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1.
Bol. méd. postgrado ; 35(2): 35-39, Jul.-Dec. 2019. graf
Article in Spanish | LILACS, LIVECS | ID: biblio-1120206

ABSTRACT

La infección por virus Zika es transmitida por la picadura del Aedes sp, aunque también se ha descrito la transmisión transplacentaria a los fetos. La microcefalia congénita es el primer hallazgo relacionado con la enfermedad y se asocia a defectos en la proliferación neuronal y muerte de las células progenitoras corticales que tiene como consecuencia una disminución de la producción neuronal y que resulta en una serie de trastornos cerebrales que comprometen la motricidad, visión, audición y funciones cognitivas. La presente investigación describió las características epidemiológicas, clínicas e imagenológicas en pacientes pediátricos con microcefalia secundario a la sospecha de infección por el virus Zika, que acudieron a la consulta de Neuropediatría del Servicio Desconcentrado Hospital Pediátrico Dr. Agustín Zubillaga de la ciudad de Barquisimeto, estado Lara durante el lapso diciembre 2016- septiembre 2017(AU)


Zika virus infection is transmitted by the bite of Aedes sp, although transplacental transmission to the fetuse has also been described. Congenital microcephaly is the first finding related to the disease and is associated with defects in neuronal proliferation and death of cortical progenitor cells, which result in a decrease in neuronal production and a group of brain disorders which compromise motor skills, vision, hearing and cognitive functions. The present study describes the epidemiological, clinical and imaging characteristics in pediatric patients with microcephaly secondary to suspected Zika virus infection who attended the Neuropediatric consultation of the Servicio Desconcentrado Hospital Pediátrico Dr. Agustín Zubillaga during the December 2016-September 2017 period(AU)


Subject(s)
Humans , Male , Female , Infant , Placental Circulation , Zika Virus/pathogenicity , Microcephaly/epidemiology , Microcephaly/diagnostic imaging , Venezuela/epidemiology , Tomography, X-Ray Computed , Reflex, Abnormal
2.
Rev. pesqui. cuid. fundam. (Online) ; 11(3): 588-593, abr.-maio 2019. tab
Article in English, Portuguese | LILACS, BDENF | ID: biblio-987542

ABSTRACT

Objetivo: Quais as associações entre os reflexos primitivos de neonatos nascidos com sexo, cor, estatura, perímetro cefálico, perímetro torácico, índice de Apgar, idade gestacional, tipo de parto, intercorrências durante o trabalho de parto? Método: estudo quantitativo do tipo documental. Foram analisados os prontuários de gestantes e neonatos que nasceram nos meses de agosto a novembro de 2014 na maternidade de um hospital do norte do estado do Rio Grande do Sul. Resultados: Foram estudados 164 prontuários avaliando se nestes constava presença ou ausência de reflexos primitivos descritos na ficha de avaliação do nascimento. A presença de reflexos primitivos do neonatos apresentou significância no que se refere a estatura perímetro cefálico perímetro torácico intercorrências no trabalho de parto e idade gestacional. Conclusão: a presença de reflexos primitivos em neonatos tem uma relação direta com a gestação, parto e pós-parto, assim verifica-se a necessidade de desenvolver ações efetivas de assistência ao pré-natal e parto


Objective: Identifying what are the associations between the newborns' primitive reflexes with sex, color, height, cephalic perimeter, thoracic perimeter, Apgar index, gestational age, type of delivery, and intercurrences during labor. Methods: It is a documentary study with a quantitative approach. The medical records of both pregnant women and newborns were analyzed. The newborns considered in this study were born over the period from August to November 2014, in the maternity ward of a hospital in the Northern region of the Rio Grande do Sul State, Brazil. Results: 164 medical records were studied assessing whether there were presence or absence of primitive reflexes on the birth assessment sheet. The presence of primitive reflexes of the neonates presented significance in terms of height, head circumference, thoracic perimeter, and intercurrences in labor and gestational age. Conclusion: The presence of primitive reflexes in newborns has a direct relationship with gestation, delivery and postpartum, so the need to develop effective prenatal and delivery assistance actions is verified


