Localization Flashcards
26 y/o w/ difficulty walking & L Leg numbness. 2 days ago foot felt “asleep”, developed numbness over left leg, trunk, arm. Next day noticed R leg and arm weak, unsteady on feet.
PEx: RUE weakness, 5/5 neck/shoulder, 3+ reflexes on R, + Babinski on R. Slow RAM w/ R hand. Vibration & Proprioception decreased throughout R, normal on L. Pain and Temperature decreased on L, normal on R.
Where is lesion?
Brown-Sequard. approx C5/C6 on R
Most likely 2/2 demyelinating lesion
NB: bowel/bladder involvement (rectal tone), sensory level can help localize to spinal cord vs. peripheral or brainstem
60 y/o weakness & atrophy of R hand x 8 months. Progressed. Similar weakness & atrophy of proximal R arm, then L arm. No numbness/pain. R leg weak. Difficult to walk up steps. Muscle twitches. Choking, voice change.
PEx: atrophy of tongue, slurred speech. Atrophy of distal arm and hand, fasciculations. Distal weakness > proximal, R>L. Reflexes 3+. R ankle clonus. Where is lesion?
ALS
UMN & LMN signs
ALS DDx
1) GBS/AIDP (wouldn’t see UMN signs)
2) Multifocal cord & brainstem lesions (rare, wouldn’t see LMN signs)
3) B12 deficiency, syphilis (but would have marked sensory findings)
4) CIDP
5) Neurmosuclar junction disorder (no UMN findings)
65 y/o sudden onset chest pain, several minutes later fluent aphasia.
PEx: face symmetric, R superior quadrant anopsia, unable to follow commands, able to imitate, unable to name/repeat, can write (unintelligible). PMH HTN, HLD, CAD, Afib. DDx?
Left MCA stroke
Cortical: Contralateral hemiparesis Face & UE>LE, Distal > proximal. Homonymous hemianopsia, aphasia/neglect
Subcortical: face, arm, leg equally involved (w/ internal capsule). Posterior part w/ sensory involvement
Brainstem: Contralateral hemiparesis (w/ cortical spinal tract up to pons), lower pons w/ ipsilateral facial nerve involvement. below pons only arm & leg weakness. Decussation of pyramids in medulla. Crossed findings and cranial nerve common in brainstem
Aphasia types
53 y/o M w/ HTN & 3 months chronic neck pain, weakness of L tricep & brachioradialis, s/p C5-C7 fusion. Supine position, pad under R buttock, R leg floated & externally rotated.
Post-Op: painless R foot drop, 0/5 dorsiflexion, 2/5 eversion. Sensory loss in anterolateral R leg and dorsum of foot. DDx
Common peroneal nerve neuropraxia
Peripheral nerve lesion (motor, sensory, LMN findings)
Radiculopathy: usually painful, motor involvement through whole root
Plexopathy: similar as above.
Sciatic neuropathy: knee flexion and sensory loss on lateral and bottom of foot
causes of foot drop
25 y/o numbness tingling R hand x2 months, 1st noticed when carrying baby, wakes from sleep. DDx
Carpal tunnel
Tinel & Phalen to dx
EMG & NCS gold standard
