title: Can clinical tests detect early signs of monohemispheric brain tumors?
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Physiotherapy, National Cancer Institute, Rio de Janeiro, Brazil. limaranhao@gmail.com
authors.forename: Eliana Teixeira
authors.initials: ET
authors.lastname: Maranhão
authors.forename: Péricles
authors.initials: P
authors.lastname: Maranhão-Filho
authors.forename: Marco Antonio
authors.initials: MA
authors.lastname: Lima
authors.forename: Maurice Borges
authors.initials: MB
authors.lastname: Vincent
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001254:Astrocytoma / Q000175:diagnosis*; D001932:Brain Neoplasms / Q000175:diagnosis*; D042241:Early Diagnosis; D004806:Ependymoma / Q000175:diagnosis; D005260:Female; D007839:Functional Laterality; D005909:Glioblastoma / Q000175:diagnosis*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008577:Meningeal Neoplasms / Q000175:diagnosis; D008579:Meningioma / Q000175:diagnosis; D008875:Middle Aged; D018306:Neurocytoma / Q000175:diagnosis; D009460:Neurologic Examination / Q000379:methods*; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D055815:Young Adult