturbances in the transmission of nerve impulses;
• benign and oncological tumors.

Causes of the disease in children:

• hypoxia;
• infectious diseases;
• inflammatory processes;
• birth injuries;
• intrauterine developmental anomalies.

Are there neurological problems in children?

When diagnosed with pyramidal insufficiency, the following neurological problems may well occur:

• various injuries that occur during childbirth;
• congenital diseases of the nervous system (spinal dysraphism, etc.);
• diseases caused by the penetration of pathogenic microorganisms and viruses into the body;
• tumors;
• purulent inflammation in the spinal cord or brain;
• disturbances in the production and outflow of cerebrospinal fluid (cerebrospinal fluid);

Each of the above pathologies has its own characteristic symptoms and methods of treatment.

Features of the clinical picture

Symptoms of pyramidal insufficiency in children:

• arms, legs and chin tremble;
• throwing the head back;
• has difficulty holding objects
• in the “standing” position, curl your toes
• walk on their toes;
• operate their fingers ineptly;
• gait, coordination and eye movement are impaired;
• low intelligence.

Symptoms of pyramidal insufficiency syndrome in adults:

In children under 2-3 months of age, pyramidal insufficiency does not cause concern, since they have a natural But if the disease is diagnosed in older children, then it already causes serious concern, because it entails movement disorder syndrome (MDS). In such children, not only attitudinal reflexes, but also motor skills develop and form late.

Dr. Komarovsky explains what pyramidal insufficiency is:

Establishing diagnosis

Methods for diagnosing pyramidal insufficiency:

• (if there are cramps/spasms or the doctor suspects it);
• (used as an additional research method);
• (the neuromuscular system is checked by recording muscle potentials);
• (helps detect tumor processes);
• (reveals hidden convulsions that occur during sleep).

In addition to the above methods, tests will be required to confirm the syndrome.

How are children with this diagnosis treated?

Basically, for children diagnosed with pyramidal insufficiency, the doctor prescribes different procedures. You may also need orthopedic means, with the help of which parts of the body are given a physiological position, and balneotherapy (health baths).

To reduce muscle tone and strengthen muscles, doctors recommend acupressure and relaxation massage, a course of which is taken every 6 months.

Every day, parents should do special health-improving and preventive exercises with their child.

If necessary, doctors can prescribe vitamins, vasoactive agents (for microcirculation) and drugs that improve the process of metabolic breakdown.

Surgeries are resorted to only when the doctor has diagnosed:

• brain or spinal cord injuries/tumors;
• acute cerebrovascular accidents that cannot be cured by chemical, physical and biological methods (for example, thrombosis or intracerebral hematoma).

Is it dangerous?

The diagnosis of “pyramidal insufficiency” in any person suggests serious damage to the nervous system. After all, this can lead to complete or partial immobility.

When the patency of the pyramidal tract is impaired, the following is observed in the body:

• state of increased muscle tone;
• hypertonicity of the flexor muscles in the upper extremities, and in the lower extensors;
• hyperreflexia(segmental reflexes are increased as a result of weakening of the inhibitory influence processes of the cerebral cortex on the segmental reflex apparatus);
• (involuntary movement of an arm or leg parallel to the voluntary movement of the other arm or leg).

With incomplete damage to pyramidal cells, for example, right-sided pyramidal insufficiency may occur, which manifests itself:

• visual impairment;
• involuntary oscillatory movements of one or both eyes, mainly in one direction ();
• decrease in mental abilities.

As for children, not everyone who is diagnosed with this condition has noticeable deviations. Moreover, for most of them, after a while everything goes away by itself.

The thing is that in newborns there are often cases of a slow process of deposition of myelin (a special sheath that improves conductivity) of the nerve fiber. The reason is oxygen starvation during childbirth and cardiopulmonary failure. But still, we should not forget that the diagnosis of “pyramidal insufficiency” hides quite serious problems that cause complete or partial immobilization.

