Summary McTimoney College of Chiropractic - Clinical Neurology
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McTimoney - Clinical Neurology
Instelling
University Of Ulster
This document contains all necessary conditions that need to be learned for the exam. It includes what it is, who gets it, hallmark symptoms and key testing for each condition. The conditions marked in pink are the important conditions provided by the lecturer. Know this list and the case study exa...
List of Conditions
Spinal Cord/Nerves Lesions
01) Cauda Equina Syndrome (CES)
What is it
Compressed cauda equina due to herniation, stenosis or infection
Who gets it
Increased risk after age >30
Hallmark symptoms
Urinary retention
B&B incontinence
Saddle anesthesia
Pain/weakness/paralysis affecting both legs
Key tests
SMR
Slump & SLR, both producing pain in back & along sciatic nerve
02) Disc Herniation
2a) Incomplete Disc Herniation (Prolapse)
What is it
Age-related disc degeneration causes it to bulge hereby compressing and/or irritating 1 or more
nerve roots
Who gets it
M>F
Most common at age 25-50
Hallmark symptoms
Severe back pain (6-8)
Flaccid myotomal weakness (4-5)
Often an inciting event triggering the pain
Burning/electrical leg/arm pain
Key tests
Slump & SLR, both producing pain in back & along sciatic nerve
SMR
2b) Complete Disc Herniation (Sequestration)
What is it
Age-related disc degeneration causes it to break and spill its chemicals into spinal canal hereby
irritating & inflaming the affected nerve and potentially nerves below
Who gets it
List of Conditions 1
, M>F
Most common at age 25-50
Hallmark symptoms
Severe back pain (9-10)
Severe functional weakness (<3)
Cauda equina signs
Urinary retention
B&B incontinence
Saddle anesthesia
Pain/weakness/paralysis affecting both legs
Impaired movement
Key tests
Slump & SLR, both producing pain in back & along sciatic nerve
SMR
CN8 balance tests → imbalance
03) Central Lumbar Stenosis
What is it
Spaces within the lumbar spine are narrowed from bony spur formation putting pressure on nerves
Who gets it
Age >65
Many people over 50 have a mild, asymptomatic stenosis
RF → OA
Hallmark symptoms
Gradual onset of numbness/paresthesia in lower extremeties
Burning/crampy pain in calves
Shopping cart sign → aggravation by walking/extension
Key tests
SMR
At level of lesion = flacced weakness, hyporeflexia
Below lesion = spastic weakness, hyperreflexia
Romberg’s → positive eyes open
Babinski → possibly positive
Observe gait → steppage & wide-based stance
Muscle tone palpation
04) Central Cervical Stenosis = Cervical Spondylotic Myelopathy (CSM)
What is it
Spaces within the cervical spine are narrowed from bony spur formation putting pressure on nerves
List of Conditions 2
, Who gets it
Age >65
Many people over 50 have a mild, asymptomatic stenosis
RF → OA
Hallmark symptoms
Neck pain & limited ROM
Neck stiffness first 30 min after waking
Subtle loss of hand dexterity & fine motor control
Development of a fluid-filled cavity (syrinx) within the spinal cord commonly caused by CSF blockage,
which can extend up surrounding the brainstem (syringobulbia)
Who gets it
In 30’s age most common
M>F
Hallmark symptoms
Dissociated sensory loss (pain/T preserved) in both arms or in scarf-like distribution
Neurogenic pain (deep, aching) in neck/shoulders
Diffuse muscle atrophy in hands (claw hand)
With syringobulbia → all CN deficits from medulla, incl. spinal nucleus CN5
Key tests
SMR → loss of light touch & vibration, preservation of pain & T
Muscle tone palpation → spasticity
List of Conditions 3
, Tendon reflex testing → arms hyporeflexia, legs hyperreflexia
Test clonus & Babinski reflex → possibly positive
06) Spinal Infection
What is it
An infectious disease that affects the vertebral body (vertebral osteomyelitis = 95%) or invertebral disc
(discitis)
Who gets it
RF → conditions that compromise the immune system
Discitis peaks in children & older adults
Hallmark symptoms
Localised central, spinal back pain
Pain progression and location enlargement over wk-mo
Pain on any movement
Malaise, fever, chills
Key tests
From clinical history and physical examination
Measure T → fever
Muscle tone palpation → paraspinal spasm
Spinal screen
Severe pain on palpation of spine
Pain on any ROM & reduced Cx ROM
07) Multiple Sclerosis (MS)
What is it
Immune-mediated inflammatory disease that destroys the CNS myelin/axons leading to neurological
deficits in relapsing (85%) or progressive (15%) pattern
Who gets it
Common at age 20-40
F>M
Hallmark symptoms
CN (variable depending on where it affects brainstem):
Possible diplopia, facial sensation loss, dysarthria, vertigo
Medially deviated eyes (CN6 palsy) or nystagmus
Optic neuritis earliest complaint
Spinal cord:
Gradual onset of sensory/motor symptoms in limbs over hours/days with variable severity
Cx → Lhermitte’s phenomenon = electric shock-like sensation down neck/back on Cx flexion
Tx → tight band-like sensation around trunk/abdomen
List of Conditions 4
, Key tests
CN2 testing → visual field loss
CN3/4/6 → diplopia, medially deviated eyes
CN5 → facial sensation loss
CN9/10 → dysarthria
SMR
08) Optic Neuritis
What is it
Inflammation of optic nerve (CN2) affecting eyes and vision
CN2 testing → visual field loss, blurring, papilledema
CN2/3 testing → reduced pupillary reflex
CN3/4/6 testing → pain on all ROM
09) Spinal Tumour
What is it
An abnormal mass of tissue within/surrounding spinal cord and/or spinal column that grows and
multiplies uncontrollably
Who gets it
Anyone, cause unknown
Hallmark symptoms
Gradual onset of segmental/back pain
Interruption of decussating pain/temp fibres
Extremeties LMN weakness at affected level, UMN weakness below level
Bilateral sensory deficit spreads down as lesion expands
Difficulty walking
Key tests
SMR
At level of lesion = flaccid weakness, hyporeflexia
Below lesion = spastic weakness, hyperreflexia
List of Conditions 5
, Romberg’s → positive eyes open or closed
CN8 balance tests → imbalance
Peripheral Nerve Lesions
10) Horner’s Syndrome
What is it
Condition affecting the eye due to interruption of the sympathetic nerve supply of the face
Who gets it
Increased risk after stroke, tumour or spinal cord injury
Hallmark symptoms
Miosis & dilation lag
Ptosis
Anhidrosis
Key tests
CN 3/4/6 testing → miosis, ptosis
CN 2/3 → dilation lag
Entrapment Neuropathies
Risk factors for all mononeuropathies = hypothyroidism, diabetes & overuse/trauma
11) Carpal Tunnel Syndrome (CTS)
What is it
A mononeuropathy causing entrapment of the median nerve at the wrist
Who gets it
Most common form
F>M
RF → repetitive strain, pregnancy, hypothyroidism
Hallmark symptoms
Pain in hand/wrist
Numbness & paresthesia (tingling & P&N) in hand/wrist
Weak wrist flexion & thumb opposition
Key tests
Cotton wool & pin prick
Muscle strength testing
Tinel’s & Phalen’s
12) Pronator Teres Syndrome (PTS)
What is it
A mononeuropathy causing entrapment of the median nerve at the elbow
Who gets it
List of Conditions 6
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