Case Study Upper Motor Neuron Lesion

CLINICAL CASE SCENARIO

Mr. B, a 69 year old right handed male, presents with a one month history of recurrent falls, left sided headaches and weakness on the right side. His wife complains that he stumbles often and seems to have become more confused within the last month. She does mention that he fell from the stairs on her birthday two months ago, but he did not injure himself. After falling again today, Mrs B decided to call the ambulance. Mr. B does not have any history of hypertension, diabetes or smoking, but he does have history of chronic alcohol abuse.

Physical examination

Vital signs: Temperature 36.8 C; Pulse 88 bpm; Blood Pressure 110/80 mmHg; Respiratory

rate 18/min

Head: No evidence of trauma

Neck: Supple with no bruits

Lungs: Clear

Heart: Regular rate, no murmurs

Abdomen: Soft, normal bowel sounds

Extremities: A few bruises on the right arm and right leg

Neurologic Exam

Mental status: Fluctuating mental status, at times oriented to time and place, at other times

lethargic. Decreased fluency of spontaneous speech

Cranial Nerves: Normal. Pupils equal, round and reactive to light

Motor: 4/5 strength in the right upper and lower extremity, normal strength on the left side

Gait: Unsteady

Reflexes: Increased reflexes in the right arm and right leg. Right Babinski’s sign.

Coordination: Not tested

10 key signs and symptoms in this case:

1. Recurrent falls, Bruising

2. 4/5 strength on right side

3. Headaches on left side

4. Confusion

5. Stumbling often

6. Unsteady Gait

7. Babinski’s sign and increased reflexes in right arm and leg

8. Lethargy

9. Fluctuating mental status

10. Decreased fluency in spontaneous speech, dysarthria

Neural tract that may be involved:

Abnormal plantar flexion reflex or Babinski’s sign indicates lesion in the upper motor neuron area which is directly affecting the motor pathways of the corticospinal tract, 4/5 strength on right side implies damage...