Essential Tremor - Motor Exam - Screening Tests Sub-exam - Patient 12
The patient is a 70-year-old Caucasian female who first noticed voice and head tremor about 15 years ago. She has had a gradual progression of this tremor that now causes her head to shake, her voice to tremor and her bilateral arm to tremor. The tremor is most noticed when the limbs maintain a posture or are in motion. Her writing is affected especially when she attempts to write small. Fine motor tasks have become more effortful as the years have passed. The tremor is worsened by fatigue. She
Myotonic Muscular Dystrophy - Motor Exam - Special Tests Sub-exam - Patient 2
Patient is a 52-year-old African-American male with a known diagnosis of myotonic muscular dystrophy. His neuromuscular symptoms began in the early 1990s with poor dexterity in the hands, dropping objects, and clumsiness with fine motor weakness. He is very slow buttoning clothes, putting on his shoes, brushing his teeth, shaving, and other similar activities. He has trouble in ambulation and falls frequently. He has trouble getting up from a chair or sofa and climbing stairs. He also reports co
Posterior Fossa Tumor - Cranial Nerves Exam - Trigeminal (CN V) Sub-exam - Patient 9
Patient is a 58-year-old white male with a history of acoustic neuroma that was resected in 1990. He has residual cranial nerve palsies on the right side and experiences tremors, ataxia and disequilibrium. His wife reports that she has noticed an increase in right hand tremor for the past year or so. The tremor worsens as the day progresses and occurs with activity. Patient reports an increase in balance problems while standing over the past 4 months. He has noticed that he staggers a step or t
Multiple Sclerosis - Sensory Exam - Cortical (Integrative) Sub-exam - Patient 20
Janie is a 39-year-old Caucasian female who initially presented with weakness and L'Hermitte’s phenomena at the age of 35. Initially mistaken as a TIA, MRI of the brain revealed numerous plaques in the white matter suggesting Multiple Sclerosis. Her lumbar puncture initially failed to demonstrate the presence of oligoclonal bands, but since progression of the disease over the past few years bands have developed.
Multiple Sclerosis - Sensory Exam - Deep Sub-exam - Patient 20
Janie is a 39-year-old Caucasian female who initially presented with weakness and L'Hermitte’s phenomena at the age of 35. Initially mistaken as a TIA, MRI of the brain revealed numerous plaques in the white matter suggesting Multiple Sclerosis. Her lumbar puncture initially failed to demonstrate the presence of oligoclonal bands, but since progression of the disease over the past few years bands have developed.
Essential Tremor - Coordination Exam - Upper Extremities Sub-exam - Patient 12
The patient is a 70-year-old Caucasian female who first noticed voice and head tremor about 15 years ago. She has had a gradual progression of this tremor that now causes her head to shake, her voice to tremor and her bilateral arm to tremor. The tremor is most noticed when the limbs maintain a posture or are in motion. Her writing is affected especially when she attempts to write small. Fine motor tasks have become more effortful as the years have passed. The tremor is worsened by fatigue. She
Essential Tremor - Motor Exam - Inspection Sub-exam - Patient 12
The patient is a 70-year-old Caucasian female who first noticed voice and head tremor about 15 years ago. She has had a gradual progression of this tremor that now causes her head to shake, her voice to tremor and her bilateral arm to tremor. The tremor is most noticed when the limbs maintain a posture or are in motion. Her writing is affected especially when she attempts to write small. Fine motor tasks have become more effortful as the years have passed. The tremor is worsened by fatigue. She
Myotonic Muscular Dystrophy - Mental Status Exam - Speech Articulation Sub-exam - Patient 2
Patient is a 52-year-old African-American male with a known diagnosis of myotonic muscular dystrophy. His neuromuscular symptoms began in the early 1990s with poor dexterity in the hands, dropping objects, and clumsiness with fine motor weakness. He is very slow buttoning clothes, putting on his shoes, brushing his teeth, shaving, and other similar activities. He has trouble in ambulation and falls frequently. He has trouble getting up from a chair or sofa and climbing stairs. He also reports co
Multiple Sclerosis - Reflexes Exam - Abnormal (Pathological) Sub-exam - Patient 18
Ed is a 57-year-old Caucasian male with a 15-year history of neurological disability that was diagnosed after his initial attack as multiple sclerosis. Lumbar puncture demonstrated the presence of numerous oligoclonal bands and MRI later showed multiple white matter plaques. Clinical history: He suffers from a significant dysarthria, as well as tremor and ataxia.
