Neuro Limb Findings

Upper vs Lower motor neuron lesion

	UMN	LMN
Weak	Y	Y
Tone	Spastic	Normal
Clonus	Y	N
Tendon jerks	↑	↓
Plantar	Extensor	Flexor
Wasting	N	Y
Fasciculation	N	Y

Dermatomes

Syndromes

Cerebral hemisphere syndrome

Causes : stroke, trauma, tumour. Signs : dysphasia (dom hemisphere), contral sensory inattention, contral weakness (spasticity, ↑tendon reflexes), contral homonymous hemianopia

Spinal cord syndrome

Causes : MS, cervical spondylotic myelopathy, trauma. Signs : Weakness, spastic tone both legs, flexor spasms in legs, ↑tendon jerks in legs, extensor plantar, abdo reflexes absent, pinprick sensation loss, JPS and VS ↓ in both toes

Peripheral neuropathy

Causes : DM, alcohol, acute inflammatory demyelinating polyneuropathy, chronic inflammatory demyelinating polyneuropathy. Signs : Distal muscle wasting (demyelinating polyneuropathies), loss of tendon jerks, impaired JPS and VS in feet, 'Glove and stocking' pinprick sensation loss. Symmetrical signs.

Cerebellar syndrome

Causes : MS, hereditary degenerative disorders. Signs : DANISH

Parkinsons

Symptoms : slowness (difficulty w buttons, difficulty turning in bed, small handwriting, difficulty washing hair, drooling), rigidity (pain/stiff limbs), shaking (intermittent, asymmetrical in hands). Signs : Tremor (at rest, asymmetrical), rigidity (cogwheel on wrist flexion/extension), akinensia (attempted rapid finder movements), posture (stooped), gait (shuffling, ↓arm swinging), mask face. Note : no weakness, no reflex Δs, patient may be dyskinetic due t L-dopa