Tone was normal. Muscle bulk was normal. There was no cogwheel rigidity or tremor. Strength in the neck flexors and extensors was 5/5. Strength in the upper extremities was:
B.P. 132/60; pulse 70; temperature 97.6F; respiration 18.
General: Well developed, well nourished male in no acute distress. Normocephalic, atraumatic; sclerae anicteric; conjunctivae pink; oropharynx clear, moist without lesions; neck supple without lymphadenopathy, thyromegaly, bruits.
Cardiovascular: Regular rate and rhythym without rubs, gallops, or murmurs.
Chest: Clear to auscultation and percussion bilaterally.
Abdomen: Soft, nontender, without visceromegaly.
Skin: No significant hyper- or hypo- pigmented lesions.
Extremities: No cyanosis, clubbing, or edema.
Reflexes: Reflexes were diminished in the upper extremities and absent in the lower extremities. Babinski's were present bilaterally. There was no Hoffman's sign. Cerebellum: Mild dysmetria on finger-nose-finger; moderate dysmetria on heel-shin test; slight truncal titubation. Gait: Unsteady, slow, wide-based, with irregular stride length; arm swing normal; the patient attempted to turn on a pivot but was very unsteady; able to walk on toes and heels in an unsteady manner; unable to tandem walk.Neurological Examination Mental status:
The patient was alert and fully oriented. Attention was intact, and speech was fluent without paraphasic errors. Comprehension, naming, repetition, reading, and writing were all intact. Short-term memory was intact, as well as constructional ability.
Cranial nerve function:
Motor examination:II -- visual acuity 20/20; visual fields full to confrontation; pupils reactive to light and accomodation
III, IV, VI -- extraocular movements full without nystagmus or ptosis
V -- intact sensation in all three divisions bilaterally; intact masseter and temporalis strength
VII -- smile symmetrical
VIII -- hearing intact to finger rub bilaterally; Weber nonlateralizing; air>bone conduction
IX, X -- palate elevates in midline; gag intact bilaterally
XI -- sternocleidomastoid and trapezius strength intact bilaterally
XII -- tongue midline without atrophy or fibrillations
Tone was normal. Muscle bulk was normal. There was no cogwheel rigidity or tremor. Strength in the neck flexors and extensors was 5/5. Strength in the upper extremities was:
Strength in gluteus maximus was 4-/5 bilaterally and strength in the hip abductors and adductors was 4+/5 bilaterally.
Strength testing of the lower extremities was:
Sensory Examination:
Decreased pinprick, temperature, and light touch in a symmetrical stocking, distribution up to the mid thigh on the leg and a glove distribution up to the mid arm; absent vibration and proprioception in the toes bilaterally; decreased vibration and proprioception in all four limbs; Rhomberg, was positive.
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