Chapter 5. Motor Deficits

Front 1

peripheral nervous system

Back 1

anterior horn cell, nerve root, limb plexus, peripheral nerve, or neuromuscular junction

Front 2

peripheral nervous system

Back 2

anterior horn cell, nerve root, limb plexus, peripheral nerve, or neuromuscular junction

Front 3

peripheral nervous system

Back 3

anterior horn cell, nerve root, limb plexus, peripheral nerve, or neuromuscular junction

Front 4

For example, weakness in the right arm and leg may result from a lesion of the contralateral motor cortex or the corticospinal pathway at any point above the

Back 4

fifth cervical (C5) segment of the spinal cord

Front 5

For example, weakness in the right arm and leg may result from a lesion of the contralateral motor cortex or the corticospinal pathway at any point above the

Back 5

fifth cervical (C5) segment of the spinal cord

Front 6

The presence and distribution of any sensory abnormalities are also helpful in localizing the lesion in patients with weakness. Sensory abnormalities lateralized to the same side as weakness suggest

Back 6

a hemispheric lesion

Front 7

The presence and distribution of any sensory abnormalities are also helpful in localizing the lesion in patients with weakness. Sensory abnormalities lateralized to the same side as weakness suggest

Back 7

a hemispheric lesion

Front 8

The presence and distribution of any sensory abnormalities are also helpful in localizing the lesion in patients with weakness. Sensory abnormalities lateralized to the same side as weakness suggest

Back 8

a hemispheric lesion

Front 9

Wasting, or muscle atrophy, suggests that weakness is due to a lesion of the

Back 9

lesion of the lower motor neurons or of the muscle itself.

Front 10

Wasting, or muscle atrophy, suggests that weakness is due to a lesion of the

Back 10

lesion of the lower motor neurons or of the muscle itself.

Front 11

Wasting, or muscle atrophy, suggests that weakness is due to a lesion of the

Back 11

lesion of the lower motor neurons or of the muscle itself.

Front 12

typical hemiplegic posture

Back 12

flexion of the upper limb and extension of the ipsilateral lower limb

Front 13

typical hemiplegic posture

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flexion of the upper limb and extension of the ipsilateral lower limb

Front 14

typical hemiplegic posture

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flexion of the upper limb and extension of the ipsilateral lower limb

Front 15

Some patients give the impression of being unable to relax and will move the limb being examined as the physician moves it, despite instructions to the contrary. In more advanced cases, there seems to be rigidity when the examiner moves the limb rapidly but normal tone when the limb is moved slowly. This phenomenon¾

Back 15

paratonia

Front 16

Some patients give the impression of being unable to relax and will move the limb being examined as the physician moves it, despite instructions to the contrary. In more advanced cases, there seems to be rigidity when the examiner moves the limb rapidly but normal tone when the limb is moved slowly. This phenomenon¾

Back 16

paratonia

Front 17

Upper motor neuron lesions (e.g., stroke) lead to weakness that characteristically

Back 17

involves the extensors and abductors more than the flexors and adductors of the arms¾and the flexors more than the extensors of the legs

Front 18

Upper motor neuron lesions (e.g., stroke) lead to weakness that characteristically

Back 18

involves the extensors and abductors more than the flexors and adductors of the arms¾and the flexors more than the extensors of the legs

Front 19

Upper motor neuron lesions (e.g., stroke) lead to weakness that characteristically

Back 19

involves the extensors and abductors more than the flexors and adductors of the arms¾and the flexors more than the extensors of the legs

Front 20

On the basis of the history and other findings, muscles that are particularly likely to be affected are selected for initial evaluation, and other muscles are subsequently examined to determine the distribution of the weakness more fully and to shorten the list of diagnostic possibilities. For instance, if an upper motor neuron (pyramidal) lesion is suspected,

Back 20

the extensors and abductors of the upper extremity and the flexors of the lower extremity are tested in more detail as these muscles will be the most affected.

Front 21

On the basis of the history and other findings, muscles that are particularly likely to be affected are selected for initial evaluation, and other muscles are subsequently examined to determine the distribution of the weakness more fully and to shorten the list of diagnostic possibilities. For instance, if an upper motor neuron (pyramidal) lesion is suspected,

Back 21

the extensors and abductors of the upper extremity and the flexors of the lower extremity are tested in more detail as these muscles will be the most affected.

