sensory impairment W4 Flashcards
testing sensory function - touch?
patients eyes shut, touch lightly with finger
testing sensory function - pain?
using testing pin
demonstrate on sternum as reference
test regions with patients eyes shut
sharp or dull? (blunt side and sharp side)
testing sensory function - vibration
tuning fork over bony eminence
test distal extremities, work proximally
testing sensory function - proprioception?
hold great toe on sides (not pad - they will feel pressure)
patient closes eyes
‘say up when you feel me move it up, down when you feel me move it down’
vary order at random
work proximally if absent
S1 root lesion sensory and reflex loss? muscle weakness?
sensory loss down lateral side of lower limb
reflex loss in ankle
muscle weakness in plantar flexion
L5 root lesion sensory and reflex loss? muscle weakness?
sensory loss lateral/anterior leg and surface of foot
no reflex loss
muscle weakness in ankle dorsiflexion and inversion
L4 root lesion sensory and reflex loss? muscle weakness?
sensory loss down anterior to medial side of lower limb
loss of knee reflex
muscle weakness on knee extension
full thickness cord lesion?
weakness, loss of all sensory modalities, sphincter disturbance
anterior spinal artery infarction?
single artery supplies anterior and lateral cord
infarction leads to:
bilateral weakness
loss of pain/temp below level of infarct
dorsal columns spared so touch proprioception, and vibration are fine
sphincter disturbance
dorsal column disease?
pathology affecting back of spinal cord
loss of touch, proprioception, vibration
positive Romberg’s test, sensory ataxia, falls, balance worse in dark
causes of unilateral dorsal column disease
MS (unilateral)
brainstem lesion classic findings
crossed sensory loss:
ipsilateral facial numbness
contralateral limb and body numbness
brainstem lesions additional features?
gaze palsy?
pyramidal weakness?
impaired swallow?
cortical sensory deficit?
may lose all modalities in a given region
may see additional cortical signs (visual/sensory inattention)
higher cortical sensations:
-two point discrimination
-stereognosis (tractile recognition)
-graphesthesia
graphesthesia?
the ability to recognise symbols when traced on the skin