1. 1 Weakness & Sensory Deficit Describe unique findings in Myopathy, NMJ disorder, neuropathy, plexopathy, radiculopathy Myelopathy, motor neuron disease Brain stem and cortical lesions

2. 2 Weakness Pertinent parameters include: Motor power pattern Sensory findings Deep tendon reflexes and muscle tone Others

3. 3 Symptomatology of Motor Dysfunction 1.Muscle mass and contour atrophy, hypertrophy, dystrophy myopathy, myotonia 2.Muscle tone spasticity rigidity decorticate, decerebrate posture hypotonia

4. 4 Symptomatology of Motor Dysfunction 3.Involuntary movement tremor, myoclonus, chorea, athetosis, ballism, dystonia, spasm, tics, clamps 4.Weakness paresis, paralysis, -plegia, palsy mono-, para-, hemi-, quadri-

5. 5 Neurologic examination 1.Cerebral function 2.Cranial function 3.Motor function 4.Sensory function 5.Reflexes and muscle tone 6.Coordination 7.Gait and posture 8.Meningeal irritation 9.Funduscopic examination

6. 6 Motor Power Grading system (British Medical Research Council) Vnormal, full resistance to external force IVpartial resistance to external force IIIagainst gravity, not to external force IIjoint movement, not against gravity Imuscle contraction, no joint movement 0no muscle contraction

7. 7 Sensory Functions 1.Dorsal column system proprioception, touch 2.Anterolateral system pain (pinprick), temperature

8. 8 Reflexes Deep tendon reflexes 4+pathological 3+normal, pathological 2+normal 1+normal, pathological 0pathological

9. 9 Etiology (VINDICATEN_HIM) Vvascular I infectious/inflammatory Nneoplastic Ddegenerative Iintoxicative Ccongenital/hereditary Aautoimmune Ttraumatic Eendocrinopathic N neoplastic Hhematologic Iidiopathic Mmetabolic & miscellaneous

10. 10 Where is the lesion? Peripheral lesions Myopathy Neuromuscular junction Peripheral nerve × polyneuropathy × mononeuropathy (single, multiple) × plexopathy × radiculopathy

11. 11 Central lesions Motor neuron Spinal cord Brainstem Cerebral hemisphere Others

12. 12 Lower Motor Neuron Lesions Muscle (myopathy) hypokalemia myositis, muscular dystrophy NMJ myasthenia gravis Peripheral nerves (neuropathy) Polyneuropathy Mononeuropathy (single, multiple)

13. 13 Plexus (plexopathy) diabetic plexopathy Nerve root (radiculopathy) Guillain-Barre Syndrome (AIDP), CIDP herniated disk Spinal cord (myelopathy) motor neuron disease

14. 14 Symptoms/Signs of LMN Lesions Focal weakness monoparesis, selective neuropathy weakness Flaccid tone Areflexia, hyporeflexia

15. 15 Upper Motor Neuron Lesions Spinal cord cord compression, myelitis Brain stem, cerebral cortex, cerebellum and basal ganglia cerebrovascular disease, tumor, degenerative disease

16. 16 Symptoms/Signs of UMN Lesions Diffuse weakness paraparesis, hemiparesis, quadriparesis Spastic tone Hyperreflexia

17. 17 Hypotonia - Hyporeflexia Reflex arc dysfunction (any components) receptor organs afferent neurons reflex center efferent neurons effector organs

18. 18

20. 20 Spasticity Hypertonia unidirectional velocity-dependent Hyperreflexia Seen in upper motor neuron lesion other than basal ganglia pathology

21. 21 Rigidity Hypertonia bidirectional velocity-independent cog-wheeling Normoreflexia Seen in basal ganglia pathology Parkisonism, Parkinsonism plus

22. 22 Coordination Equilibratory coordination Romberg sign Tandem walk Non-equilibratory coordination finger to nose, finger to finger, nose-finger-nose dysdiadokokinesia rebound past-pointing

23. 23 Gait & Posture ataxic gait (proprioceptive, vestibular, cerebellar): wide base, high swing, sway festinating gait (Parkinsonism): short, slow, rigid and shuffling steppage gait (polyneuropathy): excessive hip flexion waddling gait (myopathy): body swaying from side to side like a duck

25. 25 Motor P > D P / D with F D > P P/DP/D P/DP/D focal / diffuse diffuse Sensory normal impaired Reflexes N, De De De, I I Myopathy NMJ Peripheral nerve Plexus Root Cord Brain P = proximal, D = distal N = normal, De = decreased, I = increased

26. 26 Sensory Deficits Spinal sensory Pathways Dorsal Column system Touch, proprioception, two-point discrimination, vibratory sense Anterolateral system Pain (sharp and dull aching) Temperature sense

27. 27 Sensory Deficits Cranial sensory pathways CN I (olfaction) CN II (vision) CN V (pain and touch) CN VII, IX, X (gustatory, etc) CN VIII (hearing and vestibular sense)

28. 28 Diabetic neuropathy Clinical features - Initial tingling paresthesia - Pain - Dysesthesia - Loss of feeling distally

29. 29 Diabetic neuropathy Distal sensory impairment ascends symmetrically in legs and arms Physical exam: Glove and stocking pattern Hyperalgesia Numbness or lack of sensation

30. 30 http://www.metadon.net/ students neurologic-examination.pdf