ABSTRACT
Neurology cases lend themselves to being spot diagnoses. Neurology is often thought of as being a particularly difficult station, but if the doctors work on the premise that they are trying to find the site of the lesion and then consider the differential diagnosis, they will demonstrate to the examiners that they are organised and pragmatic. When assessing sensation, be sure to check for normal sensation on the chest first. Compare normal sensation with the peripheral sensation. It is important to decide early whether to assess sensation in a dermatomal or a peripheral pattern. This is not always possible. Therefore, start in a dermatomal distribution and move on to test glove and stocking pattern if peripherally confluent. The most likely diagnosis is motor neurone disease (MND). There is generalised wasting and fasciculation. Tone is increased with generalised weakness. Reflexes are brisk/reduced/absent. Leg reflexes are brisk and ankle clonus is present. There are bilateral extensor plantar responses.
