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Motor Neurological Examination of the Hand and Upper Limb
Published in J. Terrence Jose Jerome, Clinical Examination of the Hand, 2022
Responses that can occur:Normal response:Palm will remain flat, supine, elbows straight and the limbs horizontal.Symmetrical deviation on both sides from this position and both forearms may go in for pronation, but the dominant hand may pronate slightly more than the non-dominant hand.Positive pronator drift:If the forearm pronates, with or without downward movement, the patient is said to have a pronator drift.
Cynical Tips
Published in John Larkin, 101 Top Tips in Medicine, 2021
When performing the ‘pronator drift’ test – don’t mention the words ‘pronator drift’ just in case the patient has medical knowledge and realises (despite the fact that 80% of doctors performing the manoeuvre don’t) that an arm should not drift straight down if weak, but should drift slightly down whilst rotating outwards (towards pronation from initially supine position). Anything entirely straight should raise suspicion.
Peripheral neurological
Published in Ian Mann, Alastair Noyce, The Finalist’s Guide to Passing the OSCE, 2021
Ask the patient to stretch their arms out, with their palms facing upwards and their closed. Observe for: pronator drift (the arm drops and pronates) — upper motor neurone lesionsupward drift of the arms with oscillation — cerebellar diseasepseudoathetosis of the fingers (the palms should be facing down for this) — sensory ataxia due to decreased joint position sense.
Postoperative Focal Lower Extremity Supplementary Motor Area Syndrome: Case Report and Review of the Literature
Published in The Neurodiagnostic Journal, 2021
Nicholas B. Dadario, Joanna K. Tabor, Justin Silverstein, Xiaonan R. Sun, Randy S. DAmico
The patient was extubated and awoke initially in the operating room hemiparetic, but antigravity in all extremities. By 1–2 hours postoperatively, the patient was following commands with physical examination notable for only a left upper extremity pronator drift. On examination 12 hours later, the patient’s upper extremity pronator drift had resolved. An isolated left foot drop had developed with dorsiflexion, extensor hallucis longus, and plantar flexion flaccid paralysis. The patient was maintained on routine post-operative decadron taper and post-operative CT demonstrated absence of hematoma. EEG was negative for seizure activity. MRI of the lumbar spine was unremarkable. Given the presence of intact MEPs (specifically tibialis anterior muscle) at the end of the procedure, the foot drop was attributed to possible SMA disruption and brain MRI was deferred until after stage II. Given the patient’s excellent cognitive recovery, the patient was taken for stage II just 3 days later. At the time of the second stage, foot function had not yet recovered.
A case of Guillain–Barre syndrome following Pfizer COVID-19 vaccine
Published in Journal of Community Hospital Internal Medicine Perspectives, 2021
Shiavax J. Rao, Sahiba Khurana, Gayathri Murthy, Elliot T. Dawson, Noushin Jazebi, Christopher J. Haas
On presentation, she was mildly hypertensive, with otherwise preserved vitals. Physical examination was remarkable for proximal bilateral lower extremity muscle weakness (4-/5 strength in knee flexion/extension, hip flexion/extension, hip abduction/adduction) as well as distal bilateral upper extremity weakness (4-/5 wrist flexion/extension) with normal muscle tone and bulk throughout. No pronator drift was appreciated. Sensory examination revealed no asymmetry to pinprick but was remarkable for mild vibration loss in the feet, with otherwise preserved proprioception. Sensation to light touch was notably diminished. Deep tendon reflexes were absent throughout. Laboratory evaluation was unremarkable. MRI Brain and Cervical Spine with and without contrast demonstrated no evidence demyelinating lesions, but the presence of multilevel degenerative disc disease with protrusions at C4-C5, C5-C6 and C6-C7 (Figure 1). Lumbar puncture was performed which revealed an elevated CSF protein level of 167 mg/dL (reference range: 15–45 mg/dL) and 0 white blood cells, consistent with cytoalbuminologic dissociation.
Speech bubble: dysphasia secondary to spontaneous intraparenchymal pneumocephalus
Published in British Journal of Neurosurgery, 2020
Rathijit Mitra, Ashwin Kumaria, Stuart Harrisson, Julian Cahill
A 63 year old right handed gentleman presented with a 4 week history of increasing headaches, confusion and lethargy. In the 24 h preceding admission his drowsiness worsened and he developed right facial droop and dysphasia. These symptoms were exacerbated by sneezing and coughing. There was no cerebrospinal fluid (CSF) otorrhoea or rhinorrhoea. On examination he was drowsy, with severe receptive and expressive dysphasia. There was right sided upper motor neuron facial weakness and pronator drift.