Objetivo: ¿Cuáles son las asociaciones entre los reflejos primitivos de los recién nacidos que nacen con sexo, color, talla, circunferencia de la cabeza, circunferencia de pecho, las puntuaciones de Apgar, edad gestacional, tipo de parto, complicaciones durante el método de parto y el parto: estudio el tipo de documento. Las historias clínicas de las mujeres embarazadas y los recién nacidos que nacieron en los meses de agosto a noviembre de 2014 en la sala de maternidad de un estado al norte del hospital de Rio Grande do se analizaron Sul Resultados:. Se estudiaron 164 registros evaluar si estos presencia consistido o ausencia de reflejos primitivos descritos el nacimiento de la forma de evaluación. La presencia de reflejos primitivos de los recién nacidos mostró importancia en relación con la altura del cabezal complicaciones circunferencia circunferencia en el trabajo y la edad gestacional. Conclusión: La presencia de reflejos primitivos en los recién nacidos tiene una relación directa con el embarazo, parto y post-parto, por lo que existe la necesidad de desarrollar medidas eficaces de asistencia a la atención prenatal y el parto


Subject(s)
Humans , Female , Pregnancy , Infant, Newborn , Infant, Newborn , Reflex, Abnormal , Perinatal Care/statistics & numerical data , Perinatal Care/statistics & numerical data , Prenatal Care/statistics & numerical data , Continuity of Patient Care , Obstetric Nursing
3.
Article in English | WPRIM | ID: wpr-785599

ABSTRACT

A 34-year-old male was brought to the hospital with a chest gunshot wound. Pulseless upon arrival, blood pressure was absent for 10 minutes. A thoracotomy resulted in return of spontaneous circulation. On hospital day 5, with brainstem reflexes present, he was unresponsive to call or pain, exhibited generalized hyperreflexia and bilateral Babinskys. Median nerve somatosensory evoked potentials (mSSEPs) and brainstem auditory evoked potentials were obtained. International Federation of Clinical Neurophysiology recommendations for mSSEPs and brainstem auditory evoked potentials were followed. Despite absence of the N20 responses from cortical mSSEPs no withdrawal from care was agreed upon. After awaking on day 7, mSSEPs were repeated and present. The patient survived and was discharged with minor deficits. Bilateral absence of N20 responses from mSSEPs performed beyond 48 hours after resuscitation from cardiac arrest is highly associated with bad neurological outcomes. However, variation due to hypothermia, noisy signals, medications, and brain hypo-perfusion must be taken into account.


Subject(s)
Adult , Blood Pressure , Brain , Brain Stem , Critical Care Outcomes , Evoked Potentials, Auditory, Brain Stem , Evoked Potentials, Somatosensory , Heart Arrest , Humans , Hypothermia , Male , Median Nerve , Nervous System Diseases , Neurophysiology , Prognosis , Reflex , Reflex, Abnormal , Resuscitation , Thoracotomy , Thorax , Wounds, Gunshot
4.
Article in English | WPRIM | ID: wpr-762614

ABSTRACT

PURPOSE: The aim of this study was to evaluate the prevalence and risk factors for cardiac autonomic neuropathy (CAN) in nonobese nonobese young type 1 diabetes mellitus (T1DM) patients without micro- or macrovascular complications. METHODS: CAN was assessed in 95 patients with T1DM, aged 18–29 years, using standard cardiovascular reflex tests – heart rate response to deep breathing, standing, and the Valsalva maneuver and blood pressure response to standing. Furthermore, power spectral analyses of overall heart rate variability (HRV), standard deviation of NN intervals (SDNN), and total power (TP) were tested with DiCAN. CAN was defined as abnormal results for at least 1 of the 4 cardiovascular reflex tests. RESULTS: The prevalence of CAN was 12.6%. The frequency of one and 2 abnormal reflex tests was 10.5% and 2.1%, respectively. No significant differences were observed in age, sex, mean hemoglobin A(1c) (HbA(1c)) level, and duration of diabetes with respect to presence of CAN. Patients with CAN exhibited lower overall HRV parameters (SDNN and TP) compared with those without CAN even though there was no statistical significance. In multivariable analyses, higher mean HbA(1c) level was significantly associated with lower overall HRV (β=-44.42, P=0.002 for SDNN and β=-2.82, P<0.001 for TP). CONCLUSION: CAN can be detected in 12.6% of young adult T1DM patients even without other micro- or macrovascular complications. Glycemic control is the main determinant to maintain overall HRV and prevent CAN.


