Neurosurgery Service
San José University Children's Hospital (HIUSJ)
Hospital de San José (HSJ) - Bogotá Surgery Society
University Foundation of Health Sciences (FUCS)
Case of the Month - June 2018
Patient with spastic paraparesis, with signs of myelopathy and bilateral patellar clonus. Contrast MRI shows a compressive extra axial lesion that enhances homogeneously with the contrast medium at the T10 level.
Patient underwent resection of the lesion via the posterior route with laminectomy. Final diagnosis meningioma. Complete recovery from neurological deficit.
How to evaluate the motor examination of a patient?
The following 4 items should always be evaluated:
Strength (Oxford / Van Allen)
0 Paralysis
1 Contract (+/-)
2 Moves if gravity is removed (+/-)
3 Move against gravity (+/-)
4 Move against a certain resistance (+/-)
5 Normal force
Reflexes
0 crosses Areflexia
+ (a cross) Hyporeflexia
++ (two crosses) Normal
+++ (three crosses) Hyperreflexia
++++ (four crosses) Clonus
Trophism
Atrophy
Hypotrophy
Eutrophy
Hypertrophy
Muscular tone
Spastic
Hypertonic
Hypotonic
Atonic
References
1. Kunam VK, et al. Incomplete Cord Syndromes: Clinical and Imaging Review. Radiographics. 2018 Jul-Aug; 38 (4): 1201-1222. doi: 10.1148 / rg.2018170178.