Upper motor neuron signs

Question 1

Leg position in UMN lesion

Answer 1

Extended, internally rotated with foot plantar-flexed

Question 2

Arm position in UMN lesion

Answer 2

Flexed, internally rotated, supinated

Question 3

Gait in UMN lesion

Answer 3

If unilateral: circumducting gait

If bilateral: scissoring gait (due to adductor muscle tightness)

Question 4

UMN signs

Answer 4

Increased tone
Pyramidal distribution of weakness (leg: extensors stronger than flexors, arm: flexors stronger than extensors)
Hyper-reflexia
Extensor plantars

Question 5

Examining sensation in UMN lesion

Answer 5

Examine for sensory level: suggests cord lesion

Question 6

Completing exam of UMN lesion

Answer 6

CN exam

Cerebellar exam

Question 7

Causes of bilateral lower limb UMN lesion (spastic paraparesis)

Answer 7

Common:
Cerebral palsy
MS 
Cord compression
Cord trauma
Others:
Familial spastic paraparesis
Vascular: e.g. aortic dissection (Beck's syndrome)
Tumour e.g. ependymoma
Syringomyelia

Question 8

Causes of mixed UMN and LMN presentations

Answer 8

MAST
MND
Ataxia (Friedrich's)
Subacute combined degeneration of the spinal cord (SCDC, due to chronic low B12)
Tabo-paresis (syphilis)

Question 9

Causes of unilateral lower limb UMN lesion

Answer 9

Stroke
MS
SOL
Cerebral palsy

Question 10

Specific history for apparent UMN lesion

Answer 10

MS: tingling, eye problems, ataxia, other weakness
Cord compression: back pain, fever, weight loss
Trauma
FHx

Question 11

Investigations in UMN lesion

Answer 11

MRI: cord and brain
Further Ix:
MS - Lumbar puncture (oligoclonal bands), antibodies (MBP, NMO), evoked potentials
Cord compression - FBC (infection), CXR (malignancy), DRE (anal tone)
SCDC - B12 level, pernicious anaemia antibodies (IF/parietal cell)

Question 12

Management of upper motor neurone lesion

Answer 12

Supportive:
MDT
Orthoses
Mobility aids
Urinary - ICSC (intermittent clean self catheterisation)
Contractures - baclofen, botulinum injection, physio