ANKLE CLONUS

Ask the following questions:

1. What other symptoms and signs are present? Ankle clonus rarely occurs by itself. Usually, there are pathologic reflexes such as a Babinski's sign on the lower extremities. The patient usually also will complain of weakness and may be found to have weakness when the muscles are tested. If the ankle clonus is long-standing, there will be atrophy. There will also frequently be sensory findings, as well as sensory complaints. Finally, with bilateral ankle clonus there will often be hyperactive reflexes throughout the lower extremities and sometimes in the upper extremities.
2. Is the ankle clonus unilateral or bilateral? If it is unilateral, then it is a sign of either hemiparesis or monoplegia, and if it is hemiplegia or hemiparesis, one should consider the possibility of a cerebral disorder. If there is headache and papilledema, that disorder is most likely a space-occupying lesion of the brain such as a brain tumor, abscess, or hematoma. If there is hemiparesis and it is acute in onset, there is most likely an occlusion of one of the cerebral arteries, whereas if the hemiparesis is gradual in onset, one should consider multiple sclerosis and, once again, a brain tumor. Ankle clonus associated with monoplegia is more likely related to a spinal cord tumor, but a parasagittal tumor could also be present. Bilateral ankle clonus is more likely due to a disorder of the spinal cord such as a spinal cord tumor, amyotrophic lateral sclerosis, or multiple sclerosis. Syringomyelia and Friedreich's ataxia may also present with bilateral ankle clonus. However, if there are cranial nerve signs, one must consider a brain stem tumor as well as other degenerative diseases of the brain and brain stem.

DIAGNOSTIC WORKUP

Ankle clonus is a significant clinical sign, especially when it is unilateral. Therefore, if a brain disorder is suspected, a CT scan of the brain or MRI of the brain should be done. If a spinal cord lesion is suspected, then a CT scan at the appropriate level of the spinal cord should be done. If there are no findings on the examination to indicate a level, then of course the entire spine would have to be covered. MRI is a more cost-effective method for the cervical and thoracic levels of the cord. The spinal tap with analysis of the fluid for myelin basic protein and gamma globulin levels should be done if multiple sclerosis is suspected. In addition, somatosensory evoked potentials (SSEPs) and visual evoked potentials (VEPs) should also be done if multiple sclerosis is suspected. Finally, the most cost-effective approach to a patient with ankle clonus is to refer the patient to a neurologic specialist.

Book Source Details

• Book Title: Algorithmic Diagnosis of Symptoms and Signs
• Author(s): R. Douglas Collins
• Year of Publication: 2003
• Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.

Other Book Chapters Related to Ankle swelling

Read excerpts from these other book chapters related to Ankle swelling:

Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2008 Williams & Wilkins.

More About Causes of Ankle swelling

• Back to symptom: Ankle swelling: Introduction (review 98 causes)
• Next Book Extract About Ankle swelling: Ankle Pain/Swelling (In a Page: Signs and Symptoms)
• All Book Extracts: All Online Book Extracts for Ankle swelling

More About This Book: Title: Algorithmic Diagnosis of Symptoms and Signs Authors: R. Douglas Collins Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 0-7817-3805-9

 » Next page: Ankle Pain/Swelling (In a Page: Signs and Symptoms)

Rate This Website

What do you think about the features of this website? Take our user survey and have your say:

Website User Survey

Medical Tools & Articles:

Next articles:

• Ankle Pain/Swelling (In a Page: Signs and Symptoms)
• Periorbital Edema (In a Page: Signs and Symptoms)
• Peripheral Edema (In a Page: Signs and Symptoms)
• Edema (In A Page: Pediatric Signs and Symptoms)
• Periorbital Edema (In A Page: Pediatric Signs and Symptoms)

Tools & Services:

• Bookmark this page
• Take a survey relating to Ankle swelling
• Symptom Search
• Symptom Checker
• Medical Dictionary
• Give your feedback

Medical Articles:

• Disease & Treatments Search
• Misdiagnosis Center
• Full list of interesting articles

Forums & Message Boards

• Ask or answer a question at the Boards:
• I cannot get a diagnosis. Please help.
• Tell us your medical story.
• Share your misdiagnosis story.
• What is the best treatment for my condition?
• See all the Boards.

Enter your search terms Submit search form
Search The Web Search wrongdiagnosis.com

Common Health Mistakes

Symptom
Checker

Search Specialists by State and City