Spastic legs Flashcards
(11 cards)
Spastic legs ==> presentation
This man had difficulty in walking
Examine his lower limbs neurologically.
Clinical signs in Spastic legs
- Inspection: Wheelchair and walking sticks (disuse atrophy and contractures may be present if chronic)
- Tone: Increased tone and ankle clonus
- Power: Generalized weakness
- Reflexes: Hyper‐reflexia and extensor plantars
- Gait: ‘scissoring’
Additional signs in Spastic legs
- Examine for a sensory level suggestive of a spinal lesion
- Look at the back for scars or spinal deformity
- Search for features of multiple sclerosis, e.g. cerebellar signs, fundoscopy for optic atrophy
- Ask about bladder symptoms and note the presence or absence of urinary catheter.
- Offer to test anal tone
Common causes of Spastic legs
- Multiple sclerosis
- Spinal cord compression/cervical myelopathy
- Trauma
- Motor neurone disease (no sensory signs)
Other causes of Spastic legs
- Anterior spinal artery thrombosis: dissociated sensory loss with preservation of dorsal columns
- Syringomyelia: with typical upper limb signs
- Hereditary spastic paraplegia: stiffness exceeds weakness, positive family history
- Subacute combined degeneration of the cord: absent reflexes with upgoing plantars
- Friedreich’s ataxia
- Parasagittal falx meningioma
Cord compression
• Medical emergency
• Causes of Cord compression
- Trauma: # vertebra
- Tumour: Malignancy
- Infection: abscess or TB
- Disc prolapse (above L1/2)
• Investigation of choice for cord compression
Spinal MRI
• Treatment of cord compression
- Urgent surgical decompression
2. Consider steroids and radiotherapy (for a malignant cause)
Lumbo‐sacral root levels
L 2/3 Hip flexion
L 3/4 Knee extension => Knee jerk L 3/4
L 4/5 Foot dorsi‐flexion
L 5/S 1 Knee flexion & Hip extension
S 1/2 Foot plantar‐flexion => Ankle jerk S 1/2
Lower limb dermatomes
Hints:
L3 (L three to the knee)
L4 (L four to the floor medially)
S2, 3, 4 (keeps the faeces off the floor!)
