Can you explain a major difference between the twos to the level of USMLE? Thanks. Here is how I understand. Please let me know if they are correct. Pyramidal tracts = descending corticospinal tract (you have two - Lateral and Anterior - lateral for limbs and anterior for truncal) Pyramidal signs = seen with UMN lesions. I am confused about extrapyramidal signs/ tracts though. I saw somewhere that it means LMN signs, then in other place, it says it's of basal ganglia disorders. Thanks again.