Neuro Examination: Limbs and Cerebellar Flashcards
What are the signs of an Upper Motor Neuron (UMN) lesion?
Pyramidal weakness, spasticity, hyperreflexia, clonus, and Babinski’s sign (upgoing plantar response).
What are the signs of a Lower Motor Neuron (LMN) lesion?
Muscle wasting, fasciculations, flaccidity, hyporeflexia, and absent Babinski’s sign (downgoing plantar response).
What does a positive Pronator Drift indicate?
A downward drift with pronation indicates subtle UMN weakness on the contralateral side.
What types of gait abnormalities are seen in motor lesions?
Spastic gait: Seen in UMN lesions, characterized by stiff, dragging feet.
Waddling gait: Seen in proximal muscle weakness (e.g., myopathies).
Steppage gait: High-stepping gait due to foot drop, typically in LMN lesions or peripheral neuropathy.
What does a positive Hoffmann’s Reflex suggest?
Flexion of the thumb and index finger after flicking the distal phalanx of the middle finger suggests an UMN lesion in the cervical cord.
What is Babinski’s sign and what does it indicate?
Extension of the big toe and fanning of other toes when stroking the sole of the foot, indicating an UMN lesion.
What is Clasp-Knife Rigidity and what causes it?
Initial resistance followed by a sudden release during movement, indicative of spasticity and an UMN lesion.
What is Dysdiadochokinesis and how is it tested?
It is the inability to perform rapid alternating movements, tested by asking the patient to rapidly flip their hands back and forth on their thighs. It indicates cerebellar dysfunction.
What is tested with the Heel-Shin Test, and what would an abnormal result indicate?
The patient runs their heel down their shin; difficulty performing the task suggests cerebellar ataxia.
What does a positive Romberg’s test indicate?
Significant swaying or loss of balance with eyes closed suggests a proprioceptive or vestibular deficit (not a cerebellar sign).
Impaired proprioception is due to dysfunction in the dorsal column.
What are the features of a cerebellar gait?
A broad-based gait with instability, where the patient may sway or have difficulty with tandem gait (heel-to-toe walking).
What is Nystagmus, and what does it suggest?
Involuntary rhythmic oscillation of the eyes. When associated with other cerebellar signs, it suggests cerebellar pathology.
What does Dysmetric Saccades indicate?
Inaccurate, jumping eye movements requiring corrective adjustments, indicative of cerebellar dysfunction.
How do you test for Finger-Nose Dysmetria, and what does an abnormal result indicate?
Ask the patient to touch their nose and then your finger repeatedly. Overshooting or difficulty hitting the target indicates dysmetria, a sign of cerebellar ataxia.
What is tested with the Heel-to-Toe Walking (Tandem Gait) Test?
It tests balance and coordination. Instability during tandem walking suggests cerebellar ataxia.
