neurological examination

this is not easy!

while most of you know the sequence [what was the PALS pneumonic? - TOPCAR??], there are real variations in technique, and without good technique signs are missed

this applies to doctors (like me) not just medical students

the chap we saw was wasted proximally, with low/normal tone & symmetrical weakness 4/5 of hip & knee flexion

he had +++ reflexes at the knee & ankle with upgoing plantars

we did not really test sensation properly - he seemed to have intact JPS

he was wobbly on heel-toe walking & his heel-shin co-ordination was poor, although this may be due to his reduced power
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in my non-expert mind this does not fit together neatly!

if he has stiff then this would fit better with a UMN/cord lesion, although the pattern of weakness is not typical

he has a proximal myopathy, but classically reflexes are reduced

i will wait to see what happens!
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in the meantime i will try to have a look at one of my favourite textbooks (by john patten)

[this really is a work of art - some incredible drawings]

another very good (short) book is by geraint fuller

2 websites:

1) from the university of utah has a great collection of videos (normal & abnormal)
2) associated with an excellent neuroanatomy book by hal blumenfeld

the link to the karim meeran vodcasts is here


Salaam

sabih