Signs and Symptoms linked to conditions

Question 1

What is the most recognizable sign of spastic gait?

TSM1.114

Answer 1

Circumduction of contralateral lower limb.

Extensor hypertonia of lower limbs and flexor hypertonia of upper limbs

Question 2

What is the most recognizable sign of cerebellar ataxic gait?
TSM1.114

Answer 2

Broad-based stance

Question 3

What are the features of sensory ataxia gait?

Answer 3

Positive Romberg’s test and high step, stamping gait

Question 4

Peripheral Neuropathy Sign

Answer 4

Foot drop - loss of dorsiflexion

Question 5

Parkinsonian gait

Answer 5

Universal flexion of all joints with shuffling feet. Dragging of legs as upper body leans forward.

Question 6

Frontal gait disorder signs

Answer 6

small steps, shuffling, Marche a petit

Question 7

What causes foot drop?

i) Unilateral
ii) Bilateral

Answer 7

i) Unilateral foot drop: Injury to peroneal nerve: Supplies the anterior part of the lower leg: Anterior tibialis, Extensor hallucis longus and Extensor digitorum longus
Or Peroneal nerve palsy.
Or L5 rediculopathy
ii) Bilateral foot drop:
Brain: Stroke, Multiple Sclerosis, Cerebral palsy and Charcot-Marie-Tooth disease
Muscle dystrophy, ALS, Polio

Question 8

Cause of broad-based drunken gait?

Answer 8

Cerebellar Ataxia

Question 9

What kind of gait is this: circumduction in leg movement, and hyperextension of lower limbs with hyperflexion of upper limbs?

Answer 9

Spastic gait

Question 10

If there is no pulsations in the veins seen near the optic disk, what could it indicate?

Answer 10

Raised intracranial pressure

Question 11

How do you identify papilloedema?

Answer 11

Blurring of the optic disk margins,
loss of the optic cup,
engorgement of retinal veins,
obscuration of vessels passing through disk margins, flamed shaped haemorrhages in the nerve fiber layer

Question 12

How is the clinical presentation in cerebral abscess different from acute bacterial meningitis?

Answer 12

Fever, epilepsy and focal neurological signs are more commonly seen in cerebral abscess.

Question 13

What does positive Kernig’s sign and Brudzinski sign indicate?

Answer 13

Positive Kernig’s sign and Brudzinski sign indicates meningeal irritation (or subarachnoid haemorrhage)

Question 14

What is indicative of raised intracranial pressure?

Answer 14

Papilloedema
Headache that is worse on waking, lying down, bending forward or coughing.
Vomiting.

Question 15

What are the red flag symptoms of a patient with back pain that could indicate a possible spinal cord or cauda equina compression?

Answer 15

A patient with back pain having new symptoms of bowel or bladder dysfunction such as urinary retention, frequency, hesitancy, constipation and incontinence, could indicate spinal cord or cauda equina compression.

Question 16

What could be inferred if patient c/o worsened back pain with coughing, sneezing and straining?

Answer 16

Coughing, sneezing and straining can worsen back pain associated with nerve root compression (radiculopathy).

Question 17

What does a band-like sensory level around the trunk of a patient indicate?

Answer 17

A band-like sensory level around the trunk is a strong indicator of spinal cord pathology.

Question 18

In cauda equina and conus medullaris lesions, are the legs spastic and hyperreflexic or flaccid and areflexic?

Answer 18

Flaccid and areflexic

Question 19

What are the differential diagnosis in patients who present with weak legs but no sensory loss?

Answer 19

MND, polio, parasagittal meningioma

Question 20

What are the features of conus medullaris lesions?

What are the features of cauda equina lesions?

Answer 20

Conus Medullaris - mixed UMN and LMN leg weakness; early urinary retention and constipation; back pain; sacral sensory disturbance and erectile dysfunction.

Cauda Equina - back pain and radicular pain down the legs; asymmetrical, atrophic, and areflexic paralysis of the legs; decreased sphincter tone (PR test)