Neurological History and Examination

Question 1

What is the most basic localisation question you need to ask yourself about the upper and lower limb during a neurological exam?

Answer 1

● Is there an upper (i.e. brain or spinal cord) or lower (i.e. nerve roots, peripheral nerve, neuromuscular junction or muscle) motor neuron lesion?

Question 2

What is spasticity?

Answer 2

● Spasticity is “velocity-dependent”, meaning the faster you move the limb, the worse it is. There is typically increased tone in the initial part of the movement which then suddenly reduces past a certain point (known as “clasp knife spasticity”). Spasticity is also typically accompanied by weakness.

Question 3

What lesions is spasticity associated with?

Answer 3

● Spasticity is associated with pyramidal tract lesions (e.g. stroke)

Question 4

What is rigidity?

Answer 4

Rigidity is “velocity independent” meaning it feels the same if you move the limb rapidly or slowly. There are two main sub-types of rigidity: