Lower limb neuro

Question 1

What is being assessed when testing antero- and retropulsion?

Answer 1

Axial tone is being assessed. If there is an upper motor neuron lesion the axial tone will be increased, causing increased
antero or retro pulsion ( i.e. the patient will not be able to right themselves when pulled in one or other direction).

Question 2

What is a positive Romberg test?

Answer 2

Romberg’s ‘sign’ is said to be positive in patients with sensory ataxia and negative in cerebellar ataxia. In cerebellar
disease, the patient is often unsteady with the eyes open or closed.

Question 3

What might you observe in the gait of a patient with Parkinson’s disease?

Answer 3

Parkinsonian gait is remarkable for stooped forward posture, narrow base, shuffling nature, difficulty initiating
movement, impaired ability to stop and turn, balance problems, and limited arm movement. Other findings can
include masked/inexpressive facies and resting tremor of hand or head.

Question 4

What are some reasons for people to have muscle wasting due to disuse?

Answer 4

Seated jobs, health problems that limit movement, or decreased activity levels
* Bedridden
* Cannot move their limbs because of stroke or other brain disease

Question 5

What do you observe and feel with clonus at the ankle?

Answer 5

Feel for involuntary, rhythmic beats of gastrocnemius contraction (>2 beats = UMN lesion)

Question 6

What nerve roots are used for each of these power tests?

Answer 6

Hips Flexion = L2/L3, Extension = L4/L5
* Knees Flexion = L5/S1, Extension = L3/L4
* Ankles Dorsiflexion = L4/L5, Plantarflexion = S1/S2, Inversion = L4/L5, Eversion = L5/S1
* Big Toe Extension = L5

Question 7

What are some signs of cerebellar damage?

Answer 7

Mnemonic = DANISH
Dysdiadokinesia and Dysmetria (past pointing) - Ataxia - Nystagmus - Intention tremor - Slurred speech - Hypotonia

Question 8

What is a positive plantar reflex (Babinski) and its likely cause?

Answer 8

The normal reflex is toe flexion (toe down). If the toes extend and separate, this is an abnormal finding called a
positive Babinski’s sign and indicates an UMN lesion on the side affected.

Question 9

What are the areas of the lower body that can be tested for each dermatome?

Answer 9

• upper part of the upper leg (L2)
• lower-medial part of the upper leg (L3)
• medial lower leg (L4)
• lateral lower leg (L5)
• sole of foot (S1)

Question 10

What are some causes of peripheral neuropathy?

Answer 10

Mnemonic = STAGLAND
Sarcoid – Thyroid – Amyloid - Guillian-Barré– Lead – Alcohol -Nutritional - Drugs/Diabetes

Question 11

What tract is being tested with vibration sense?

Answer 11

Vibration sensation is mediated by the dorsal column/medial lemniscus system.