It has been a while since I wrote. There is nothing more important in short case examination and PACES than to see more and more cases everyday and to practice again and again what you would do in your exam. Neurology is a very interesting field.....
You can see in the video, movements of the left lower limb.....
The question is ..
is this a movement disorder, seizure, a voluntary movement or something else ?
I saw this patient today and thought that many who read this will learn something from this.
(Do not miss this in the exam !)
12 comments:
clonus?
movement disorder
Sustained left Ankle clonus
What Elmutaz said...
The answer is left ankle clonus.
Where is the site of lesion ?
Right anterior cerebral artery territory?
Or left thoracic level? Brown Sequard?
Since clonus is caused by UMN lesion and I assume the hands are not affected.
Btw, thanks for sharing the case.
He's not using his left hand in the video, so it might be affected as well. You can't really tell where the lesion is, except for it's from a central origine. Then there are two possibilities:
1) below decussation on the left (anywhere from epiconus up)
2) above decussation on the right
Yes, the lesion for this patient is in the brain (right hemisphere) and the rest can't be told from the video. Basically he had a right lacunar infarct.
Hi Dr. Wuchereria, may I know if there is any MRCP PACES Preparatory Course in 2011? My email is ryanychu@gmail.com
Thank you so much.
There will be Advances in Neurology 18th March 2011. Many topics for the MRCPian.
Will keep you in touch via the blog.
why not restless leg syndrome? ddx akathisia/EPSE of anti-psychotics.
You expect those to be generalized, not only in one leg (restless legs in 2 legs). Furthermore it's elicited by putting the foot on the holder, thus stretching the Achilles tendon. Akathisia and restless legs are most prominent in rest. When his leg slips and the tendon isn't stretched, the movement stops, so in rest there's no movement.
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