What are the typical symptoms of spinal onset amyotrophic lateral sclerosis?
(MND, most common form)
- Progressive, often asymmetric limb weakness.
- Difficulty with coordinating movement.
- Difficulty with fine motor tasks.
What are the typical symptoms of bulbar onset amyotrophic lateral sclerosis?
(MND)
- Slurred or nasal speech.
- Dysphagia.
- Increased secretions/drooling (sialorrhoea).
- Emotional lability.
What upper motor neurone signs may be present in a patient with motor neurone disease?
- Increased muscle tone or spasticity.
- Increased DTRs.
- Clonus.
- Babinski response and Hoffmann’s sign.
What lower motor neurone signs may be present in a patient with motor neurone disease?
- Decreased muscle tone.
- Hypotrophy/atrophy.
- Muscles weakness.
- Flaccid dysarthria.
- Reduced or absent DTRs.
- Fasciculations.
- Axial instability.
What are the most common symptoms on initial presentation of multiple sclerosis?
- Limb numbness/altered sensation.
- Subacute onset limb weakness.
- Cerebellar symptoms – loss of balance, diplopia, dysarthria, tremor.
What certain phenomena are considered characteristic of multiple sclerosis?
- Uhthoff’s phenomenon – worsening of symptoms on exercise or in warm environments (e.g., in a bath).
- Lhermitte’s phenomenon – lightning-shock pain down the spin on flexion of the neck – occurs due to cervical cord plaque formation.
What peripheral nervous system signs are suggestive of multiple sclerosis?
- Abnormal sensation.
- Hypertonia.
- Decreased power.
- Hyperreflexia.
- Clonus.
What are the typical motor symptoms associated with Parkinson’s disease?
- Slowness of movement.
- Rigidity.
- Tremor.
- Instability.
- Reduced dexterity.
What are the typical autonomic symptoms associated with Parkinson’s disease?
- Postural hypotension.
- Excessive salivation or sweating.
- Constipation.
- Urinary dysfunction.
- Sexual dysfunction.
Aside from motor and autonomic symptoms, what other features are associated with Parkinson’s disease?
- Mood changes.
- Emotional lability.
- Sleep disturbance and daytime sleepiness.
- Anosmia or reduced sense of smell.
What are the typical clinical findings on neurological examination of a patient with Parkinson’s disease?
Motor features are often unilateral in early disease, before progressing to become bilateral.
- Bradykinesia.
- ‘Pill-rolling’ tremor at rest.
- Rigidity.
- Abnormal shuffling gait, with reduced arm swing and difficulty turning or manoeuvring obstacles.
- Postural instability.
What findings on general examination may indicate Parkinson’s disease?
- Hypomimia – decreased facial expression.
- Postural hypotension.
- Confusion.
- Reduced dexterity, esp. with fine motor tasks.
