This is not a complete note or a guide. This was prepared by me based on the teachings of Dr.R.M.Mudiyanse just to aid the short cases.

1. Lower limb short cases
1.
2.
3.
4.
5.
Severity: functional capacity- walk with support,
muscle power
Structural/ functional
Anatomy
Severity
Etiology
Complications
Etiology
Quadriplegia
Dysmorphism
CP- OFC, ↓glucose
Monoplegia
Hemiplegia: vascular
Diplegia:
ICH-int capsule- usually in premature
Cerebellum: chickenpox, malaria, agenesis, ArnoldChiari
malformation,
Ataxia
telengiectasia
(→nystagmus→ bulbar telengiectasia)
Basal ganglia: ↑ bilirubin
Possible exam cases
Structural
Bone: rickets, CTEV
Muscle: congenital myopathy, DMD
Skin/vascular: Klippel-Trenaunay Sy
Functional
UMN: CP, ataxia
LMN: GBS
Complications
Contractures: adductor/ Achilles’ tendon
Anatomy
UMN
1. ↑ Tone
2. ↑ Reflex
3. Upgoing plantar
4. Clonus
5. +/- global dvt delay
6. Microcephaly
Could this be cortical lesion?
1. UMN features with higher functionscommunication/ speech
2. Cortical type motor (fine motor loss)/
sensory (graphesthesia, steriognosis) loss
3. Microcephaly: seizures
Differentiate GBS-diplegia-paraplegia
GBS: LMN lesion
Diplegia: paralysis involving both sides of the body &
affecting legs > arms
Cerebral diplegia→ UMN
Paraplegia: paralysis of both legs, usually due to dx or
injury of the SC. So sensory loss+ disturbed bladder
function
Comprehensive diagnosis
This child probably having target joint on L/S may
have presented with haemophilia & wasting of
quadriceps on L/S with contractures.
Mid-brain
1. Eye muscle
2. Dense hemiplegia
Pons
1.
2.
Facial muscle
Mastication muscles
Medulla
1. Swallowing/ palatal palsy
Spinal cord
1. Motor & sensory level
2. Bladder bowel involvement
Mixed
1.
Hereditary: inverted Shampane bottle
Cerebellum
1. Ataxia
2. Nystagmus
Basal ganglia
1. Dyskinesia
LMN
1.
2.
3.
4.
↓ Tone
↓ Reflex
Fasciculation
Generally sparing higher functions
Yapa Wijeratne