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Table 180-2

Findings Helpful for Localizations Within the Nervous System

Signs
CerebrumAbnormal mental status or cognitive impairment
Seizures
Unilateral weaknessa and sensory abnormalities including head and limbs
Visual field abnormalities
Movement abnormalities (e.g., diffuse incoordination, tremor, chorea)
BrainstemIsolated cranial nerve abnormalities (single or multiple)
“Crossed” weaknessa and sensory abnormalities of head and limbs, e.g., weakness of right face and left arm and leg
Spinal cordBack pain or tenderness
Weaknessa and sensory abnormalities sparing the head
Mixed upper and lower motor neuron findings
Sensory level
Sphincter dysfunction
Spinal rootsRadiating limb pain
Weaknessb or sensory abnormalities following root distribution (see Figs. 180-1 and 180-2)
Loss of reflexes
Peripheral nerveMid or distal limb pain
Weaknessb or sensory abnormalities following nerve distribution (see Figs. 180-1 and 180-2)
“Stocking or glove” distribution of sensory loss
Loss of reflexes
Neuromuscular junctionBilateral weakness including face (ptosis, diplopia, dysphagia) and proximal limbs
Increasing weakness with exertion
Sparing of sensation
MuscleBilateral proximal or distal weakness
Sparing of sensation

aWeakness along with other abnormalities having an “upper motor neuron” pattern, i.e., spasticity, weakness of extensors > flexors in the upper extremity and flexors > extensors in the lower extremity, and hyperreflexia.

bWeakness along with other abnormalities having a “lower motor neuron” pattern, i.e., flaccidity and hyporeflexia.