Front 22

On the basis of the history and other findings, muscles that are particularly likely to be affected are selected for initial evaluation, and other muscles are subsequently examined to determine the distribution of the weakness more fully and to shorten the list of diagnostic possibilities. For instance, if an upper motor neuron (pyramidal) lesion is suspected,

Back 22

the extensors and abductors of the upper extremity and the flexors of the lower extremity are tested in more detail as these muscles will be the most affected.

Front 23

On the basis of the history and other findings, muscles that are particularly likely to be affected are selected for initial evaluation, and other muscles are subsequently examined to determine the distribution of the weakness more fully and to shorten the list of diagnostic possibilities. For instance, if an upper motor neuron (pyramidal) lesion is suspected,

Back 23

the extensors and abductors of the upper extremity and the flexors of the lower extremity are tested in more detail as these muscles will be the most affected.

Front 24

On the basis of the history and other findings, muscles that are particularly likely to be affected are selected for initial evaluation, and other muscles are subsequently examined to determine the distribution of the weakness more fully and to shorten the list of diagnostic possibilities. For instance, if an upper motor neuron (pyramidal) lesion is suspected,

Back 24

the extensors and abductors of the upper extremity and the flexors of the lower extremity are tested in more detail as these muscles will be the most affected.

Front 25

Jendrassik maneuver

Back 25

an attempt by the patient to pull apart the fingers of the two hands when they are hooked together

Front 26

Jendrassik maneuver

Back 26

an attempt by the patient to pull apart the fingers of the two hands when they are hooked together

Front 27

Jendrassik maneuver

Back 27

an attempt by the patient to pull apart the fingers of the two hands when they are hooked together

Front 28

an attempt by the patient to pull apart the fingers of the two hands when they are hooked together

Back 28

Jendrassik maneuver

Front 29

an attempt by the patient to pull apart the fingers of the two hands when they are hooked together

Back 29

Jendrassik maneuver

Front 30

In addition, reflexes are often depressed during the acute stage of an upper motor neuron lesion, in patients who are deeply comatose, and in patients with

Back 30

cerebellar disease.

Front 31

In addition, reflexes are often depressed during the acute stage of an upper motor neuron lesion, in patients who are deeply comatose, and in patients with

Back 31

cerebellar disease.

Front 32

In addition, reflexes are often depressed during the acute stage of an upper motor neuron lesion, in patients who are deeply comatose, and in patients with

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cerebellar disease.

Front 33

In addition, reflexes are often depressed during the acute stage of an upper motor neuron lesion, in patients who are deeply comatose, and in patients with

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cerebellar disease.

Front 34

contractions of a muscle that is suddenly subjected to sustained stretch, with each beat caused by renewed stretch of the muscle during relaxation from its previous contracted state. Sustained clonus¾more than three or four beats in response to sudden sustained stretch¾is always pathologic and is associated with an abnormally brisk reflex.

Back 34

clonus

Front 35

contractions of a muscle that is suddenly subjected to sustained stretch, with each beat caused by renewed stretch of the muscle during relaxation from its previous contracted state. Sustained clonus¾more than three or four beats in response to sudden sustained stretch¾is always pathologic and is associated with an abnormally brisk reflex.

Back 35

clonus

Front 36

contractions of a muscle that is suddenly subjected to sustained stretch, with each beat caused by renewed stretch of the muscle during relaxation from its previous contracted state. Sustained clonus¾more than three or four beats in response to sudden sustained stretch¾is always pathologic and is associated with an abnormally brisk reflex.

