Hyperreflexia

Hyperreflexia is a classic sign of UMN disease but can be seen in other conditions such as thyrotoxicosis.
Hyperreflexia in one limb or in lower but not upper extremities can help localize lesions.

Patient 1

This is an older man who presented with progressive paresthesias of the hands and difficulty walking. He was diagnosed with severe cervical myelopathy from degenerative joint disease.

This patient also has a positive Hoffmann’s sign and a spastic gait.