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Can Clinical Tests Detect Early Signs of Monohemispheric Brain Tumors?

Maranhão, Eliana Teixeira PT, MSc; Maranhão-Filho, Péricles MD, PhD; Lima, Marco Antonio MD, PhD; Vincent, Maurice Borges MD, PhD

Journal of Neurologic Physical Therapy: September 2010 - Volume 34 - Issue 3 - p 145–149
doi: 10.1097/NPT.0b013e3181e5c10e

Background and Purpose: Prior to modern neuroimaging, neurological treatment decisions were based on findings obtained from patient history and clinical examination. Despite the availability of sophisticated neuroimaging methods, to identify intracranial tumors the clinical recognition of associated subtle motor deficits is important for practice. Precise clinical tests are particularly advantageous, as some tumors may remain unnoticed for many. The purpose of this study was to determine the sensitivity and specificity of 13 clinical tests for detection of subtle motor deficits in patients with unilateral brain tumors.

Methods: Sixty patients with unilateral brain tumors without obvious focal signs and 30 controls with normal magnetic resonance imaging were examined. Thirteen clinical maneuvers described to detect motor deficits were performed and their sensitivity, specificity, and positive and negative predictive values were estimated.

Results: The test with greatest sensitivity and specificity (with 95% confidence interval) was the Digit Quinti Sign: 0.51 (0.41-0.61) and 0.70 (0.61-0.79), respectively. The agreement measurement among the 3 most sensitive signs (Digit Quinti Sign, Pronator Drifting Test, and Finger Rolling Test) was 21%. The Kappa index for these 3 tests indicated no significant concordance.

Conclusions: The Digit Quinti Sign, the Pronator Drifting Test, and the Finger Rolling Test are simple yet very useful maneuvers that clinicians can perform at bedside. Even without apparent motor deficits, when present, these signs suggest that comprehensive investigation for intracranial neoplams should be undertaken.

Department of Physiotherapy (E.T.M.) and Department of Neurosurgery (P.M.-F., M.A.L.), National Cancer Institute, Rio de Janeiro, Brazil; and Department of Neurology (P.M.-F., M.B.V.), Universitary Hospital Clementino Fraga Filho, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.

Correspondence: Eliana Teixeira Maranhão, PT, MSc, Av. Canal de Marapendi, 1680/APT 1802, Rio de Janeiro, Brazil 22631-050 ( and

Funded by the following organizations: National Institutes of Health, Wellcome Trust, Howard Hughes Medical Institute, and other(s).

© 2010 Neurology Section, APTA