Back 36

clonus

Front 37

eliciting the finger flexion reflex may cause flexion of the thumb

Back 37

Hoffmann sign

Front 38

Hoffmann sign

Back 38

eliciting the finger flexion reflex may cause flexion of the thumb

Front 39

eliciting the finger flexion reflex may cause flexion of the thumb

Back 39

Hoffmann sign

Front 40

Hoffmann sign

Back 40

eliciting the finger flexion reflex may cause flexion of the thumb

Front 41

Focal reflex deficits often relate to root, plexus, or peripheral nerve lesions. For example, unilateral depression of the ankle jerk commonly reflects an

Back 41

S1 radiculopathy resulting from a lumbosacral disk lesion

Front 42

Focal reflex deficits often relate to root, plexus, or peripheral nerve lesions. For example, unilateral depression of the ankle jerk commonly reflects an

Back 42

S1 radiculopathy resulting from a lumbosacral disk lesion

Front 43

Focal reflex deficits often relate to root, plexus, or peripheral nerve lesions. For example, unilateral depression of the ankle jerk commonly reflects an

Back 43

S1 radiculopathy resulting from a lumbosacral disk lesion

Front 44

Focal reflex deficits often relate to root, plexus, or peripheral nerve lesions. For example, unilateral depression of the ankle jerk commonly reflects an

Back 44

S1 radiculopathy resulting from a lumbosacral disk lesion

Front 45

Focal reflex deficits often relate to root, plexus, or peripheral nerve lesions. For example, unilateral depression of the ankle jerk commonly reflects an

Back 45

S1 radiculopathy resulting from a lumbosacral disk lesion

Front 46

The polysynaptic superficial abdominal reflexes, which depend on the integrity of the

Back 46

T8-T12 spinal cord segments, are elicited by gently stroking each quadrant of the abdominal wall with a blunt object such as a wooden stick. A normal response consists of contraction of the muscle in the quadrant stimulated, with a brief movement of the umbilicus toward the stimulus

Front 47

The polysynaptic superficial abdominal reflexes, which depend on the integrity of the

Back 47

T8-T12 spinal cord segments, are elicited by gently stroking each quadrant of the abdominal wall with a blunt object such as a wooden stick. A normal response consists of contraction of the muscle in the quadrant stimulated, with a brief movement of the umbilicus toward the stimulus

Front 48

The polysynaptic superficial abdominal reflexes, which depend on the integrity of the

Back 48

T8-T12 spinal cord segments, are elicited by gently stroking each quadrant of the abdominal wall with a blunt object such as a wooden stick. A normal response consists of contraction of the muscle in the quadrant stimulated, with a brief movement of the umbilicus toward the stimulus

Front 49

The polysynaptic superficial abdominal reflexes, which depend on the integrity of the

Back 49

T8-T12 spinal cord segments, are elicited by gently stroking each quadrant of the abdominal wall with a blunt object such as a wooden stick. A normal response consists of contraction of the muscle in the quadrant stimulated, with a brief movement of the umbilicus toward the stimulus

Front 50

The polysynaptic superficial abdominal reflexes, which depend on the integrity of the

Back 50

T8-T12 spinal cord segments, are elicited by gently stroking each quadrant of the abdominal wall with a blunt object such as a wooden stick. A normal response consists of contraction of the muscle in the quadrant stimulated, with a brief movement of the umbilicus toward the stimulus

Front 51

The cremasteric reflex, mediated through the

Back 51

L1 and L2 reflex arcs, consists of retraction of the ipsilateral testis when the inner aspect of the thigh is lightly stroked; it is lost in patients with a lesion involving these nerve roots. It is also lost in patients with contralateral upper motor neuron disturbances.

Front 52

The cremasteric reflex, mediated through the

Back 52

L1 and L2 reflex arcs, consists of retraction of the ipsilateral testis when the inner aspect of the thigh is lightly stroked; it is lost in patients with a lesion involving these nerve roots. It is also lost in patients with contralateral upper motor neuron disturbances.

Front 53

The cremasteric reflex, mediated through the

Back 53

L1 and L2 reflex arcs, consists of retraction of the ipsilateral testis when the inner aspect of the thigh is lightly stroked; it is lost in patients with a lesion involving these nerve roots. It is also lost in patients with contralateral upper motor neuron disturbances.

Front 54

The cremasteric reflex, mediated through the

Back 54

L1 and L2 reflex arcs, consists of retraction of the ipsilateral testis when the inner aspect of the thigh is lightly stroked; it is lost in patients with a lesion involving these nerve roots. It is also lost in patients with contralateral upper motor neuron disturbances.

