Reflexes, Palsies Flashcards
Absent Ankle Jerk with extensor plantar response
- Subacute combined degeneration of spinal cord
- Friedrich Ataxia
- Motor neuron disease
- Taboparesis
- Cauda Equina syndrome
- Multiple sclerosis
- Peripheral neuropathy with cervical myelopathy
- Peripheral neuropathy in stroke patients
1- Can occur due to vitamin B12 deficiency
5- Lesion in conus medullaris of spinal cord
Hypotonia with hyporeflexia
(Features of lower motor neuron lesion)
- Guillaine Barre syndrome
- Poliomyelitis
- Transverse myelitis (early stages)
During early stage of acute transverse myelitis, patient is in spinal shock, so lower motor neuron feaures are found. After recovering from spinal shock, upper motor neuron lesion features are found.
Root value
Knee Jerk
L3,L4
Root value
Ankle Jerk
S1
Root value
Biceps Jerk
C5
Root value
Triceps jerk
C7
Root value
Finger Jerk
C8
Clinical features
3rd nerve palsy
(Isolated/supranuclear lesion)
- Complete ptosis
- Extraocular muscle palsy (eye down and out)
- Divergent squint (abduction of eyeball)
- Mydriasis (dilation of pupil)
Depending upon site of lesion, other cranial nerve palsies (like 4,5,6) or contralateral upper motor neuron signs can be seen.
Severe headache+3rd nerve palsy
- Cavernous sinus thrombosis
- Lacrimal abscess
- Intracranial haemorrhage
Cranial nerve involved
Gag reflex
- Glossopharyngeal nerve (IX)
- Vagus nerve (X)
features seen in
Upper motor neuron lesion
Inspection
Tone
Pattern of weakness
Deep tendon reflexes
Planter response
Inspection: Normal (wasting maybe seen in chronic lesions)
Tone: Increased with clonus
Pattern of weakness: Preferentially affects extensors in arms, Flexors in leg, hemiparesis, paraparesis or tetraparesis
Deep tendon reflexes: Increased
Planter response: Extensor (Babinski sign)
Gait: Pyramidal gait
Lesion likely from Brain/spinal cord
features seen in
Lower motor neuron lesion
Inspection
Tone
Pattern of weakness
Deep tendon reflexes
planter response
Inspection: Wasting , fasiculation
Tone: Normal or decreased, no clonus
Pattern of weakness: Typically focal, in the distribution of nerve root or peripheral nerve, with associated sensory changes
Deep tendon reflexes: diminished or absent
Planter response: flexor
Lesion likely from: Peripheral nervous system
Pseudobulbar palsy
UMNL
Vascular: Bilateral hemisphere (lacunar) infarction
Degenerative: Motor neuron disease
Inflammatory/infective: Multiple sclerosis, cerebral vasculitis
Neoplastic: High brainstem tumors (parsaggital meningioma)
Jaw jerk present, emotional disability, dysphagia
Hot potato sppech (sounds like pt is talking with theirmouth full)
spasm in tongue occurs
Bulbar palsy
LMNL
Genetic: Kennedy’s disease (X linked bulbospinal neuronopathy)
Vascular: Medullary infarction
Degenerative: Motor neuron disease, syringobulbia
Inflammatory/infective: Guillian Barre syndrome, Myasthenia, Poliomyelitis, Lyme disease, vasculitis
neoplastic: Brainstem glioma, malignant meningitis
Nasal tone while speaking. Wasting, fasiculation of tongue
