Wall's

Wall's sign is a clinical sign used in the field of neurology to assess the integrity of the upper motor neuron pathway, particularly in the context of diagnosing conditions such as stroke and multiple sclerosis. It is named after the physician who first described it. The sign is elicited by observing the patient's ability to perform certain movements or reflexes that are typically diminished or altered when there is damage to the upper motor neurons.

Procedure

To test for Wall's sign, a healthcare provider asks the patient to perform a specific task that involves the use of muscles controlled by the upper motor neurons. One common method involves asking the patient to rapidly alternate between flexion and extension of the fingers or to perform rapid movements of the feet. The presence of slowness, clumsiness, or the inability to perform these movements can indicate a positive Wall's sign, suggesting a lesion in the upper motor neuron pathway.

Clinical Significance

A positive Wall's sign is indicative of a problem with the upper motor neuron pathway but is not specific to any single disease. It can be observed in various neurological conditions, including:

• Stroke: Sudden loss of brain function due to a disturbance in the blood supply to the brain.
• Multiple sclerosis: A chronic autoimmune disease that affects the central nervous system, leading to demyelination and neurological disability.
• Amyotrophic lateral sclerosis (ALS): A progressive neurodegenerative disease that affects nerve cells in the brain and the spinal cord.
• Cerebral palsy: A group of permanent movement disorders that appear in early childhood.

Differential Diagnosis

While Wall's sign can be a useful tool in the neurological examination, it is important to consider it in the context of other findings. A comprehensive assessment including history, physical examination, and possibly further diagnostic testing (e.g., MRI, CT scan) is necessary to determine the underlying cause of the positive sign.

Limitations

The sensitivity and specificity of Wall's sign can vary, and it may not be present in all patients with upper motor neuron lesions. Additionally, the ability to perform the test may be influenced by the patient's age, cognitive function, and cooperation.

See Also

• Babinski sign
• Hoffmann's sign
• Upper motor neuron
• Neurological examination