Ataxia | Paraneoplastic disease, cerebellar tumour, Whipple’s disease, Creutzfeldt-Jakob disease (CJD), AIDS dementia complex, spinocerebellar ataxia (SCA), Wernicke-Korsakoff syndrome, Hallervorden-Spatz, ornithine transcarbamylase deficiency, Niemann-Pick disease, mitochondrial disorders, adrenoleucodystrophy, neurodegeneration with brain iron accumulation (NBIA), lead poisoning |
Involuntary movements | Huntington’s disease (HD), inherited metabolic disorders including Wilson’s disease, CJD, corticobasal degeneration (CBD), systemic lupus erythematosis, Whipple’s disease, Hallervorden Spatz, Lesch-Nyhan |
Myoclonus | Post-anoxia, CJD, Alzheimer’s disease (AD), subacute sclerosing panencephalitis (SSPE), myoclonic epilepsies, Hashimoto’s encephalopathy, dementia with Lewy bodies, CBD |
Extrapyramidal signs | Dementia with Lewy bodies, Parkinson’s disease, progressive supranuclear palsy (PSP), vascular dementia, frontotemporal dementia (FTD), CJD, Wilson’s disease, HD, dentato-rubro-pallido-luysian atrophy (DRPLA), neuroacanthocytosis, cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy (CADASIL), Niemann-Pick, mitochondrial disorders, NBIA |
Pyramidal signs | Motor neuron disease, CJD, LCBD, B12 deficiency, multiple sclerosis (MS), SCA, multi system atrophy, hydrocephalus, AD, Hallervorden Spatz, CADASIL, mitochondrial disorders, adrenoleucodystrophy, FTD |
Optic disc pallor | MS, B12 deficiency |
Papilloedema | Tumour, subdural haematoma, hydrocephalus |
Cortical blindness | Vascular disease, AD, CJD |
Anosmia | Subfrontal meningioma, head injury, AD, PD, HD |
Abnormal eye movements | Progressive supranuclear palsy, Wernicke-Korsakoff, Whipple’s disease, CBD, mitochondrial cytopathies, cerebellar tumours, causes of raised intracranial pressure, CJD, mitochondrial disorders, HD, Niemann Pick type C |
Other cranial nerve signs | Sarcoidosis, tumours, neoplasia, tuberculous meningitis |
Alien hand | CBD |
Visual field defect | Tumour, vascular disease, CJD |
Pupillary abnormalities (Argyll Robertson pupil) | Neurosyphilis |
Peripheral neuropathy | Vitamin B12 deficiency, paraneoplastic disorders, neuroacanthocytosis, spinocerebellar ataxia, Hallervorden Spatz, adrenoleucodystrophy, NBIA, lead poisoning, systemic lupus erythematosus (SLE) |
Early onset incontinence | Tumour, hydrocephalus, PSP |
Bulbar features | Frontal dementia (motor neuron disease) |
Fasciculations | Frontal dementia (motor neuron disease), rarely CJD |
Seizures | Vasculitis, neoplasia, primary angiitis of the nervous system, limbic encephalitis, AIDS dementia complex, neurosyphilis, SSPE, Hashimoto’s encephalopathy |
Grimacing facial expression | Wilson’s disease |