A massive bundle of fibres originating from pyramidal cells of various sizes in the fifth layer of the precentral motor (area 4), the premotor area (area 6), and to a lesser extent from the postcentral gyrus. Cells of origin in area 4 include the gigantopyramidal cells of Betz. Fibres from these cortical regions descend through the internal capsule, the middle third of the crus cerebri, and the ventral part of the pons to emerge on the ventral surface of the medulla oblongata as the pyramis. Continuing caudally, most of the fibres cross to the opposite side in the pyramidal decussation and descend in the dorsal half of the lateral funiculus of the spinal cord as the lateral pyramidal tract, which distributes its fibres throughout the length of the spinal cord to interneurons of the zona intermedia of the spinal gray matter. In the (extremity-related) spinal cord enlargements, fibres also pass directly to motoneuronal groups that innervate distal extremity muscles subserving particular hand-and-finger or foot-and-toe movements. The uncrossed fibres form a small bundle, the anterior pyramidal tract, which descends in the anterior funiculus of the spinal cord and terminates in synaptic contact with interneurons in the medial half of the anterior horn on both sides of the spinal cord. Interruption of the pyramidal tract at or below its cortical origin causes impairment of movement in the opposite body-half, especially severe in the arm and leg; characterised by muscular weakness, spasticity and hyperreflexia (i.e. clinically; upper motor neurone signs), and a loss of discrete finger and hand movements. Babinskis sign is associated with this condition of hemiplegia.