Patterns of neurological disease

Question 1

Pattern of upper motor neurone weakness

Answer 1

Increased tone, brisk reflexes

Question 2

Two types of increased tone

Answer 2

Spasticity and rigidity

Question 3

Difference between spasticity and rigidity

Answer 3

Spasticity is velocity dependent, rigidity is not velocity dependent

Question 4

Pattern of lower motor neurone weakness

Answer 4

Decreased tone, reduced or absent reflxes, fasciculation

Question 5

Pattern of weakness due to muscle disease

Answer 5

Wasting, usually proximal, decreased tone

Question 6

Pattern of weakness due to NMJ pathology

Answer 6

Fatiguable weakness

Question 7

Two typical patterns of peripheral nerve involvement

Answer 7

Symmetrical, often length dependent polyneuropathy with weakness and sensory deficit;
Mononeuropathy or mononeuritis multiplex

Question 8

What do the following patterns of sensory loss suggest about the underlying pathology?

a) glove and stocking
b) sensory level
c) hemianaesthesia
d) dissociated sensory loss

Answer 8

a) length dependent neuropathy
b) spinal cord lesion
c) contralateral cerebral lesion
d) hemicord damage e.g. Brown-Sequard

Question 9

Describe cerebellar gait

Answer 9

Broad-based and unsteady

Question 10

Signs of cerebellar disease (DANISH)

Answer 10

Dysdiadochokinesis
Ataxia
Nystagmus
Intention tremor/past-pointing
Slurred/staccato speech
Hypotonia

Question 11

What does a positive Romberg’s test imply?

Answer 11

Sensory ataxia rather than cerebellar