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Neuro exam - simple explanation anyone please? x

Hi All!

Can anyone interpret, give info on this neuro exam report in plain English for me please?? I know it’s all to do with movement etc and can understand the bulk of ot - but I’m confused with the relevance of these bits below!!

Increased tone of the right leg

Dorsiflexion 3/5 in both feet

Plantarflexion 3/5

Extensor hallus longus 2/5

Brisk knee reflex - right

Myoclonus +++

Left Plantar downgoing. Extensor on right plantar

xxxjenxx

Hi, dont they baffle us with all this medi-speak? There`s a smashing lass on here, called Karen (Rizzo) and she is great at interpreting for us.

I`ve got some of what you mention too and it means my legs and feet have abnormal reactions.

Dont panic...........Karen will explain Im sure.

luv Pollx

Hello - thanks Poll xxx no not panicking xx promise!!

It’s just that these comments keep coming up in my doctor/neuro exam reports x

I’ve just had a thoracic and lumbar spine MRI that shows discs out in my thoracic and lumbar spine and some degeneration (probs from my RTA 16yrs ago) - the orthospinal consultant says that although they could cause problems it’s not bad enough to do surgery yet - he also insists that my symptoms and clinical signs are not due to a ‘mechanical’ problem but point to a neurological cause

The neurospinal consultant I saw last week agrees and said that while my spine issues can definitely cause me symptoms he also believes the problem is neurological as his tests also point to it and he can’t see any significant nerve inpingement!!

So - if my spine MRI’s are coming back ok - and the brain scan they did last year is normal (apart from an enlarged pituitary gland and lesions in the frontal lobe) what the heck is causing all this for me? I just want to make sense of it all as I’m going from pillar to post with no answers xxxjenxxxx

Not sure Poll’s faith in me is justified!

I think that the first three scores out of five are a measure of spasticity (i.e. tight muscles). The higher the number, the worse the flexibility of the muscle / action. Dorsiflexion & plantarflexion bending your foot at the ankle (dorsi is toes up, plantar is toes down). Had to google extensor hallus longus. The extensor hallucis longus is a muscle that moves the big toe. So it seems that your foot movements are quite stiff; your big toe slightly less so. Spasticity is a sign of a problem with the upper motor neuron (the pathway between the brain and the nerves to the muscles that tells the muscle to relax).

Brisk reflex can be normal, but I don’t know why they would note it like this is if it was, so I guess it was abnormally brisk.

Myoclonus is jerks / spasms in which bits of the body move involuntarily - the sort of thing that anyone can get when falling asleep. Clonus is also a muscle contraction thing but with repeats, like a regular beat. I’m wondering whether the person writing the report meant myoclonus or clonus? A reflex test that elicits lots of beats of clonus is the highest end of the scale (no response is the lowest).

Downgoing/upgoing plantars refers to when the neuro scrapes the sole of your foot. Downgoing (when your sole arches away from the scrape and your big toe goes down) is normal. Upgoing or an extensor movement (big toe going up, sole pushing into the scrape) is abnormal. From this and your reflex result, it’s your right side that’s got the problem.

All of these things are related to the upper motor neuron I think.

Hth!

Karen x

Thanks Karen!!

One more question! Do you know if these signs can be caused by that disc protruding in my thoracic area? I know when I had the MRI I was not experiencing the ‘hug’ type symptoms - so I’m wondering if when I move about I may aggravate it somehow?

The doc I saw last year said that the thoracic area is too ‘stable’ for that to happen - but I’m wondering if he’s wrong and it could explain a lot of my symptoms like not feeling my bladder, spasms etc etc etc xxx

Fwiw (in my completely unqualified opinion!), I agree with the doc. I don’t think a protruding thoracic disc would do anything to the bladder or cause significant upper motor neuron signs - it would have to be seriously protruding to do much more than cause pain and sensory symptoms (I think!).

Kx

Eww! I just wish I could get to the bottom of it!!

I just came accross this

http://www.ncbi.nlm.nih.gov/books/NBK10898/

I fit the bill - even the loss of the ability to write before Christmas!

but they are talking about lesions - and my recent spinal MRI and the brain MRI I had done last year don’t show any!! I just keep thinking they are missing something!!

Frustrating!

xxxjenxxx

Lesion is one of those words with a multitude of applications. In general, it just means “damage”. If someone has upper motor symptoms, then there is a lesion of that pathway, ie that pathway is damaged to the extent that it is no longer working properly. The lesion may not be visible on MRI. Kx