sensory impairment W4

Question 1

testing sensory function - touch?

Answer 1

patients eyes shut, touch lightly with finger

Question 2

testing sensory function - pain?

Answer 2

using testing pin
demonstrate on sternum as reference
test regions with patients eyes shut
sharp or dull? (blunt side and sharp side)

Question 3

testing sensory function - vibration

Answer 3

tuning fork over bony eminence
test distal extremities, work proximally

Question 4

testing sensory function - proprioception?

Answer 4

hold great toe on sides (not pad - they will feel pressure)
patient closes eyes
‘say up when you feel me move it up, down when you feel me move it down’
vary order at random
work proximally if absent

Question 5

S1 root lesion sensory and reflex loss? muscle weakness?

Answer 5

sensory loss down lateral side of lower limb
reflex loss in ankle
muscle weakness in plantar flexion

Question 6

L5 root lesion sensory and reflex loss? muscle weakness?

Answer 6

sensory loss lateral/anterior leg and surface of foot
no reflex loss
muscle weakness in ankle dorsiflexion and inversion

Question 7

L4 root lesion sensory and reflex loss? muscle weakness?

Answer 7

sensory loss down anterior to medial side of lower limb
loss of knee reflex
muscle weakness on knee extension

Question 8

full thickness cord lesion?

Answer 8

weakness, loss of all sensory modalities, sphincter disturbance

Question 9

anterior spinal artery infarction?

Answer 9

single artery supplies anterior and lateral cord
infarction leads to:
bilateral weakness
loss of pain/temp below level of infarct
dorsal columns spared so touch proprioception, and vibration are fine
sphincter disturbance

Question 10

dorsal column disease?

Answer 10

pathology affecting back of spinal cord
loss of touch, proprioception, vibration
positive Romberg’s test, sensory ataxia, falls, balance worse in dark

Question 11

causes of unilateral dorsal column disease

Answer 11

MS (unilateral)

Question 12

brainstem lesion classic findings

Answer 12

crossed sensory loss:
ipsilateral facial numbness
contralateral limb and body numbness

Question 13

brainstem lesions additional features?

Answer 13

gaze palsy?
pyramidal weakness?
impaired swallow?

Question 14

cortical sensory deficit?

Answer 14

may lose all modalities in a given region
may see additional cortical signs (visual/sensory inattention)
higher cortical sensations:
-two point discrimination
-stereognosis (tractile recognition)
-graphesthesia

Question 15

graphesthesia?

Answer 15

the ability to recognise symbols when traced on the skin

Question 16

stereognosis?

Answer 16

perception of depth by the senses

Question 17

two point discrimination?

Answer 17

Two-point discrimination (2PD) is the ability to discern that two nearby objects touching the skin are truly two distinct points, not one.

Question 18

Romberg’s test?

Answer 18

positive if unable to maintain an erect posture over 60 seconds with eyes closed