Classic Motor & Sensory Presenting Patterns

Question 1

What is functional localisation?

Answer 1

-Pattern of motor impairment and/or sensory loss should give you the anatomical diagnosis

Question 2

Where can localisation be?

Answer 2

-Peripheral nerve or root
-Spinal cord
-Cranial nerve
-Brain stem
-Brain

Question 3

Pattern for motor peripheral nerve or root

Answer 3

-Focal weakness of a specific part of body
=Weakness one foot/ one part of hand

Question 4

Pattern of motor spinal cord lesion

Answer 4

-Above level of cord lesion: UMN control as normal
-Below: UMN control impaired
-At level: LMN control impaired

-Thoracic lesion: Spasticity, brisk TRs, extensor plantars below lesion= paraplegia (UMN impaired)
-High cervical cord lesion: tetraplegia
-Brainstem lesion: Hemiparesis (e.g. right pons lesion= LMN supply of face, UMN supply of body crossed)

Question 5

Cranial nerve motor lesion

Answer 5

-Affects same side of head/neck with weakness pattern of that nerve

=Left 7th nerve: weakness of left side of face both upper and lower face

Question 6

Hemisphere brain motor lesion

Answer 6

-Facial weakness now UMN facial weakness
-Weakness of whole one side of body (hemiparesis)

Question 7

Sensory system individual nerve and root lesion

Answer 7

-Sensory loss is focal circumscribed area of abnormal sensation
=match to known distribution

Question 8

Polyneuropathy

Answer 8

-Glove and stocking
-Impaired sensation
-May be absent tendon reflexes (sensory arc affected)
=Generalised

Question 9

Sensory system thoracic cord lesion (transverse)

Answer 9

-Below lesion sensation impaired
-impaired sensation
=May also be UMN signs

Question 10

Describe the spinothalamic and dorsal column tracts

Answer 10

-SPINOTHALAMIC (Pain & Temperature) SENSORY DATA
=Enter cord, CROSS SIDES on entry, ascend on other side of cord

-DORSAL COLUMN (Proprioception etc) SENSORY DATA
=Enter cord, ascend on same side and cross only as enter brain stem

Question 11

Sensory system thoracic hemi-cord lesion (RHS)

Answer 11

-Below lesion sensation impaired
=Impaired spinothalamic
=Impaired simple touch proprioception
=UMN signs of right

Question 12

Sensory system brain stem lesion

Answer 12

-May be R LMN 7th
-May be UMN signs in L limbs

Question 13

Sensory system hemisphere brain lesion

Answer 13

-May be UMN signs on right