Amyotrophic lateral sclerosis physical examination
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohamadmostafa Jahansouz M.D.[2]
Overview
The presence of both Upper motor neuron and lower motor neuron signs on Physical examination in the same region with the exclusion of any other Neurological condition is highly suggestive of Amyotrophic lateral sclerosis.
Physical Examination
- ALS leads to progressive degeneration of the motor neurons that supply voluntary muscles, including Lower motor neurons in the medulla and anterior horn of the spinal cord as well as Lower motor neurons in the cerebral cortex.
- Physical examination of patients with amyotrophic lateral sclerosis is usually remarkable for:[1][2][3]
- Lower motor neuron signs:
- Upper motor neuron signs:
- Spasticity
- Hyperreflexia
- Weakness
- Positive Babinski sign
- Positive Hoffmann sign
- Emotional lability
- Foot drop
- Difficulty walking
- Abnormal gait patterns
- ALS begins in the limbs, usually the arms, in about two-thirds of patients. The first symptoms are most often unilateral and focal. As limb function deteriorates, patients become dependent on caregivers.[1][2][3]
- Sphincter and sensory functions are usually, but not always, spared. Eye movements are preserved until advanced stages.[1]
HEENT
- Dropped head
- Atrophied fasciculating tongu
- Nystagmus in advanced diseases
- Extra-ocular movements may be abnormal
- Hearing acuity is normal
Lungs
- Asymmetric chest expansion or decreased chest expansion may be seen
Heart
Abdomen
- Abdominal examination of patients with ALS is usually normal.
Back
- Back examination of patients with ALS is usually normal.
Genitourinary
- Urinary retention is common in patients with ALS. Urological evaluation is indicated in ALS patients with prominent spasticity.[6]
Neuromuscular
- Hyperreflexia or hyporeflexia
- Positive Babinski bilaterally
- Muscle rigidity
- Proximal and distal muscle weakness bilaterally
- Bilateral upper and lower extremity weakness
- Abnormal gait
Extremities
Physical examination of extremities in patients with amyotrophic lateral sclerosis is usually remarkable for:[1][2][3]
- Lower motor neuron signs:
- Upper motor neuron signs:
- Spasticity
- Hyperreflexia
- Weakness
- Positive Babinski sign
- Positive Hoffmann sign
- Emotional lability
- Foot drop
- Difficulty walking
- Abnormal gait patterns
References
- ↑ 1.0 1.1 1.2 1.3 Gordon PH (2013). "Amyotrophic Lateral Sclerosis: An update for 2013 Clinical Features, Pathophysiology, Management and Therapeutic Trials". Aging Dis. 4 (5): 295–310. doi:10.14336/AD.2013.0400295. PMC 3794725. PMID 24124634.
- ↑ 2.0 2.1 2.2 Zarei S, Carr K, Reiley L, Diaz K, Guerra O, Altamirano PF; et al. (2015). "A comprehensive review of amyotrophic lateral sclerosis". Surg Neurol Int. 6: 171. doi:10.4103/2152-7806.169561. PMC 4653353. PMID 26629397.
- ↑ 3.0 3.1 3.2 Goldfarb BJ, Simon SR (1984). "Gait patterns in patients with amyotrophic lateral sclerosis". Arch Phys Med Rehabil. 65 (2): 61–5. PMID 6696604.
- ↑ Namazi MH, Khaheshi I, Haybar H, Esmaeeli S (2014). "Cardiac failure as an unusual presentation in a patient with history of amyotrophic lateral sclerosis". Case Rep Neurol Med. 2014: 986139. doi:10.1155/2014/986139. PMC 4123615. PMID 25133001.
- ↑ Rosenbohm A, Schmid B, Buckert D, Rottbauer W, Kassubek J, Ludolph AC; et al. (2017). "Cardiac Findings in Amyotrophic Lateral Sclerosis: A Magnetic Resonance Imaging Study". Front Neurol. 8: 479. doi:10.3389/fneur.2017.00479. PMC 5623666. PMID 29021775.
- ↑ Lopes de Carvalho ML, Motta R, Battaglia MA, Brichetto G (2011). "Urinary disorders in amyotrophic lateral sclerosis subjects". Amyotroph Lateral Scler. 12 (5): 352–5. doi:10.3109/17482968.2011.574141. PMID 21506896.