Front 55

An extensor plantar response can also be elicited, though less reliably, by such maneuvers as pricking the dorsal surface of the big toe with a pin

Back 55

(Bing sign

Front 56

An extensor plantar response can also be elicited, though less reliably, by such maneuvers as pricking the dorsal surface of the big toe with a pin

Back 56

(Bing sign

Front 57

An extensor plantar response can also be elicited, though less reliably, by such maneuvers as pricking the dorsal surface of the big toe with a pin

Back 57

(Bing sign

Front 58

An extensor plantar response can also be elicited, though less reliably, by such maneuvers as pricking the dorsal surface of the big toe with a pin

Back 58

(Bing sign

Front 59

An extensor plantar response can also be elicited, though firmly stroking down the anterior border of the tibia from knee to ankle

Back 59

Oppenheim maneuver

Front 60

An extensor plantar response can also be elicited, though firmly stroking down the anterior border of the tibia from knee to ankle

Back 60

Oppenheim maneuver

Front 61

An extensor plantar response can also be elicited, though firmly stroking down the anterior border of the tibia from knee to ankle

Back 61

Oppenheim maneuver

Front 62

An extensor plantar response can also be elicited, though firmly stroking down the anterior border of the tibia from knee to ankle

Back 62

Oppenheim maneuver

Front 63

An extensor plantar response can also be elicited, though firmly stroking down the anterior border of the tibia from knee to ankle

Back 63

Oppenheim maneuver

Front 64

flicking the little toe

Back 64

Gonda maneuver

Front 65

flicking the little toe

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Gonda maneuver

Front 66

flicking the little toe

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Gonda maneuver

Front 67

flicking the little toe

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Gonda maneuver

Front 68

This gait is seen in its most extreme form in children with spastic diplegia from perinatally acquired static encephalopathy.

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scissorlike.

Front 69

This gait is seen in its most extreme form in children with spastic diplegia from perinatally acquired static encephalopathy.

Back 69

scissorlike.

Front 70

This gait is seen in its most extreme form in children with spastic diplegia from perinatally acquired static encephalopathy.

Back 70

scissorlike.

Front 71

This gait is seen in its most extreme form in children with spastic diplegia from perinatally acquired static encephalopathy.

Back 71

scissorlike.

Front 72

This gait is seen in its most extreme form in children with spastic diplegia from perinatally acquired static encephalopathy.

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scissorlike.

Front 73

Anterior horn cell, peripheral motor nerve, or striated muscle disorders¾ These disorders lead to gait disturbances if the muscles involved in locomotion are affected. Weakness of the anterior tibial muscles leads to foot drop; to avoid catching or scuffing the foot on the ground, the patient must lift the affected leg higher than the other, in a characteristic steppage gait. Weakness of the calf muscles leads to an inability to

Back 73

walk on the balls of the feet.

Front 74

Anterior horn cell, peripheral motor nerve, or striated muscle disorders¾ These disorders lead to gait disturbances if the muscles involved in locomotion are affected. Weakness of the anterior tibial muscles leads to foot drop; to avoid catching or scuffing the foot on the ground, the patient must lift the affected leg higher than the other, in a characteristic steppage gait. Weakness of the calf muscles leads to an inability to

Back 74

walk on the balls of the feet.

Front 75

Anterior horn cell, peripheral motor nerve, or striated muscle disorders¾ These disorders lead to gait disturbances if the muscles involved in locomotion are affected. Weakness of the anterior tibial muscles leads to foot drop; to avoid catching or scuffing the foot on the ground, the patient must lift the affected leg higher than the other, in a characteristic steppage gait. Weakness of the calf muscles leads to an inability to

Back 75

walk on the balls of the feet.

Front 76

Anterior horn cell, peripheral motor nerve, or striated muscle disorders¾ These disorders lead to gait disturbances if the muscles involved in locomotion are affected. Weakness of the anterior tibial muscles leads to foot drop; to avoid catching or scuffing the foot on the ground, the patient must lift the affected leg higher than the other, in a characteristic steppage gait. Weakness of the calf muscles leads to an inability to

Back 76

walk on the balls of the feet.

