Presenter: Tyler Reimschisel, MD Preceptor: Harvey Singer, MD


October 07, 2002

General Physical Examination

On general appearance, the patient is alert, pleasant, and well nourished, with no abnormalities found on general examination. Significantly, there is no hepatosplenomegaly.

Neurologic Examination

Mental status: The patient is fully oriented. She has no problems with fluency, comprehension, naming, and repetition. Concentration is normal. Her affect is somewhat constricted, but she does occasionally smile and laugh.

Cranial nerves: Visual acuity is normal with corrective lenses. Fundoscopic examination is normal. She has full extraocular movements with normal smooth pursuit and saccades. There is no visual field deficit. Facial sensation is intact, but her lower facial musculature is weak bilaterally and spontaneous facial movements are diminished. Hearing is intact.

She has poor articulation with lingual and palatal phonation. There are no tongue fasciculations. Gag reflex is normal. She has difficulty initiating a swallow, but no difficulty swallowing after it is initiated. She has no observable abnormal facial movements.

Motor: Bulk, tone, and power are normal and symmetric. There are no abnormal movements noted in her extremities or trunk. Her movements are fluid.

Tendon reflexes: Deep tendon reflexes are 2/4 throughout. Babinski sign is absent bilaterally.

Cerebellar function: Finger-nose-finger, rapid alternating movements, sequential finger tapping, ability to stop rapid movements, and heel-shin testing are normal. Romberg test is negative.

Gait: The patient demonstrates a diminished swing-through of her arms while walking. She does not appear to have any incoordination. She can toe-walk, heel-walk, and tandem-walk without difficulty.


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