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Pyramidal versus inverse pyramidal patterns in functional limb weakness
  1. Jon Stone
  1. Department of Clinical Neurosciences, Center for Clinical Sciences, University of Edinburgh, Edinburgh, UK
  1. Correspondence to Dr Jon Stone, Dept Clinical Neurosciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK; jon.stone{at}

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Charles Mark Wiles makes some excellent points about pyramidal weakness.1 What we observe is largely just the ‘normal’ pattern of asymmetry of strength in the upper and lower limbs, amplified by disease and sometimes spasticity, and can often be found in lower motor neurone syndromes as well as upper.

But there is one clinical scenario where I would argue it remains …

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  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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