![]() ![]() Prescriptions: prescribing charts or personal prescriptions can provide useful information about the patient’s recent medications.Walking aids: the ability to walk can be impacted by a wide range of neurological pathology.Look for objects or equipment on or around the patient that may provide useful insights into their medical history and current clinical status: Ophthalmoplegia can be caused by a wide range of neurological disorders including multiple sclerosis and myasthenia gravis. Ophthalmoplegia: weakness or paralysis of one or more extraocular muscles responsible for eye movements.Ptosis and frontal balding: typically associated with myotonic dystrophy.Hypomimia: a reduced degree of facial expression associated with Parkinson’s disease.This condition can develop secondary to treatment with neuroleptic medications including antipsychotics and antiemetics. Tardive dyskinesia: involuntary, repetitive body movements which can include protrusion of the tongue, lip-smacking and grimacing.whilst falling asleep) however persistent widespread myoclonus is associated with several specific forms of epilepsy (e.g. All individuals experience benign myoclonus on occasion (e.g. Myoclonus: brief, involuntary, irregular twitching of a muscle or group of muscles.Patients with Huntington’s disease typically present with chorea. Chorea: brief, semi-directed, irregular movements that are not repetitive or rhythmic but appear to flow from one muscle to the next.Pseudoathetosis: abnormal writhing movements (typically affecting the fingers) caused by a failure of proprioception.Associated with lower motor neuron pathology (e.g. Fasciculations: small, local, involuntary muscle contraction and relaxation which may be visible under the skin.Tremor: there are several subtypes including resting tremor and intention tremor.Wasting of muscles: suggestive of lower motor neuron lesions or disuse atrophy.Scars: may provide clues regarding previous spinal or lower limb surgery. ![]() ![]() Perform a brief general inspection of the patient, looking for clinical signs suggestive of underlying pathology: You might also be interested in our OSCE Flashcard Collection which contains over 2000 flashcards that cover clinical examination, procedures, communication skills and data interpretation. Position the patient appropriately on an examination couch (typically with the headrest elevated to 30-45°).Īsk the patient if they have any pain before proceeding with the clinical examination. Gain consent to proceed with the examination.Īdequately expose the patient’s legs (typically this involves the patient wearing only their underwear) and provide a blanket to cover the patient when not being examined. Introduce yourself to the patient including your name and role.Ĭonfirm the patient’s name and date of birth.īriefly explain what the examination will involve using patient-friendly language. Wash your hands and don PPE if appropriate. Reduced or absent (hyporeflexia or areflexia) classically a proximal weakness in muscle disease, a distal weakness in peripheral neuropathy) Increased (spasticity or rigidity) +/- ankle clonusĬlassically a “pyramidal” pattern of weakness (extensors weaker than flexors in arms, and vice versa in legs)ĭifferent patterns of weakness, depending on the cause (e.g. No fasciculation or significant wasting (there may however be some disuse atrophy or contractures) The table below provides a summary of key upper motor neuron (UMN) and lower motor neuron (LMN) signs you may identify in a lower limb neurological examination. nerve roots, peripheral nerve, neuromuscular junction or muscle) motor neuron lesion? The most basic localisation question you have to think about during the upper and lower limb examination is: This can seem daunting, but with practice, it is relatively straightforward. The main purpose of a neurological examination is to localise where in the nervous system the problem is. ![]()
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