Table 1.27-1. Manifestations of upper and lower motor neuron dysfunction

Manifestation

Upper motor neuron

Lower motor neuron

Weakness

Often hemiparetic pattern

Often proximal in muscular weakness and distal in peripheral nerve weakness

Tendon reflexes

Hyperreflexia

Reduced or absent

Clonus (eg, foot clonus)

Present

Absent

Pathologic signs

Present (Babinski sign)a

Absent

Muscle atrophy

Absent; secondary atrophy possible due to lack of use of weak muscles

Develops relatively rapidly

Muscle tone

Increased (spastic)

Normal or reduced (flaccid)

Abdominal skin reflexes

Absent

Present

Pathologic movements (eg, chorea)

Present

Absent

Fasciculations

Absent

Occasionally present

a Babinski sign: dorsiflexion (extension) of the big toe on scratching the sole of the foot (with a blunt object moved along the outer aspect of the foot from the heel towards the front and the big toe).