Lower Limb Neuro Exam Flashcards
What are some upper motor neurone signs?
- Hypertonicity (spasticity)
- “Pyramidal” pattern of weakness
- Hyper-reflexia
- Ankle clonus
- Babinski positive
Potentially:
- Disuse atrophy
What are some lower motor neurone signs?
- Muscle wasting
- Fasciculations
- Hypotonia
- Varying patterns of weakness
- Hyporeflexia or areflexia
- Normal or absent planter reflex
What around the bed may suggest neurological problems?
- Wheelchair
- Walking aids
- Catheter
What menmonic can help with a neuro visual inspection?
A SWIFT
What does the mnemonic A SWIFT mean?
A - Asymmetry
S - Scars
W - Wasting
I - Involuntary movements
F - Fasciculations
T - Tremor
What are some involuntary movements to look for in neuro inspection?
- Dystonia
- Chorea
- Myoclonus
- Athetosis
- (Fasciculations)
- (Tremor)
What is an important distinction to make about tremors?
Resting vs Kinetic
Involuntary sustained or intermittent muscle contractions cause twisting and repetitive movements, abnormal postures, or both
Dystonia
Random-appearing sequence of one or more discrete involuntary movements
Chorea
Slow, continuous, involuntary writhing movements often affecting the extremities
Athetosis
Repeated, often non-rhythmic, brief shock-like jerks due to sudden involuntary contraction or relaxation of one or more muscles
Myoclonus
Rhythmic back-and-forth or oscillating involuntary movement about a joint axis
Tremor
Give 2 causes of dystonia
- Parkinson’s Disease
- Dyskinetic Cerebral Palsy
Give 2 causes of chorea
- Dyskinetic Cerebral Palsy
- Huntington’s Disease
Give 2 causes of athetosis
- Dyskinetic Cerebral Palsy
- Huntington’s Disease
Give a cause of myoclonus
Myoclonic epilepsy
What is a common cause of resting tremor?
Parkinson’s Disease
What is a common cause of a kinetic tremor?
Benign essential tremor
When inspecting a patient in a neuro exam, what clues may be seen in the face?
- Hypomimia
- Ptosis
- Ophtalmoplegia
What is hypomimia?
Lack of facial expression
What is a common cause of hypomimia?
Parkinson’s Disease
What systemic neurological condition can cause ptosis and ophthalmoplegia?
Myasthenia gravis
What is shown here?
![](https://s3.amazonaws.com/brainscape-prod/system/cm/337/426/655/q_image_thumb.jpg?1567075534)
Muscle wasting
What function should be tested first in a lower limb neuro exam?
Gait
How is gait assessed?
- Back and forth walking
- Heel-to-toe walking
What are some abnormal types of gate?
- Ataxic
- Parkinsonian
- High-stepping
- Waddling
- Hemiparetic
- Spastic paraperesis
What are the features of an ataxic gait?
- Broad based
- Unsteady
- Unable to heel-toe walk
What are the potential causes of an ataxic gait?
- Cerebellar lesion
- Sensory ataxia (proprioceptive loss)
What can differentiate a sensory ataxic gait from a cerebellar gait?
In a sensory ataxic gait they may stare intensely at their feet to make up for loss of proprioception
What are the features of a parkinsonian gait?
- Shuffling steps
- Stooped posture
- Reduced arm swing
- Several steps to turn
What is a high stepping gait?
Lifts one (or both) feet high to compensate for foot drop
What causes foot drop?
Weakness of ankle dorsiflexion
What is the most common cause of weak ankle dorsiflexion?
Peroneal nerve injury
What are the features of a high-stepping gait?
- Shoulders sway side-to-side
- Legs lifted off by tilting the trunk
What causes a waddling gait?
Weakness of the pelvic girdle muscles
What are the features of a hemiparetic (and spastic paraparetic) gait?
- Stiff legs
- Circumduction
- -
- (Bilateral and scissoring of feet)
What is circumduction of the legs when walking?
Swinging them in an arc with each stride
What is scissoring of the feet?
Inverted feet
What sort of lesion causes a hemiparetic or paraparetic gait?
UMN lesion
What is a common cause of hemiparetic or paraparetic gait?
Cerebral palsy
What disorders can cause problems with heel-toe walking?
- Proprioception impairment
- Cerebellar disorder
What test shoudl be performed after gait?
Romberg’s Test
How is Romberg’s test performed?
- Ask the patient to stand with feet together and eyes closed
- Place arms front and back of patient to reduce sway in a positive test
- Obsever for excessive swaying for 10 ~seconds (1 min is ideal but come on this is an OSCE)
What is a positive Romberg’s test?
Swaying or falling over