A 45-year-old man comes to the clinic due to a 2-month history of increased left arm clumsiness and weakness. He has recently developed problems with his gait. The patient's symptoms have interfered with daily activities such as bathing and dressing. He has had no recent injury, headaches, or bowel/bladder symptoms. On physical examination, there is reduced muscle strength in the left upper extremity. Further evaluation with brain MRI reveals a lesion involving the corticospinal tract. Which of the following additional signs is most likely to been seen in this patient?

Question

A 45-year-old man comes to the clinic due to a 2-month history of increased left arm clumsiness and weakness. He has recently developed problems with his gait.  The patient's symptoms have interfered with daily activities such as bathing and dressing.  He has had no recent injury, headaches, or bowel/bladder symptoms.  On physical examination, there is reduced muscle strength in the left upper extremity.  Further evaluation with brain MRI reveals a lesion involving the corticospinal tract.  Which of the following additional signs is most likely to been seen in this patient?

Quizplus · Accepted Answer

Eductional Objective: Upper motor neuron damage leads to spastic paralysis, hyperreflexia, and an upgoing plantar reflex (Babinski sign) due to loss of descending inhibition over lower motor neurons in the anterior horn.  Conversely, lower motor neuron lesions cause flaccid paralysis, hypotonia, hyporeflexia, muscle atrophy, and fasciculations.

A 45-Year-Old Man Comes to the Clinic Due to a 2-Month