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The Wald-Wolfowitz runs test, commonly referred to as the runs test, is a nonparametric test used to assess the randomness of ordered data. The test evaluates the number of runs, which are consecutive sequences of similar elements within the data. If the number of runs is significantly higher or lower than expected, the data is considered non-random, indicating a detectable pattern or structure.
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Don't neglect the clock drawing test.

Michal Vinker Shuster1, Maayan Hannah2, Zalut Todd2

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Summary
This summary is machine-generated.

A patient presented with left arm weakness and abnormal reflexes. Neurological examination and clock drawing suggested a right parietal lesion, possibly a neoplasm, as the most likely cause.

Keywords:
Emergency DepartmentsNeurology

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Area of Science:

  • Neurology
  • Neuroscience
  • Medical Diagnostics

Background:

  • A 63-year-old woman with hypertension presented with a 2-day history of left arm paresis.
  • She experienced preceding flu-like symptoms with intermittent left arm weakness.
  • Neurological examination revealed left upper limb weakness (4/5), drift, pronation, and hyper-reflexia.

Observation:

  • The patient denied noticing any difference in arm positions.
  • Cranial nerve function was normal, and other motor, cerebellar, sensation, and gait functions were intact.
  • A clock drawing test was performed to assess cognitive and visuospatial function.

Findings:

  • The clinical presentation and neurological signs pointed towards a focal neurological deficit.
  • The specific pattern of symptoms, including hemiparesis and reflex changes, suggested a lesion in the right cerebral hemisphere.
  • The differential diagnosis included right cerebral bleeding, middle cerebral artery occlusion, and a right parietal lesion.

Implications:

  • A right parietal lesion, potentially a neoplasm, was identified as the most probable etiology.
  • This case highlights the importance of thorough neurological examination and specific tests like the clock drawing test in diagnosing neurological conditions.
  • Prompt diagnosis and management are crucial for patients presenting with acute neurological deficits.