The Lower Limb Neuro Exam
Positioning: patient sitting up in bed
Common central neurologic syndromes
Parkinsonism
Cerebellar Pathology
Spinal Cord Syndromes
Common peripheral neurologic syndromes
Lower Limb Radiculopathy (Nerve Root Palsy)
Lower Limb Peripheral Mononeuropathy
Mononeuritis Multiplex
Peripheral Polyneuropathy
Signs of neurologic diseases
Multiple Sclerosis
Motor Neurone Disease
Chronic Inflammatory Demyelinating Polyneuropathy
Myaesthenia Gravis
The Patient
Around the Room
Mobility devices, ankle-foot orthoses
General Features
Age, gender, general comfort
Skin
Cafe au lait spots, neurofibromas
Posturing
Decorticate (flexion) / decerebrate (extension)
Muscles
Wasting, fasciculations
Abnormal Movements
Tremor, chorea, dystonia, myoclonus, tics
Tremor
Resting / postural / intention / psychogenic
Rhythmic involuntary vibration of 1+ body parts
Chorea
Abrupt irregular movements
Dystonia
Contractions resulting in abnormal posture
Myoclonus
Shock-like jerking movements
Tics
Suppressible stereotyped movements preceded by urge
Feet
Foot drop, pes cavus
Functional Assessment
Motor Assessment
Summary of UMN and LMN findings
Patterns of weakness
Upper Motor Neuron Weakness
Cerebrum, brainstem or spinal cord pathology
Lower Motor Neuron Weakness
Spinal root, lumbar plexus or peripheral nerve pathology
Upper and Lower Motor Neuron Weakness
Classically motor neurone disease (ALS)
Proximal Weakness
More commonly muscular in aetiology
Distal Weakness
More commonly neurologic in aetiology
Tone
Passive movement of hips, knees, ankles
Clonus
Rotate then sharply dorsiflex the ankle
Power
0/5 no flicker, 3/5 vs. gravity, 5/5 normal
Movement against gravity & resistance, R vs. L
Reflexes
0 no response, 2+ normal, 3+ brisk, 4+ very brisk
Patellar, ankle, Babinski ± reinforcement
Babinski Sign
Run a key up lateral aspect of sole of foot