Examination of other organ systems is most useful in finding clues that may establish the cause of the weakness. Examination of the skeletal system can help to confirm localization of the lesion in certain circumstances. For example, the presence of a scoliosis may increase suspicion of a thoracic cord lesion. An asymmetry in the length or size of the limbs on one side suggests a deficit in growth during development that is compatible with a congenital hemispheral motor lesion.
Examination of the skin may disclose the cafe-au-lait spots or axillary freckling of neurofibromatosis, a hairy patch or dimple over the lumbar spine at the site of a tethered cord, or inflammatory skin changes compatible with dermatomyositis. If a stroke or transient ischemic attack (TIA) is suspected, it is especially important to examine the heart for murmurs and arrhythmias and the carotid arteries for a bruit or pulse deficit. Inflammation or deformities of the joints may also limit the ability of the patient to exert full strength and give a false sense of weakness. The optic fundi should be examined for the presence of papilledema and lesions of the retina and macula that may be seen in patients with metabolic, developmental, or inflammatory diseases.
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