Symptoms

The most common symptoms related to the sensory system include the following.

Hypoaesthesia (decreased sensation). This may be an awareness that the sensations of temperature, pain or light touch are diminished when compared with normal limbs. A patient may inadvertently burn the lingers if pain and temperature modalities are disturbed (as, for example, in cervical syringomyelia).

Altered sensations. These may be spontaneous (paraesthesiae) or elicited by touch or other stimuli (dysaesthesiae). They

KEY POINTS

• Abnormalities of tone need to be interpreted in the light of other clinical findings,

• Alti)bugh a few beats of clonus are present in some normal people, sustained clonus indicates upper motor neurone damage and is a hard clinical sign.

• The pattern of weakness and associated clinical features will indicate which anatomical category of disease underlies a paresis,

• Disturbances in deep tendon reflexes afford objective signs of neural dysfunction.

• ft is important to strike the tendon, not the muscle, when eliciting a tendon reflex.

• Deciding whether or not a deep tendon reflex is pathologically brisk can be difficult.

• Diminished or absent tendon reflexes are usually caused by diseases of lower motor neurones.

• An extensor plantar response is an uneguivocal sign of a pyramidal tract lesion.

• Rapid alternating movements in the upper limbs are normally performed more guickly on the dominant side.

« Lesions of the cerebellar vermis causing truncal and gait ataxia may be missed if the patient is examined only lying in bed.

Cerebral hemisphere

Cerebral hemisphere

Pyramidal Tract Pyramidal Tract

Fig. 6.44 E The main sensory pathways. ED Spinothalamic tract. To show layering of the spinothalamic tract in the cervical region: C represents fibres from cervical segments which lie centrally; fibres from thoracic lumbar and sacral segments (labelled T, L and S respectively) lie progressively more laterally.

Fig. 6.44 E The main sensory pathways. ED Spinothalamic tract. To show layering of the spinothalamic tract in the cervical region: C represents fibres from cervical segments which lie centrally; fibres from thoracic lumbar and sacral segments (labelled T, L and S respectively) lie progressively more laterally.

may be pins and needles, tightness or constriction or feelings of warmth or coldness.

Pain. Pain is an extremely common symptom, In some diseases, such as trigeminal neuralgia (V nerve distri bution), glossopharyngeal neuralgia (IX nerve distribution), post-herpetic neuralgia and discogenic radiculopathies, the description of distribution of pain and its type may be diagnostic. In most cases, however, symptoms of pain do not conform to standard dermatomal or peripheral nerve distribution (Figs 6.45 and 6.46). and often pain may be perceived inappropriately (e.g. touch felt as pain): this phenomenon is termed hyperpathia or aliodynia.

Numbness. Caution should be exercised when a patient describes a limb as 'numb" since this means weakness or heaviness to some people rather than loss of feeling.

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