Info

Cerebral Cortex (1)

Brainstem (2)

Spinal Cord (3)

Subcortical Gray Matter: Basal Ganglia (4)

Cerebellar (not illustrated)

Chronic contralateral upper motor neuron weakness and spasticity. Flexion is stronger than extension in the arm, plantar flexion is stronger than dorsiflexion in the foot, and the leg is externally rotated at the hip.

Weakness and spasticity as above, plus cranial nerve deficits such as diplopia (from weakness of the extraocular muscles) and dysarthria

Weakness and spasticity, as above, but often affecting both sides (when cord damage is bilateral), causing paraplegia or quadriplegia depending on the level of injury

Slowness of movement (bradykinesia), rigidity, and tremor

Hypotonia, ataxia, and other abnormal movements, including nystagmus, dysdiadochokinesis, and dysmetria

Contralateral sensory loss on the limbs and trunk on the same side as the motor deficits

Variable. No typical sensory findings

Dermatomal sensory deficit on the trunk bilaterally at the level of the lesion, and sensory loss from tract damage below the level of the lesion

Sensation not affected

Sensation not affected t

Normal or -l

Cortical stroke

Brainstem stroke, acoustic neuroma

Trauma, causing cord compression

Normal or -l Parkinsonism

Cerebellar stroke, brain tumor

Peripheral Nervous System Disorders

Efferent motor fiber

Posterior horn

Posterior root

Posterior root ganglion

Afferent sensory fiber

Anterior root ^

Anterior horn

Anterior horn cell

Anterior root ^

Posterior horn

Posterior root

Posterior root ganglion

Afferent sensory fiber

Efferent motor fiber

Anterior horn

Anterior horn cell

Typical Findings

Location of Lesion

Motor

Sensory

Deep Tendon Reflexes

Examples of Cause

Anterior Horn Cell (1)

Spinal Roots and Nerves (2)

Peripheral NerveMononeuropathy (3)

Peripheral Nerve— Polyneuropathy (4)

Neuromuscular Junction (5)

Muscle (6)

Weakness and atrophy in a segmental or focal pattern; fasciculations

Weakness and atrophy in a root-innervated pattern; sometimes with fasciculations

Weakness and atrophy in a peripheral nerve distribution; sometimes with fasciculations

Weakness, and atrophy more distal than proximal; sometimes with fasciculations

Fatigability more than weakness

Weakness usually more proximal than distal; fasciculations rare

Sensation intact

Corresponding dermatomal sensory deficits

Sensory loss in the pattern of that nerve

Sensory deficits, commonly in stocking-glove distribution

Sensation intact

Sensation intact

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