Front 77

Anterior horn cell, peripheral motor nerve, or striated muscle disorders¾ These disorders lead to gait disturbances if the muscles involved in locomotion are affected. Weakness of the anterior tibial muscles leads to foot drop; to avoid catching or scuffing the foot on the ground, the patient must lift the affected leg higher than the other, in a characteristic steppage gait. Weakness of the calf muscles leads to an inability to

Back 77

walk on the balls of the feet.

Front 78

Loss of superficial abdominal reflexes UMN/LMN?

Back 78

UMN

Front 79

Loss of superficial abdominal reflexes UMN/LMN?

Back 79

UMN

Front 80

Loss of superficial abdominal reflexes UMN/LMN?

Back 80

UMN

Front 81

Loss of superficial abdominal reflexes UMN/LMN?

Back 81

UMN

Front 82

A parasagittal intracranial lesion produces an upper motor neuron deficit that characteristically affects

Back 82

both legs and may later involve the arms.

Front 83

A parasagittal intracranial lesion produces an upper motor neuron deficit that characteristically affects

Back 83

both legs and may later involve the arms.

Front 84

A parasagittal intracranial lesion produces an upper motor neuron deficit that characteristically affects

Back 84

both legs and may later involve the arms.

Front 85

A parasagittal intracranial lesion produces an upper motor neuron deficit that characteristically affects

Back 85

both legs and may later involve the arms.

Front 86

lesion at the level of the internal capsule, where the descending fibers from the cerebral cortex are closely packed, commonly results in a severe hemiparesis that involves

Back 86

the contralateral limbs and face

Front 87

lesion at the level of the internal capsule, where the descending fibers from the cerebral cortex are closely packed, commonly results in a severe hemiparesis that involves

Back 87

the contralateral limbs and face

Front 88

lesion at the level of the internal capsule, where the descending fibers from the cerebral cortex are closely packed, commonly results in a severe hemiparesis that involves

Back 88

the contralateral limbs and face

Front 89

lesion at the level of the internal capsule, where the descending fibers from the cerebral cortex are closely packed, commonly results in a severe hemiparesis that involves

Back 89

the contralateral limbs and face

Front 90

A brainstem lesion commonly¾but not invariably¾leads to

Back 90

bilateral motor deficits, often with accompanying sensory and cranial nerve disturbances, and disequilibrium. A more limited lesion involving the brainstem characteristically leads to a cranial nerve disturbance on the ipsilateral side and a contralateral hemiparesis

Front 91

A brainstem lesion commonly¾but not invariably¾leads to

Back 91

bilateral motor deficits, often with accompanying sensory and cranial nerve disturbances, and disequilibrium. A more limited lesion involving the brainstem characteristically leads to a cranial nerve disturbance on the ipsilateral side and a contralateral hemiparesis

Front 92

A brainstem lesion commonly¾but not invariably¾leads to

Back 92

bilateral motor deficits, often with accompanying sensory and cranial nerve disturbances, and disequilibrium. A more limited lesion involving the brainstem characteristically leads to a cranial nerve disturbance on the ipsilateral side and a contralateral hemiparesis

Front 93

A brainstem lesion commonly¾but not invariably¾leads to

Back 93

bilateral motor deficits, often with accompanying sensory and cranial nerve disturbances, and disequilibrium. A more limited lesion involving the brainstem characteristically leads to a cranial nerve disturbance on the ipsilateral side and a contralateral hemiparesis

Front 94

A brainstem lesion commonly¾but not invariably¾leads to

Back 94

bilateral motor deficits, often with accompanying sensory and cranial nerve disturbances, and disequilibrium. A more limited lesion involving the brainstem characteristically leads to a cranial nerve disturbance on the ipsilateral side and a contralateral hemiparesis

Front 95

A unilateral spinal cord lesion above the C5 level causes

Back 95

an ipsilateral hemiparesis that spares the face and cranial nerves. Lesions between C5 and the first thoracic segment (T1) affect the ipsilateral arm to a variable extent as well as the ipsilateral leg; a lesion below T1 will affect only the ipsilateral leg.

Front 96

A unilateral spinal cord lesion above the C5 level causes

Back 96

an ipsilateral hemiparesis that spares the face and cranial nerves. Lesions between C5 and the first thoracic segment (T1) affect the ipsilateral arm to a variable extent as well as the ipsilateral leg; a lesion below T1 will affect only the ipsilateral leg.

