1. Localization in Neurology- 2
Specific lesions & syndromes

2. Lesion- CNS
 Upper motor neuron
 Weakness
 Disuse atrophy
 Spasticity
 Reflexes
 Extensor plantar
 NCV- normal
 No denervation
potentials in EMG
 Lower motor neuron
 Weakness
 Wasting-marked & early
 Flaccidity
 Loss of reflexes
 Fasciculations
 NCV- abnormal
 Denervation potentials
in EMG

3. Lesion- brain
 UMN
 Spasticity
 UL-flexor, LL-extensor
 Paralysis of voluntary
movements
 No involuntary move.
 Exaggerated DTR
 Plantar-extensor
 EPS
 Rigidity
 All-flexor>extensor
 Mildly decreased
voluntary movements
 Involuntary movements
 Normal DTR
 Plantar-flexor

4. Localization in spinal cord
 Uppermost sensory level
 Pain over a vertebra
 Radicular pain
 Band-like sensation
 Isolated flaccidity/atrophy/areflexia
& distal UMN signs

5. Lesion- spinal cord
 Extramedullary
 Radicular pain
 Localised vertebral t’ness
 Brown-Sequard hemicord
syndrome
 Early UMN signs
 Ascending sensory symp.
 Sharp sensory level
 Marked sacral sensory loss
 Early CSF abnormalities
 Intramedullary
 Poorly localised burning pain
 Dissociated loss of pain, with
spared joint position sense
 Late UMN signs
 Commom coexistence of
LMN+UMN signs
 Descending sensory symp.
 Sacral sparing
 Normal/minimally altered
CSF

6. Lesion- lower spinal cord
 Cauda equina
 Pain common, projected
to perineum/thigh
 LMN type paraparesis
 Asymmetric
 Saddle anaesthesia
 Late bladder & bowel
involvement
 Conus medullaris
 Pain less prominent
 Absent anal reflex
 More symmetrical
 B/L saddle anesthesia
 Early bladder & bowel
involvement and
impotence

7. MCA infarct
 Embolic
 Contralateral hemiplegia &/or
hemianaesthesia
 Dominant hemisphere- aphasia
 Non-dominant hemisphere-
agnosia & apraxia

8. Basilar artery infarct
 Mostly embolic
 Bilateral long tract signs-
sensory & motor
 With cranial nerve- V-VIII- symptoms
 With cerebellar dysfunction

9. Medullary syndromes
 Lateral
 Trigeminal sensory nucleus & spinothalamic tracts affected
 Causing I/L face & C/L body loss of pain & temperature
sensation
 Ataxia, nystagmus, vertigo, dysphagia, hoarseness
 Horner’s syndrome- ptosis, miosis, I/L anhidrosis
 Medial
 Hypoglossal nerve, medullary pyramids & medial leminiscus
affected
 Causing I/L tongue deviation, C/L hemiplegia & C/L loss of
touch/position/vibration sensation

10. Bulbar palsy
 B/L LMN defect of IX-XII cranial nerves
 Dysphagia (liquid>solid), nasal regurgitation,
slurred speech
 Nasal speech, wasted tongue with fasciculation,
absent gag reflex
 Pseudobulbar palsy-
 B/L UMN defect of IX-XII cranial nerves
 Dysphagia, dysarthria, emotional lability
 Slow indistinct speech, spastic tongue, brisk jaw jerk
 Frontal release signs

11. Craniovertebral junction anomaly
 Neck/shoulder pain
 Short, webbed neck with ROM
 Vertigo, drop attacks, syncope- due to
vertebrobasilar ischemia
 Upper cord compression- spastic paresis,
posterior column defects ± Lhermitte sign
 Brain compression- nystagmus, hoarseness,
dysarthria, dysphagia, ataxia

12. Spinal cord
 Transverse myelitis
 Upper sensory level for all sensations,
LMN signs at the level of lesion, flaccid paralysis
(spinal shock)UMN signs distally, B/B involved
 Anterior spinal artery syndrome
 Upper sensory level for pain/temperature,
sparing of posterior columns, UMN signs distally
 Brown-Sequard syndrome
 I/L spastic paralysis & loss of joint/position sense,
C/L loss of pain/temperature sensation

13. Motor neuron disease
 Selectively affect motor neurons, that
control voluntary muscle activity
 Types-
 Amyotrophic lateral sclerosis- UMN+LMN
 Primary lateral sclerosis- UMN
 Progressive muscular atrophy- LMN
 Bulbar palsy- bulbar LMN
 Pseudobulbar palsy- bulbar UMN

14. Inflammatory demyelinating polyneuropathy
 Acute- AIDP
 Symmetric ascending weakness, cranial n. may be
involved, areflexia, myalgia
 With or without dysesthesias, loss of position sense
more common & severe than loss of pain/temp.
 Autonomic dysfunction- orthostatic hypotension
 Chronic- CIDP- >8 weeks

15. In the end
 Neuromuscular junction-
 Symmetrical proximal muscle weakness,
with bulbar involvement
 Fatigable, variable
 Sensory, reflexes, bladder-bowel- normal
 Myopathy-
 Symmetrical proximal muscle weakness, bulbar
spared
 Progressive, waddling gait
 Sensory, reflexes, bladder-bowel- normal