This cranial MRI is from a young woman who presented with low-grade fever, confusion, visual hallucinations and status epilepticus. Significant orofacial dyskinesias and autonomic dysfunction was also noted. Lumbar puncture was performed and cerebrospinal fluid (CSF) revealed mild lymphocytic predominant leukocytosis and slightly elevated protein. CSF glucose was within normal range and CSF for microbiological…
A middle-aged woman was admitted with drowsiness, weakness of all four limbs and visual impairment. Physical examination revealed that the patient had bilateral complete ophthalmoplegia, generalized weakness and spasticity,with brisk reflexes and bilateral upgoing plantar reflexes. A hyper-intense lesion at the level of the midbrain was noted on cerebral MRI (Figure 1). Cerebro-spinal fluid examination…
In this video, the examiner is testing the tone of the lower limbs. After ensuring that the patient is fully relaxed, he first of all rolls each leg using both hands – one placed above the knee and another below the knee. Then, the examiner lifts up each leg at the level of the popliteal fossa. Besides…
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…
In this video, the presence of ankle clonus is being tested. Clonus is defined as a series of rhythmic, involuntary muscular contractions induced by sudden passive stretching of a muscle or tendon. To test for ankle clonus, the leg and foot should be relaxed and the knee and ankle placed in a slight flexed position….