Neurological exam

Neurology

A 44 year old builder presents with weakness over the past 48 hours

A neurological exam reveals the following (N=normal):

Upper Limbs

Lower Limbs

Right

Left

Right

Left

Tone

N

reduced

N

N

Power (MRC)

4/5

4/5

3/5

4/5

Coordination

N

N

N

N

Sensation

Fine touch

Proprioception

N

N

N

N

N

N

N

N

Reflexes

Biceps

triceps

supinator

– (absent)

– (absent)

+

– (absent)

– (absent)

+ with reinforcement

Knee

Ankle

Plantar

– (absent)

– (absent)

down

– (absent)

– (absent)

down

Which of the following is the most likely diagnosis?

a. Polio
b. Motor Neurone disease
c. Myasthenia gravis
d. Stroke
e. Multiple sclerosis
f. Creutzfeldt Jacob disease
g. Guillain Barre Syndrome

Guillain Barre Syndrome.

Now check your hypothesis against the clinical signs:

Tone Any sign of UMN lesion or hypotonia (cerebellar?) NO

But there is some reduced tone in the left arm:

Power He is weak and its come on
over the past few days: this is classical of GBS: an ascending peripheral
motor and sensory poylneuropathy.
Coordination Normal: as expected
Sensation Normal: So can it still be
GBS???

YES! The sensory signs are often vary vague: there may be only back
pain as the presenting feature.

Reflexes Clinical tip: no reflexes
Auggests a lower motor neurone problem. Could it me MND? Very unlikely:
there’s only LMN signs and the onset of the illness is too acute.
Other things GBS: measure the Forced Vital Capacity:

If this is low: the patient may need ventilation.

Also remember: cardiac conduction deficits (monitor the patient on
a cardiac monitor)

Remember FVC monitoring in GBS.

Leave a Reply