- 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.
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.