The gait is wide-based and the patient requires assistance from the physician for stabilization. The patient cannot turn within one or two steps but requires multiple steps. The physician then asks the patient to perform tandem-walking at the end of the video but the patient is unable to do so due to severe instability. The patient exhibits ataxia which could be due to a cerebellar problem or deficits in proprioception.
This is a video from a middle-aged man with myotonic dystrophy type 1, an autosomal dominant multi-systemic disorder that not only affects the muscles, but also causes other problems such as cataracts, arrhythmias and diabetes mellitus. The video shown here is typical of myotonia which can be seen in these patients. The tone is usually…
This patient presented with a few week history of progressive weakness affecting the four limbs associated with muscle pain. He found it increasingly difficult to lift up his arms to above his shoulder level and also to climb stairs. There was in addition unintentional weight loss of 20 pounds (baseline of 180 pounds) during the…
To elicit this sign, the examiner strikes the patient’s sole using a blunt orange stick, starting from the heel, along the lateral border of the sole then medially to the base of the first toe. As one can see from the two videos, the patient demonstrates dorsiflexion of the big toe when testing for the…
Intention tremor can be elicited by the finger-nose test. In normal patients, the movements between the physician’s finger and patient’s nose should be smooth, but adjustment is allowed according to the patient’s upper limb power. This man has intention tremor and impaired finger-nose test on the right side, whilst the left side is normal. Discussion on intention…
These two photos (Figures 1 and 2) show wasting of the left small hand muscles including the interosseous muscles, 3rd and 4th lumbricals and hypothenar muscles. The picture also shows an ulnar claw hand in which there is extension of the metacarpophalangeal joints and flexion of the proximal and distal interphalangeal joints of the 4th…
This middle-aged man was admitted after a generalized tonic-clonic seizure that occurred at home. Physical examination did not reveal any significant external wounds as a result of the seizure and there were no focal neurological signs. However, examination of the oral cavity showed presence of a haematoma at the side of the tongue. This occasionally…