Stroke - Cranial Nerves Exam - Glossopharyngeal (CN IX) and Vagus (CN X) Sub-exam - Patient 19
This video features a 65-year-old right-handed white male. He was in the Air Force from 1962 until his retirement in 1982. The veteran reported that in 1995 he was diagnosed with inclusion body myositis. He first reported a problem in the early 1990s when carrying his briefcase. He noted problems lifting his right leg up to step onto the bus. Falls began around1994, prompting him to seek medical attention. The initial evaluation showed primarily lower motor neuron findings. He underwent several
Spastic Paraplegia - Station and Gait Exam - Gait Sub-exam - Patient 5
This video features a 54-year-old white male with a history of spastic paraplegia (diagnosed in 1994) and no previous history of heart disease or cardiac workup. He presented to the Emergency Room complaining of three days on-and-off retrosternal chest pain. Patient presented to the ER complaining of three days on-and-off retrosternal chest pain, rated 3/10, lasting approximately 30 minutes, occurring multiple times daily at rest or during activity. The first episode occurred three days before
Cervical Myelopathy - General Observations Exam - Opening Interview Sub-exam - Patient 13
This 46-year-old African American male presented with progressive weakness of the lower extremities for three months. He had increasing difficulty with walking and balance and now is unable to walk without assistance. He also complained of numbness and "pins and needles" sensation in the upper extremities with clumsiness and decreased dexterity in his right hand. He did not have neck or radicular pain and had no bowel or bladder problems or sexual dysfunction, but did have some urinary urgency.
Primary Lateral Sclerosis - Cranial Nerves Exam - Oculomotor, Trochlear, and Abducens (CN III, IV, V
This video features a 54-year-old white male who presented for evaluation of progressive spastic paraparesis. He stated that symptoms first started in 1997 when "things were different with my legs" (i.e., leg weakness, imbalance, and speech problems). Symptoms started in his left foot, when he couldn't keep time to music. His feet started dragging and he also noticed problems with balance. In 1999, he started falling and sought medical attention. He was diagnosed with spastic paraparesis after
Spastic Paraplegia - Motor Exam - Muscle Strength Sub-exam - Patient 5
This video features a 54-year-old white male with a history of spastic paraplegia (diagnosed in 1994) and no previous history of heart disease or cardiac workup. He presented to the Emergency Room complaining of three days on-and-off retrosternal chest pain. Patient presented to the ER complaining of three days on-and-off retrosternal chest pain, rated 3/10, lasting approximately 30 minutes, occurring multiple times daily at rest or during activity. The first episode occurred three days before
Cerebellar Degeneration - Motor Exam - Muscle Tone Sub-exam - Patient 17
This 62-year-old white male has had neurological problems dating back to 1990. His initial symptoms consisted of blurred vision and incoordination. When he turns his head to read road signs, his vision is distorted. Gait disturbances have progressed to the point that he is now extremely unsteady. He reels from side-to-side and hangs onto walls for balance. There has been progressive worsening in the dexterity of his hands. Writing, buttoning, holding equipment and manipulating small objects hav
Spastic Paraplegia - Cranial Nerves Exam - Hypoglossal (CN XII) Sub-exam - Patient 5
This video features a 54-year-old white male with a history of spastic paraplegia (diagnosed in 1994) and no previous history of heart disease or cardiac workup. He presented to the Emergency Room complaining of three days on-and-off retrosternal chest pain. Patient presented to the ER complaining of three days on-and-off retrosternal chest pain, rated 3/10, lasting approximately 30 minutes, occurring multiple times daily at rest or during activity. The first episode occurred three days before
Multiple Sclerosis - General Observations Exam - Opening Interview Sub-exam - Patient 20
Janie is a 39-year-old Caucasian female who initially presented with weakness and L'Hermitte’s phenomena at the age of 35. Initially mistaken as a TIA, MRI of the brain revealed numerous plaques in the white matter suggesting Multiple Sclerosis. Her lumbar puncture initially failed to demonstrate the presence of oligoclonal bands, but since progression of the disease over the past few years bands have developed.
Primary Lateral Sclerosis - Cranial Nerves Exam - Hypoglossal (CN XII) Sub-exam - Patient 14
This video features a 54-year-old white male who presented for evaluation of progressive spastic paraparesis. He stated that symptoms first started in 1997 when "things were different with my legs" (i.e., leg weakness, imbalance, and speech problems). Symptoms started in his left foot, when he couldn't keep time to music. His feet started dragging and he also noticed problems with balance. In 1999, he started falling and sought medical attention. He was diagnosed with spastic paraparesis after
Primary Lateral Sclerosis - Station and Gait Exam - Station Sub-exam - Patient 14
This video features a 54-year-old white male who presented for evaluation of progressive spastic paraparesis. He stated that symptoms first started in 1997 when "things were different with my legs" (i.e., leg weakness, imbalance, and speech problems). Symptoms started in his left foot, when he couldn't keep time to music. His feet started dragging and he also noticed problems with balance. In 1999, he started falling and sought medical attention. He was diagnosed with spastic paraparesis after
Parkinson Disease - Cranial Nerves Exam - Hypoglossal (CN XII) Nerve Sub-exam - Patient 10
The patient is a 68-year-old Caucasian male admitted to the VA on February 27, 2002, because of severe tremors and inability to walk due to chronic Parkinson Disease. This gentleman had been living with Parkinson Disease for many years and apparently, in spite of prescribed medications, had not improved or was getting worse. He experiences tremors, drooling, an inability to walk, and difficulty swallowing. Recently he had been unable to take the full dose of his carbidopa/levodopa medication du
