- pronator drift (pyramidal drift) was the 1st to be described
- Dr. Barre was the 1st to report it
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Pronator drift (Barre’s sign)
progress from distal to proximal
1st downward arm drift
2nd forearm pronation
3rd flexion of the wrist and elbow
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Pronator drift – assessment
"patient extends both arms upright in the supinated position and hold them at shoulder height for at least 10 sec (patient should be asked to keep eyes open initially and later test again with eyes closed)"
via: daihocyduoc 4/
Response
“the examiner can simple wait for the response or hasten the process by tapping on the patient’s palms or having the patient turn the head back and forth, or both”
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Pronator drift development
The stronger muscles of the upper limbs are "pronators, biceps, and internal rotators of the shoulder"
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Clinical significance
a. can detect subtle upper motor neuron lesion which goes unrecognized by routine motor examination
b. included in initial examination of stroke
c. if only one motor test could be done in a patient – the best single test would be to examine the drift
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Mechanism
Why pronator drift occurs when eyes are closed?
Why pronator overcomes supinator in pyramidal lesion?
“downward drift without pronation of the paretic arm”
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Leg drift
“patient lies supine with the hips and knees flexed, the knees forming an angle of about 45 degrees”
-positive, heel will gradually slide downward, knee slowly extends, and the hip goes into extension, external rotation, and abduction
- no clear localization
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Meningitis
-inflammation of leptomeninges & underlying subarachnoid CSF
Meningismus
-morbid state characterized by meningitic syndrome (triad: headache, photophobia, nuchal rigidity)
Meningism
-synonymous of meningismus
-neck stiffness w/o meningeal inflammation
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Mechanism
“maneuvers used to elicit meningeal signs produce tension on inflamed and hypersensitive spinal nerve roots, and the resulting signs are postures, protective muscle contractions, or other movements that minimize the stretch and distortion of the meninges and roots”
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