Cases for finals #4 – Examination

  • Speech normal
  • HMF – normal
  • Cranial nerves – normal
  • Limbs
  • ULs – normal
  • LLs – tone increased with clonus; power reduced in left leg as follows – HF 3/5, HE 5/5, KF 3/5, KE 5/5, ADF/APF 5/5; reflexes brisk; plantars extensor bilaterally
  • Sensation – reduced pin, temp in right leg; reduced vibration and JPS in left leg

Alright, so you got me, I sneaked in a textbook case to showcase neuro-nerdery.

First, the signs are all central. I hope you are all happy with that. We have spasticity, pyramidal (UMN) pattern weakness, brisk reflexes and extensor plantar responses.

The sensory information is rarely that helpful – except here!

This is a Brown-Sequard syndrome (hemi-cord lesion).

In this case, the lesion is on the left of the cord (the side of the weaker leg). Reduced JPS/vibration on the left, and reduced pin/temp on the right confirm this.

Brown-Sequard Syndrome (Hemi-Cord) Diagram

The most common cause in younger patients is “inflammatory” – transverse myelitis or MS. Have a look at minute 25 of the MS lecture for more details.

You can find useful references on spinal cord disorders here.

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