Subject(s)
Autonomic Nervous System Diseases , Blood Pressure , Diabetes Mellitus, Type 1 , Heart Rate , Humans , Korea , Prevalence , Reflex , Reflex, Abnormal , Respiration , Risk Factors , Valsalva Maneuver , Young Adult
5.
Rev. bras. anestesiol ; 68(1): 96-99, Jan.-Feb. 2018. graf
Article in English | LILACS | ID: biblio-897810

ABSTRACT

Abstract Background and objectives Ischemic cardiomyopathy is characterized by imbalance between supply and demand of myocardial oxygen. Endoscopic transthoracic sympathectomy is a therapeutic option indicated in refractory cases. However, the patient's position on the operating table may favor ischemic coronary events triggering the Bezold-Jarisch reflex. Case report A female patient, 47 years old, with refractory ischemic cardiomyopathy, admitted to the operating room for endoscopic transthoracic sympathectomy, developed the Bezold- Jarisch reflex with severe bradycardia and hypotension after placement in semi-sitting position to the procedure. Conclusion Bradyarrhythmia, hypotension, and asystole are complications potentially associated with patient placement in a semi-sitting position, particularly in cases with previous ischemic heart disease.


Resumo Justificativa e objetivos A cardiomiopatia isquêmica caracteriza-se pelo desbalanço entre a oferta e o consumo de oxigênio pelo miocárdio. A simpatectomia transtorácica endoscópica é uma opção terapêutica indicada nos casos refratários. Contudo, a posição do paciente na mesa cirúrgica pode favorecer eventos coronarianos isquêmicos e deflagrar o reflexo de Bezold-Jarisch. Relato de caso Paciente do sexo feminino, 47 anos, portadora de cardiomiopatia isquêmica refratária, admitida na sala de cirurgia para simpatectomia transtorácica endoscópica, deflagrou o reflexo de Bezold-Jarisch e desenvolveu bradicardia e hipotensão graves logo após colocação em posição semissentada para o procedimento. Conclusão Bradiarritmia, hipotensão e assistolia são complicações potencialmente associadas à colocação do paciente em posição semissentada, especialmente nos casos em que há prévio comprometimento isquêmico do coração.


Subject(s)
Humans , Female , Sympathectomy/methods , Bradycardia/etiology , Patient Positioning/adverse effects , Hypotension/etiology , Intraoperative Complications/etiology , Angina Pectoris/surgery , Reflex, Abnormal , Endoscopy , Respiratory Rate , Middle Aged
6.
Arq. bras. neurocir ; 37(3): 258-262, 2018.
Article in English | LILACS | ID: biblio-1362879

ABSTRACT

Objective Broader access to magnetic resonance imaging (MRI) has increased the diagnosis of tonsillar ectopia, with most of these patients being asymptomatic. The early diagnosis and treatment of type I Chiari malformation (CM I) patients has impact on the prognosis. This study supplements information about the neurologic exam of symptomatic patients with CM I. Methods The sample was composed of 32 symptomatic patients with CM I diagnosed by a combination of tonsil herniation of more than 5 mm below the magnum foramen (observed in the sagittal T2 MRI) and at least one of the following alterations: intractable occipital headache, ataxia, upper or lower motor neuron impairment, sensitivity deficits (superficial and deep) or lower cranial nerves disorders. Results Occipital headache was the most frequent symptom (53.12%). During the physical exam, the most common dysfunctions were those from the pyramidal system (96.87%), followed by posterior cord syndrome (87.5%). Discussion In this study, patients became symptomatic around the fifth decade of life, which is compatible with previous descriptions. Patients withmore than 2 years of evolution have worse responses to treatment. Occipital headache, symptoms in the upper limbs, gait and proprioceptive disorders are common findings in patients with CM I. Conclusion Deep tendinous reflexes and proprioception disorders were the main neurologic features found in symptomatic CM I patients.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Arnold-Chiari Malformation/surgery , Arnold-Chiari Malformation/diagnosis , Arnold-Chiari Malformation/epidemiology , Proprioception , Pyramidal Tracts , Reflex, Abnormal , Data Interpretation, Statistical , Headache Disorders , Gait Disorders, Neurologic , Neurologic Examination/methods
7.
Article in English | WPRIM | ID: wpr-715332

