eurologic Exam:
Mental Status: History was consistent and coherent. Alert and oriented to person, place, time. Attention span was intact, and fund of knowledge was intact to current events. Speech is fluent without aphasia, apraxia, or dysarthria. No notable speech abnormality or voice abnormality.
Cranial Nerves: Pupils equal, round, and reactive to light bilaterally. Visual fields full to confrontation. Funduscopic exam: limited by pupillary constriction bilaterally. Extraocular movements were intact without nystagmus. No eyelid ptosis. Facial appearance was symmetric and full strength. Full, symmetric facial sensation V1-V3. Hearing acuity was intact to finger rub bilaterally. Palate and tongue were midline. Tongue movement was intact, full strength, no atrophy or fascics. There was no dysarthria. SCM and shoulder strength full bilaterally.
Motor: Normal bulk and tone. Full strength in bilateral upper and lower
HLD (hyperlipidemia).: Mother. HTN (hypertension): Father. Heart failure: MGF.
brother: healthy
2 children: healthy
MGF had Parkinsons, otherwise no family history of neurological disease.
extremities. No involuntary movement. There were 1-2 beats of non-sustained clonus in right ankle. No tremor noted at rest or with action. No pronator drift. No observed fasciculations.
Reflex: 3+ and symmetric in biceps, triceps, brachioradialis, patellar, Achilles. There was spread with patellar reflexes (ankle dorsiflexion). There was spread with biceps reflexes (finger flexion). Plantar reflexes downgoing. Negative Hoffman bilaterally. Negative jaw jerk.
Sensory exam: Full sensation to light touch, pinprick, temperature, and vibration in all extremities. Negative Romberg. No extinction or neglect. Cerebellar: No incoordination with rapid alternating movements. Finger to nose and heel-shin accurate.
Gait: Physiologic gait and station with full arm swing. Normal heel walk and toe walk. Normal tandem gait.
Assessment/Plan
1. Fasciculations
39 yo male with history of HLD, GERD, anxiety, depression, increased eye
pressure bilaterally, and recently diagnosed sleep apnea on CPAP presents for evaluation of various symptoms over the past 1 year, including left side weakness, perceived abnormal movement of tongue and face, perceived difficulty with speech and possibly swallowing, and perceived involuntary muscle twitches of face and extremities. On examination today, he has symmetrically brisk reflexes with spread, but no pathologic reflexes. He has 1-2 beats of clonus right ankle. He otherwise has normal cranial nerve function, strength, sensation, and gait. I did not note any tongue fasciculations, or other body fasciculations today.
I reviewed outside records from his local neurologist, Dr. Chan, and he did mention noting some tongue "dyskinesias" on his examination, but in assessment found now signs of any serious neurological condition. I reviewed patient's brain MRI report which was notable for a 7 mm cyst stable since 2009, otherwise unremarkable. I reviewed his cervical spine MRI report which was overall unremarkable, no significant spinal stenosis or neuroforaminal stenosis. I reviewed his outside EMG of left arm, left leg from June 2018, and this was normal.
I explained to patient that the cause of his various symptoms is idiopathic at this time.
I wanted to share this with everyone. It is the complete notes from my exam. Can anyone tell me what “spread means when it comes to reflexes? Please any advice if there is something in the notes to be of concern. Thanks for your time.