Lower Limb

Question 1

Ddx spastic parapesis (bilateral UMN signs)

Answer 1

Sagittal sinus lesion eg parasaggital meningioma
Bilateral strokes
Cord trauma or compression
Intrinsic cord disease eg tumour or MS

Question 2

Ddx flaccid parapesis (bilateral LMN signs)

Answer 2

Polio
Guillain-Barre
Lead poisoning
Charcot-Marie-Tooth

Question 3

Ddx mixed UMN and LMN signs

Answer 3

MND

Subacute combined degeneration of the cord

Question 4

Ddx unilateral leg weakness

Answer 4

UMN - stroke, tumour, MS

LMN - root lesion, nerve lesion

Question 5

Ddx peripheral neuropathy

Answer 5

Mostly sensory - diabetes mellitus, uraemia (renal failure)

Mostly motor - Guillain-Barre, lead poisoning, Charcot-Marie-Tooth (aka peroneal muscular atrophy)

Mixed - B12/folate deficiency, thiamine deficiency, alcohol, Vasculitis/SLE, paraneoplastic, amyloid

Question 6

Ddx foot drop

Answer 6

Common peroneal nerve palsy
Stroke
L4/ L5 root lesion
MND
Charcot-Marie-Tooth

Question 7

Positive babinksi sign indicates what?

Answer 7

UMN lesion

Question 8

What does a positive Romberg’s test indicate and what are the potential causes?

Answer 8

Sensory ataxia

Dorsal column loss - tabes dorsalis, SCDC, MS
Sensory peripheral neuropathy

Question 9

Ddx acute and progressive parapesis (bilateral leg weakness)

Answer 9

Acute spinal cord compression eg vertebral tumour, spinal TB

Cauda equina syndrome (at or distal to L1) eg disc prolapse

Guillain-Barré syndrome usually triggered by infection (campylobacter jejuni, Epstein-Barr virus, cytomegalovirus)