In the video shown here, the patient is in the left lateral recumbent position. The lumbosacral region of the patient is clearly exposed. The doctor has put on sterile gloves and is applying disinfectant over the lumbar region. Sterile draping is then applied as shown in the photo here.
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…
In this video, the patient exhibits a positive heel-shin test on the right side. Compared to the left (normal) side, the right lower limb is seen to be rather clumsy. The heel-shin test is a test to screen for ipsilateral cerebellar function. Once again, clear instructions are required for this test, and you could see…
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…
Before touching the patient, it is important and good practice to stand back and spend some time in performing a thorough general examination of the patient. Unfortunately, students often rush into touching the patient, hence often neglecting crucial signs which may lead to the diagnosis. An approach to the general examination of a patient presenting…
The set of cranial MRIs shown here are from a young woman with a known history of relapsing-remitting multiple sclerosis. In the first scan (T2W axial cut), we can see multiple T2 hyperintense lesions involving bilateral cerebral cortices (Figure 1). These lesions are noted to be of a juxta-cortical and also peri-ventricular distribution, which are classical of multiple sclerosis. In the next…
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…