Case study presented by Mike Huntington and Andrew Ritchison, Page 2
Neurological ExaminationMental status:
Awake and cooperative. Response time was somewhat slowed. Mini-mental exam 26/30 (missed three points on serial 7 subtraction and was unable to recall 1 of 3 objects at 5 minutes). Speech was fluent with no evident dysarthria.
Motor examination:
Normal bulk of muscles. Increased tone in lower extremity muscles. Muscle strength 5/5 in all muscle groups with the exception of 4/5 in the iliopsoas muscles, bilaterally.
Sensory Examination:
Diminished pinprick sensation in a stocking-and-glove distribution (to wrist and to ankles). Vibration and proprioception sense loss in both lower extremities from the waist down. Romberg test showed patient able to stand with feet together with eyes open, but unsteady with eyes closed.
Cerebellar: Normal finger-to-nose, heel-to-shin, and rapid alternating movements.Gait:
Slow, cautious, unsteady wide-based gait. With each step, the foot was thrust outwards and made an audible slapping sound as it struck the floor.
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