As one can appreciate in this video, this middle-aged man has right-sided intention tremor. The right index finger shows exaggerated tremor when approaching the target, i.e. his nose and physician’s finger. Please note that the examiner should place his finger at around one arm’s length from the patient. This is so that the patient could fully extend his upper limb in order to accurately elicit the clinical sign.
Archive for the ‘Neurological Signs’ Category
Intention Tremor
Tuesday, August 19th, 2014Postural Tremor
Tuesday, August 19th, 2014The patient in this video has no hand tremor during rest. However, when the patient is asked to maintain her arms in an outstretched position, a right hand tremor can be seen (postural tremor). The patient also had an action tremor (not shown in this video) and was subsequently diagnosed to have essential tremor – the most common of all movement disorders. The cause is currently unknown, however a positive family history is often noted and genetic linkage has been established in several chromosomal regions. Essential tremor is a postural and action tremor and tends to affect the hands, head and voice. If the head is affected, the movement can be anterior-posterior (affirmative, yes-yes tremor) or lateral (negative, no-no tremor). Patients with mild non-disabling symptoms do not require treatment. Those with moderate-severe, disabling symptoms can be treated medically and beta-blockers (e.g. propranolol) are used as first line medications. Use of deep-brain stimulation and high intensity focused ultrasound are emerging therapies that are used in specialized centres for severe cases of essential tremor that are not responsive to medications.
Lower Limb Wasting, Pes Cavus and Clawing of Toes
Tuesday, August 19th, 2014In this photo, there is apparent leg-length discrepancy and wasting of the lower limb muscles – the left side relatively more severe. Typical pes cavus (high-arched foot) are seen on both sides. Clawing of the toes can also be seen. This sign is postulated to be due to a different degree of wasting – the peroneus brevis and tibialis anterior muscles are affected more, whilst the peroneus longus and tibialis posterior muscles are relatively spared. These signs are often seen in chronic neuropathies, such as Charcot-Marie Tooth disease (Hereditary Motor and Sensory Neuropathy Type I) and Friedreich’s Ataxia.
Ulnar Neuropathy
Tuesday, August 19th, 2014These 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 and 5th digits. This pattern of wasting is compatible with an ulnar neuropathy.
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- Figure 1
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- Figure 2
Carpal Tunnel Syndrome
Tuesday, August 19th, 2014This patient complained of on and off tingling sensation over the lateral 3 ½ fingers of the right hand. There was wasting of the thenar muscles as noted in this photo. Further testing showed that the thumb abduction and opposition was weak. Tinel’s sign and Phalen’s test was positive. A nerve conduction study was performed, which confirmed the presence of a compressive median neuropathy at the wrist. The patient was diagnosed to have carpal tunnel syndrome of the right hand.