Can anyone explain what the Neurologist wrote to my GP

Sorry if posted in wrong section.

I have just received a copy of my Neurologists letter to my GP and I am trying to understand it. I was diagnosed in 1999 with primary progressive MS.

He has wrote : On examination cranial nerves were normal. There was some give way weakness in the upper limbs. Tone was normal in the upper limbs. There was subtle increased tone in lower limbs. All reflexes in upper and lower limbs were brisk. There was some non organic weakness in lower limbs. Hoover’s sign was positive bilaterally. Planters were downgoing. Clinially, she seemed to have soft myelopathic signs with the presence of positive oligocional bands.

Any help to interpret this would be appreciated. Thankyou

The bit about Hoovers sign was about checking for malingering. That’s the only bit I know about. Google Hoovers sign or look at the test on utube. The trouble is I don’t know which way round it goes…best look it up.

Look at the above link…non organic weakness means fake weakness. Hoovers sign is a test for faking leg weakness.

I’m sure it cant mean that he was looking to see whether your faking it…I’m sure we all give erratic examinations sometimes.

This is interesting andnim a bit disappointed nobody else has replied on the thread.


Bernie, suggest you ask your MS Nurse for a translation! Realise that the Neuro’s letter was for your GP with copy for you but wonder whether the GP understands it too. If you don’t ask you don’t get!!

Hi Bernie,

These are the symptoms that your neurologist found.

  • give way weakness = is weakness of the arms due to the nervous system not working properly.
  • subtle increased tone = stiffness of the leg muscles.
  • reflexes in upper and lower limbs were brisk = tap on the knee results in an exaggerated jump.

I can’t give simplified explanations of the other terms without risking inaccuracies, but basically he’s saying these are (part of) what led him to your diagnosis of PPMS.

I would have thought that there would be other tests involved like an MRI, visual tests or lumber puncture.



Hoovers sign is where the neurologist tests your relative leg strength or weakness, ie they ask you to push away with your heel when your foot is flexed. It can be used to check for ‘malingering’, but in general it’s used just to test relative strength.

Bilateral means both legs / arms etc. Unilateral would be one side only.

Give way weakness is likely to be similar to Hoovers sign, but in upper limbs, ie where the neuro asks you to push with your hands, or pull back.

As Anthony said, tone means stiffness of muscles.

Brisk reflexes again as Anthony said, jumping of limbs when tapped.

Plantars downgoing means when the sole of the foot is scratched the toes react downwards. In non MS people, the toes react upwards. Also known as the Babinski sign.

Myelopathy relates to changes (eg lesions) in the spinal cord.

Positive Oligoclonal bands is what are tested for on LP. 80 to 95% of people with MS have Oligoclonal bands in their CSF.

It seems to me the neurologist is saying ‘you have MS’. Big news??


Ssssue, you got the Babinski sign the wrong way round …

Oh well. It’s just as well I’m not a neurologist!!

Hi everyone, sorry for the delay in replying but thank you for all the replies.