Plus-Hex CLINICAL same level as the L6 – L7 vertebral space , meaning that the nerve-to-muscle pathways of the thoracic and lumbar regions were not interrupted , indicating it was less likely to be a spinal cord problem [ 6 ] . Cranial nerve examination revealed markedly reduced palpebral ( blink ) reflexes in both eyes . Spinal palpation was unremarkable .
Based on the examination , Ruby ' s condition was localised to the neuromuscular system . Table 2 [ 7 ] shows how findings from each part of a neurological examination can be localised within the neuromuscular system . Ruby ' s clinical signs were consistent with a working diagnosis of polyneuropathy .
Table 2 . A breakdown of how clinical signs and neurological findings can be localised within the neuromuscular system [ 7 ] .
Evaluation Neuronopathy Mononeuropathy Polyneuropathy Junctionopathy
Mental status Usually normal . May be obtunded if brainstem nuclei are affected
Normal Normal Normal
Posture |
Progressively unable to support trunk and head |
Varies according to location of affected nerve |
May be unable to support trunk or head |
May be unable to support trunk or head . May show generalised or focal involvement |
Muscle mass and tone
Usually proximal muscles , atrophy progressing to distal muscles
Gait Tetraparesis . Variations in severity of thoracic versus pelvic limb involvement
Cranial nerves May be affected , may manifest as dysphonia , megaoesophagus
Asymmetric limb involvement . Rapid and severe atrophy of affected muscles
Generalised and symmetrical rapid and severe atrophy . Distal muscles more affected than proximal muscles ± muscle tone flaccidity
Monoparesis / plegia May be stilted . Tetraparesis / plegia
May be affected May be affected , facial paresis , dysphonia
Muscles usually normal . Muscle tone may be flaccid
Episodic paresis , pelvic limbs may be more severely affected , stilted
May be affected , facial paresis , megaoesophagus , dysphonia
Postural reactions |
Decreased / absent . Limb involvement may vary |
Decreased to absent in affected limb |
Decreased to absent in all limbs |
Normal if patient is not weak . May be decreased / absent depending on degree of weakness |
Spinal hyperaesthesia
None |
None |
None ( except |
|
|
in rare cases of |
|
|
polyradiculoneuritis ) |
None
Pain perception |
Normal |
Dermatomal |
|
|
hypoaesthesia or |
|
|
analgesia |
Usually normal ± paraesthesia
Normal
Micturition |
Usually normal until late in disease course |
Usually not affected unless S1 – S3 spinal nerves are involved |
May manifest as detrusor / sphincter hypotonia |
Usually normal |
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