Limb Weakness

LESION LOCALISATION

The foregoing clinical features readily distinguish weakness of an upper motor neuron, lower motor neuron or mixed pattern. Combining these findings with other neurological signs enables localisation of the lesion site.

UPPER MOTOR

NEURON LIMB WEAKNESS - UNILATERAL

UPPER MOTOR

NEURON LIMB WEAKNESS - UNILATERAL

..Face (lower motor neuron pattern).

HEMIPLEGIA

..Face (lower motor neuron pattern).

Leg HEMIPLEGIA

HEMIPLEGIA

Leg HEMIPLEGIA

Useful localising features (not always present)

Impairment of conscious level.

Visual field deficit.

Dysphasia (if dominant hemisphere).

Alert.

No dysphasia (if dominant hemisphere).

Visual field deficit rare.

Contralateral III nerve palsy.

Conjugate gaze deviation towards the weak limbs (impaired movement towards the 'normal' limb).

Lower motor neuron facial weakness on side opposite the weak limbs.

MONOPLEGIA

MONOPLEGIA

Visual field deficit. Discriminatory sensory deficit. Pain and temperature loss on the same side as the weakness and a Horner's syndrome and weak palate and tongue on the opposite side.

Pain and temperature loss on the opposite side to the limb weakness and a Horner's syndrome and proprioception loss on the same side.

Visual field deficit. Dysphasia (if dominant hemisphere).

Discriminatory sensory deficit. Discriminatory sensory deficit. \ i Pain and temperature loss in the opposite leg, proprioception loss on the same side.

Lesion site

CONTRALATERAL HEMISPHERE LESION

CONTRALATERAL INTERNAL CAPSULE LESION

CONTRALATERAL MIDBRAIN LESION

CONTRALATERAL PONTINE LESION

CONTRALATERAL CORTEX LESION

CONTRALATERAL MEDULLARY LESION

1PS1LATERAL SPINAL LESION

CONTRALATERAL CORTEX

CONTRALATERAL PONTINE LESION

CONTRALATERAL CORTEX LESION

CONTRALATERAL MEDULLARY LESION

LESION

IPSILATF.RAL . SPINAL LESION

1PS1LATERAL SPINAL LESION

CONTRALATERAL CORTEX

IPSILATF.RAL . SPINAL LESION

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