Eliana Teixeira Maranhão

Can Clinical Tests Detect Early Signs of Monohemispheric Brain Tumors

Background and Purpose: Prior to modern neuroimaging, neurological treatment decisions were based on findings obtained from patient history and clinical examination. Despite the availability of sophisticated neuroimaging methods, to identify intracranial tumors the clinical recognition of associated subtle motor deficits is important for practice. Precise clinical tests are particularly advantageous, as some tumors may remain unnoticed for many. The purpose of this study was to determine the sensitivity and specificity of 13 clinical tests for detection of subtle motor deficits in patients with unilateral brain tumors. Methods: Sixty patients with unilateral brain tumors without obvious focal signs and 30 controls with normal magnetic resonance imaging were examined. Thirteen clinical maneuvers described to detect motor deficits were performed and their sensitivity, specificity, and positive and negative predictive values were estimated. Results: The test with greatest sensitivity and specificity (with 95% confidence interval) was the Digit Quinti Sign: 0.51 (0.41-0.61) and 0.70 (0.61-0.79), respectively. The agreement measurement among the 3 most sensitive signs (Digit Quinti Sign, Pronator Drifting Test, and Finger Rolling Test) was 21%. The Kappa index for these 3 tests indicated no significant concordance. Conclusions: The Digit Quinti Sign, the Pronator Drifting Test, and the Finger Rolling Test are simple yet very useful maneuvers that clinicians can perform at bedside. Even without apparent motor deficits, when present, these signs suggest that comprehensive investigation for intracranial neoplams should be undertaken.

Evaluation of the "spasticity of conjugate gaze phenomenon" in unilateral cerebral lesions

The spasticity of conjugate gaze phenomenon (SCG) is a subtle motor ocular sign that usually indicates unilateral acute cerebral lesion. We analyzed the sensitivity of this sign in a prospective blinded study using 57 patients. All patients had monohemispheric brain lesions without resting deviation of the eyes and no motor complaints. Fourteen individuals without cerebral lesions were included as controls. Patients and controls were submitted to a brain magnetic resonance image. We observed SCG in just 1/57 (sensitivity of 1.7%), while all controls had a normal Bells phenomenon. We speculate that SCG may disappear over time and is not useful to diagnose a long-lasting unilateral brain lesion.