) Numbness and tingling- Subacute combined degeneration, spinal tumours, disc protrusion, fluorosls.

malformation with minor bleed or oedema, hysterical. 7. SYMPTOMS - (a) Pain - Constant or intermittent in extramedullary spinal tumour, may be aggravated by coughing or straining. Rool pains in radicular spinal syndrome, syringomyella. (b) Numbness and tingling- Subacute combined degeneration, spinal tumours, disc protrusion, fluorosls. (c) Progress of symptoms - Frequent arrests In mutiple sclerosis and syringomyelia. Rapid progress in malignant deposits. (d) Psychological symptoms - Euphoria common in multiple sclerosis. Mental symptoms in subacute combined degeneration and GPI Mental deficiency in cerebral diplegia. (e) Fever - may be present with tuberculosis of spine, or epidural abscess. It Physical examination - . SPEECH • Staccato speech in multiple sclerosis, dysarthria in arnyotrophic lateral sclerosis and syringomyelia. CRANIAL NERVES - Paralysis in inlracraniat tumours. Nystagmus in multipie sclerosis. Pupillary changes in neurosyphilis. Inability to swallow In arnyotrophic lateral sclerosis. 3. MOTOR SYSTEM - (a) Wasting - In presence of Increased jerks suggestive of amyotrophlc lateral sclerosis. Combination of upper motor paralysis In lower extremities and lower motor in upper extremities - (1) Arnyotrophic lateral sclerosis, (il) Syringomyelia. (iilj HaematomyeliaH (iv) Hypertrophic cervical pachy meningitis, and fv) Compression of cervical region by tumour or cervical cfec degeneration, (vl) Multiple sclerosis, (vii) Nutritional deficiencies. (b) Co-ordination - Ataxia combined with spastlcity Jn early stage of subacute combined degeneration; multiple sclerosis. Friedreich's ataxig, cervical spondylotic myelopathy, craniovertabral anomalies. (e) involuntary movements - Tremors in multiple sclerosis. Muscular fascieul ations In amyotrophlc lateral sclerosis* and synngomyelia Chore oath etc id movements In cerebral dplegia