You perform an initial evaluation on Joe. The following are what you have learned.
Both of his feet tingle. Strength in both legs is good, but his legs are stiff.
Currently, Joe has poor balance. He needs to hold onto walls or large pieces of furniture to keep from falling. He fell about 10 times during the last month.
Joe has a frequency of urination of about once an hour, and complains that he often has the sensation that he has to urinate NOW. He says that it feels like his bladder does not completely empty. Joe reports that ejaculation is delayed.
Joe denies a history of vertigo, nausea, hearing problems, ringing in the ears, and constipation or diarrhea. He has no known medical allergies. His parents are both healthy, with no family history of neurological or cardiovascular illness.
During your examination, you note that Joe is alert and oriented x3. During the mental status exam, Joe’s speech is of normal volume and tone. He can recall past presidents to Reagan, and he correctly spells “world” backwards. He can count down by 7’s to 86. His immediate recall is 3 out of 3, but five minutes later he can only recall 1 item with and without cues.
Visual fields are full and vision is 20/20 without correction. Eye movements are normal, and his pupils are of equal size and reactive to light. Hearing is normal. Sensation and movement of the face is normal.
Motor Exam
Lower Extremity:
bilateral moderate spasticity, strength 5/5
Clonus: Bilateral
Babinski’s sign: Bilateral
Heel to shin dysmetria: Moderate on left, mild on right
Upper Extremity:
Strength 5/5
Reflexes normal
No finger to nose dysmetria
Can Tandem walk
Romberg test: negative
Sensory Exam: Light touch, pinprick and proprioception normal
Lower Extremity
Vibratory sensation: reduced in right leg and distal to mid-shin on left
Are the motor deficits due to an upper motor neuron lesion, lower motor neuron lesion, both, or neither?
1) The bilateral moderate spasticity, clonus, and Babinski's sign leads me to believe that it is an upper motor neuron lesion. (Betsy)
Upper Motor neuron lesion (Amber)
UMN Lesion (Missy)
Because there is no flaccidity and more accounts of spasticity and if it was both LMN and UMN you would see the LMN signs so this is how I reasoned it to be only the UMN lesion. (Denise)
I agree with the previous that it would be an UMN lesion again due to the spasticity, clonus,…. If it was a LMN problem there would be more of a flaccidity problem which in this case he does not have. (Sara)
Good job to everybody who answered. Yes, this is an UMN lesion.
Question 24 - DonaldLAllen - 05 Mar 2012 20:07
Question 23 - DonaldLAllen - 05 Mar 2012 20:06
Question 22 - DonaldLAllen - 05 Mar 2012 19:55
Question 21 - DonaldLAllen - 05 Mar 2012 19:54
Question 20 - DonaldLAllen - 05 Mar 2012 19:52
Question 19 - DonaldLAllen - 05 Mar 2012 19:51
Question 18 - DonaldLAllen - 05 Mar 2012 19:50
Question 17 - DonaldLAllen - 05 Mar 2012 19:41
Question 16 - DonaldLAllen - 05 Mar 2012 19:40
Question 15 - DonaldLAllen - 20 Feb 2012 19:41
Question 14 - DonaldLAllen - 20 Feb 2012 19:25
Question 13 - DonaldLAllen - 20 Feb 2012 19:24
Question 12 - DonaldLAllen - 20 Feb 2012 19:23
Question 11 - DonaldLAllen - 20 Feb 2012 19:23
Question 10 - DonaldLAllen - 20 Feb 2012 19:22
Question 9 - DonaldLAllen - 20 Feb 2012 19:20
Question 8 - DonaldLAllen - 20 Feb 2012 19:16
Question 7 - DonaldLAllen - 20 Feb 2012 19:15
Question 6 - DonaldLAllen - 20 Feb 2012 19:01
Question 5 - DonaldLAllen - 13 Feb 2012 16:26