Expanded Neurological Deficit & Lesion Localization Chart

Expanded Neurological Deficit & Lesion Localization Chart

Expanded Neurological Deficit & Lesion Localization Chart

Neurological Deficit / Named Sign Likely Lesion Location Notes / Examples
Hemiplegia / HemiparesisContralateral motor cortex or corticospinal tract above medullaMCA stroke → opposite side weakness
QuadriplegiaBilateral cervical spinal cord or brainstemHigh cervical injury, brainstem infarct
ParaplegiaThoracic spinal cordTrauma, tumor, transverse myelitis
MonoplegiaCortical motor area or peripheral nerveStroke, plexopathy
Foot dropCommon peroneal nerve, L5 rootPeripheral neuropathy, disc prolapse
Wrist dropRadial nerveHumeral fracture, lead poisoning
Babinski signCorticospinal tract (UMN lesion)Stroke, MS
Hoffman signCorticospinal tractCervical myelopathy
Clasp-knife rigidityUMN lesionStroke, spinal cord injury
Cogwheel rigidityBasal gangliaParkinson’s disease
ChoreaBasal gangliaHuntington’s disease
HemiballismusSubthalamic nucleusStroke
Loss of touch/pain/temp (one side)Contralateral parietal lobe or sensory tractMCA stroke, thalamic lesion
Loss of vibration & proprioceptionDorsal columnsPosterior cord syndrome
Sensory level on trunkSpinal cordTransverse myelitis
Glove-and-stocking sensory lossPeripheral neuropathyDiabetes
ParesthesiaPeripheral nerve / spinal cord / cortexMultiple causes
AllodyniaThalamus / sensory pathwayPost-stroke pain
Romberg signDorsal columns or vestibular systemPositive if unsteady with eyes closed
Lhermitte signCervical spinal cord (dorsal columns)MS, B12 deficiency
AstereognosisContralateral parietal lobeCannot identify object by touch
AgraphesthesiaParietal lobeCannot identify numbers traced on skin
Facial weakness (upper+lower)Ipsilateral facial nerveBell’s palsy
Facial weakness (lower only)Contralateral motor cortexUMN lesion
DiplopiaCN III, IV, VI or brainstemStroke, MS
PtosisCN III or sympathetic pathwayHorner’s, CN III palsy
AnisocoriaCN III or sympathetic pathwayHorner’s, CN III palsy
Bitemporal hemianopiaOptic chiasmPituitary adenoma
Homonymous hemianopiaOptic tract/radiations/occipital cortexStroke, tumor
Internuclear ophthalmoplegiaMLF in brainstemMultiple sclerosis
Kernig signMeningeal irritationMeningitis
Brudzinski signMeningeal irritationMeningitis
Dysarthria & dysphagiaMedulla / CN IX, X, XIILateral medullary syndrome
Loss of corneal reflexCN V (sensory) or VII (motor)Brainstem lesion
Loss of gag reflexCN IX, XBrainstem lesion
AtaxiaCerebellum (ipsilateral)Stroke, tumor
DysdiadochokinesiaCerebellar hemisphereInability for rapid alternating movements
Intention tremorCerebellar hemisphereMS, stroke
NystagmusCerebellum / vestibularVestibular neuritis
HypotoniaCerebellumAcute lesion
Rebound phenomenonCerebellumFailure to stop movement
TitubationMidline cerebellumHead tremor
Wide-based gaitCerebellumMidline lesion
AphasiaDominant hemisphereBroca’s/Wernicke’s area
ApraxiaDominant parietal lobeCannot perform learned movement
NeglectNon-dominant parietal lobeRight parietal stroke → left neglect
AgnosiaParietal/occipital/temporal cortexFailure to recognize objects
Alexia without agraphiaDominant occipital cortex + splenium corpus callosumStroke
Gerstmann syndromeDominant parietal lobe (angular gyrus)Agraphia, acalculia, finger agnosia, L-R disorientation
Seizures with focal signsCerebral cortexEpilepsy, tumor
Acute confusion + memory lossBilateral hippocampus / diffuse cortexHypoxia, encephalitis
Ophthalmoplegia + ataxia + confusionMidbrainWernicke’s encephalopathy

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