Excellent prevention for the body as a whole is swimming, gymnastics, massage and exercises for coordination of movements.

Pyramidal insufficiency most often occurs in infants under one year of age. However, this disease can also occur in adults who have had heart and vascular disease or have cancer. Treatment for pyramidal insufficiency will be aimed at eliminating the underlying cause.

How does it arise?

Pyramidal insufficiency is a syndrome, not a specific disease, although many doctors tend to perceive it as a disease and make a diagnosis. Pyramidal insufficiency is not included in the worldwide list of diagnoses. In medicine they tend to refer to it as central paralysis or paresis. The pathology consists of a disorder localized in the pyramidal cells of the fifth layer of the cerebral cortex.

Pyramidal cells (Bertz cells, named after their discoverer) have fibers that transmit impulses to different parts of the body. If cell damage occurs, a condition close to paralysis or paresis occurs, and the reflex activity of the body is disrupted.

In children, pyramidal insufficiency develops due to hypoxia, birth injuries or intrauterine developmental anomalies. In adults, the causes of the development of the disease differ:

• inflammation in the brain (meningitis, encephalitis and other infections);
• changes in blood circulation in the brain (stroke);
• skull injuries that provoke disturbances in the transmission of nerve impulses;
• benign and oncological tumors.

In adults, pyramidal insufficiency is an acquired disease that requires treatment of the underlying cause along with symptom management.

How to recognize?

Pyramidal insufficiency in adults can be detected based on modern diagnostic equipment and examination by a neurologist. In order for the doctor to obtain a complete picture of the disease, the patient must undergo:

• magnetic resonance imaging (prescribed if there are seizures or suspected epilepsy);
• computed tomography of the brain;
• electroencephalography - allows you to identify hidden convulsions, which often occur during sleep and do not allow diagnosing the disease when examining the patient;
• electromyography – examines the electrical muscle potential;
• Ultrasound of the brain - allows you to identify tumor processes.

Outwardly noticeable symptoms, as well as conditions that are easily diagnosed upon examination by a doctor, will help indicate pyramidal insufficiency in adults:

• hypertonicity of the muscles of the limbs;
• hypertension;
• partial or complete paralysis of individual parts of the body;
• convulsions;
• decreased reflex activity;
• sometimes - obesity, sexual dysfunction, if the hylothalamic-pituitary system is affected.

It is impossible to talk about pyramidal insufficiency solely on the basis of a medical examination. All tests are required. Then the information obtained will enable the doctor to talk about a specific disease.

Treatment

In adults, therapy for pyramidal insufficiency resembles that for children. But in children, the causes of the disease are hidden. In adults, they are easier to diagnose, since the syndrome is often a consequence of a stroke, injury or infectious disease of the brain.

Primary therapy is aimed at eliminating the cause. Infectious diseases can be treated with medications (antiviral medications, antibiotics); in parallel, the doctor prescribes symptomatic therapy.

For skull injuries or tumors in adults, surgical intervention is not necessary. In case of injury, the integrity of the skull is restored, damage that negatively affects the vital functions of the body is eliminated. After the patient recovers, the symptoms of pyramidal insufficiency in adults begin to be eliminated.

Therapy for the disease in adults involves a regimen of increased physical activity. Physical therapy classes, long walks, swimming, and sports are recommended in the absence of contraindications. If you perform individual exercises, it is important to do them while exhaling. This measure contributes to the correct distribution of muscle load. Walking should be done at a moderate pace, without overexertion. As soon as a clinic client feels tired and overworked, classes should be stopped.

Relaxing massage and physiotherapy give results. If necessary, the patient is prescribed to walk in orthopedic shoes. Warm baths, paraffin therapy (heat paraffin to a liquid state and apply to the affected limbs), electrophoresis are recommended.

With properly selected treatment, pyramidal insufficiency in adults recedes and rarely manifests itself in the form of paralysis. For therapy to be successful, you must choose the right clinic and qualified doctor. Our specialists will provide assistance and prevent the development of the disease.