Examining the Sensory System
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Intention Tremor
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…
Positioning and Exposure
Positioning For general examination, examining the cortical function and upper limbs, the optimal position would be to sit the patient upright at an approximate 45-60º angle to the bed (Figure 1). Of course, if the patient is ambulatory, the patient can also be examined whilst sitting comfortably on a chair (Figure 2). The optimal position…
Cerebral Abscess
The scans shown are from two immunocompromised patients who presented with high fever and recurrent seizures. The contrast cranial CT of the first patient shows that the patient had a rim-enhancing lesion at the left basal ganglia (Figure 1). A set of cranial MRIs of the second patient also showed multiple contrast enhancing lesions in the…
Lower Limb Wasting, Pes Cavus and Clawing of Toes
In 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…
Areflexia
The knee-jerk, ankle-jerk and plantar reflexes are being examined in this patient. There is a slight down-going plantar reflex on the right side. Otherwise, all other reflexes are absent. Discussion of the sign Areflexia may indicate deficits in the reflex loop. This may be due to a lesion involving the sensory neuron or the lower motor…
Skull Fracture
This is a non-contrast cranial CT from a patient who sustained a fall injury, landing on the back of the head. The CT here shows the cranium utilizing the “bone window”. One can appreciate that the details of the skull bone is shown in greater detail. In contrast, the contents within the skull as well…