Front 97

A unilateral spinal cord lesion above the C5 level causes

Back 97

an ipsilateral hemiparesis that spares the face and cranial nerves. Lesions between C5 and the first thoracic segment (T1) affect the ipsilateral arm to a variable extent as well as the ipsilateral leg; a lesion below T1 will affect only the ipsilateral leg.

Front 98

A unilateral spinal cord lesion above the C5 level causes

Back 98

an ipsilateral hemiparesis that spares the face and cranial nerves. Lesions between C5 and the first thoracic segment (T1) affect the ipsilateral arm to a variable extent as well as the ipsilateral leg; a lesion below T1 will affect only the ipsilateral leg.

Front 99

A unilateral spinal cord lesion above the C5 level causes

Back 99

an ipsilateral hemiparesis that spares the face and cranial nerves. Lesions between C5 and the first thoracic segment (T1) affect the ipsilateral arm to a variable extent as well as the ipsilateral leg; a lesion below T1 will affect only the ipsilateral leg.

Front 100

Brown-Sequard syndrome

Back 100

If there is an extensive but unilateral cord lesion, the motor deficit is accompanied by ipsilateral impairment of vibration and position sense and by contralateral loss of pain and temperature appreciation (Brown-Sequard syndrome)

Front 101

Brown-Sequard syndrome

Back 101

If there is an extensive but unilateral cord lesion, the motor deficit is accompanied by ipsilateral impairment of vibration and position sense and by contralateral loss of pain and temperature appreciation (Brown-Sequard syndrome)

Front 102

Brown-Sequard syndrome

Back 102

If there is an extensive but unilateral cord lesion, the motor deficit is accompanied by ipsilateral impairment of vibration and position sense and by contralateral loss of pain and temperature appreciation (Brown-Sequard syndrome)

Front 103

Brown-Sequard syndrome

Back 103

If there is an extensive but unilateral cord lesion, the motor deficit is accompanied by ipsilateral impairment of vibration and position sense and by contralateral loss of pain and temperature appreciation (Brown-Sequard syndrome)

Front 104

Brown-Sequard syndrome

Back 104

If there is an extensive but unilateral cord lesion, the motor deficit is accompanied by ipsilateral impairment of vibration and position sense and by contralateral loss of pain and temperature appreciation (Brown-Sequard syndrome)

Front 105

With compressive and other focal lesions that involve the anterior horn cells in addition to the fiber tracts traversing the cord, the muscles innervated by the affected cord segment weaken and atrophy. Therefore, a focal lower motor neuron deficit exists at the level of the lesion an

Back 105

an upper motor neuron deficit exists below it, in addition to any associated sensory disturbance.

Front 106

With compressive and other focal lesions that involve the anterior horn cells in addition to the fiber tracts traversing the cord, the muscles innervated by the affected cord segment weaken and atrophy. Therefore, a focal lower motor neuron deficit exists at the level of the lesion an

Back 106

an upper motor neuron deficit exists below it, in addition to any associated sensory disturbance.

Front 107

With compressive and other focal lesions that involve the anterior horn cells in addition to the fiber tracts traversing the cord, the muscles innervated by the affected cord segment weaken and atrophy. Therefore, a focal lower motor neuron deficit exists at the level of the lesion an

Back 107

an upper motor neuron deficit exists below it, in addition to any associated sensory disturbance.

Front 108

With compressive and other focal lesions that involve the anterior horn cells in addition to the fiber tracts traversing the cord, the muscles innervated by the affected cord segment weaken and atrophy. Therefore, a focal lower motor neuron deficit exists at the level of the lesion an

Back 108

an upper motor neuron deficit exists below it, in addition to any associated sensory disturbance.

Front 109

With compressive and other focal lesions that involve the anterior horn cells in addition to the fiber tracts traversing the cord, the muscles innervated by the affected cord segment weaken and atrophy. Therefore, a focal lower motor neuron deficit exists at the level of the lesion an

Back 109

an upper motor neuron deficit exists below it, in addition to any associated sensory disturbance.