The most common clinical cause of a positive pyramidal tract sign is damage to the corticospinal tract. The corticospinal tract is a conduction tract that emanates from the cerebral hemisphere and travels through the brainstem to the spinal cord. Therefore, when the corticospinal tract is involved in a hemispheric lesion, or a brainstem lesion or a spinal cord lesion, it can lead to a positive cone tract sign. Common clinical conditions include infarcts in the cerebral hemispheres, infarcts in the brainstem, and lesions in the spinal cord. A positive pyramidal tract sign, which can also be called a positive pathological sign, needs to be combined with clinical symptoms and imaging to determine which disease the patient is suffering from.