ABSTRACT

PURPOSE: The neurological molecular mechanisms underlying the voiding dysfunction associated with nonbacterial chronic prostatitis/chronic pelvic pain syndrome remain poorly understood. In this study, we assessed whether prostate inflammation activated bladder afferent neurons, leading to bladder dysfunction, and sought to elucidate the underlying mechanisms. METHODS: Thirty male Sprague-Dawley rats were divided into 3 groups: sham-saline, formalin-injected, and capsaicin-pretreated and formalin-injected. Chemical prostatitis was induced by 0.1 mL of 10% buffered formalin injected into the ventral prostate. Capsaicin was injected subcutaneously to desensitize capsaicin-sensitive nerves. In each group, conscious cystometry was performed, and c-fos expression within the spinal cord was determined immunocytochemically. Double immunofluorescent staining with c-fos and choline acetyltransferase (ChAT) was performed. On the third day after pseudorabies virus (PRV) infection, c-fos and PRV double-staining was performed. RESULTS: Intraprostatic formalin significantly increased the maximal voiding pressure and decreased the intercontraction interval, compared with controls. Pretreatment with capsaicin significantly reversed these effects. More c-fos-positive cells were observed in the sacral parasympathetic nucleus (SPN) and dorsal gray commissure (DCM) in the prostatitis group than in the sham group. c-fos-positive cells decreased in the capsaicin-pretreated group. Preganglionic neurons labeled by c-fos and ChAT were observed in the SPN in rats with prostatitis. Interneurons labeled by c-fos and PRV were identified in the DCM after PRV infection. CONCLUSIONS: Our results suggest that prostate inflammation activates afferent nerve fibers projecting to the lumbosacral spinal cord, producing reflex activation of spinal neurons innervating the bladder and bladder hyperreflexia. This is mediated by capsaicin-sensitive prostate afferent neurons.


Subject(s)
Animals , Capsaicin , Choline O-Acetyltransferase , Formaldehyde , Herpesvirus 1, Suid , Humans , Inflammation , Interneurons , Male , Models, Animal , Nerve Fibers , Neurons , Neurons, Afferent , Pelvic Pain , Prostate , Prostatitis , Rats , Rats, Sprague-Dawley , Reflex , Reflex, Abnormal , Spinal Cord , Urinary Bladder
8.
Braz. j. otorhinolaryngol. (Impr.) ; 83(3): 330-340, May-June 2017. tab, graf
Article in English | LILACS | ID: biblio-889267

ABSTRACT

Abstract Introduction: The vestibular evoked myogenic potential is a potential of mean latency that measures the muscle response to auditory stimulation. This potential can be generated from the contraction of the sternocleidomastoid muscle and also from the contraction of extraocular muscles in response to high-intensity sounds. This study presents a combined or simultaneous technique of cervical and ocular vestibular evoked myogenic potential in individuals with changes in the vestibular system, for use in otoneurologic diagnosis. Objective: To characterize the records and analyze the results of combined cervical and ocular VEMP in individuals with vestibular hyporeflexia and in those with Ménière's disease. Methods: The study included 120 subjects: 30 subjects with vestibular hyporeflexia, 30 with Ménière's disease, and 60 individuals with normal hearing. Data collection was performed by simultaneously recording the cervical and ocular vestibular evoked myogenic potential. Results: There were differences between the study groups (individuals with vestibular hyporeflexia and individuals with Ménière's disease) and the control group for most of wave parameters in combined cervical and ocular vestibular evoked myogenic potential. For cervical vestibular evoked myogenic potential, it was observed that the prolongation of latency of the P13 and N23 waves was the most frequent finding in the group with vestibular hyporeflexia and in the group with Ménière's disease. For ocular vestibular evoked myogenic potential, prolonged latency of N10 and P15 waves was the most frequent finding in the study groups. Conclusion: Combined cervical and ocular vestibular evoked myogenic potential presented relevant results for individuals with vestibular hyporeflexia and for those with Ménière's disease. There were differences between the study groups and the control group for most of the wave parameters in combined cervical and ocular vestibular evoked myogenic potential.


Resumo Introdução: O potencial evocado miogênico vestibular é um potencial de média latência que avalia a resposta muscular decorrente de estimulação auditiva. Pode ser gerado a partir da contração do músculo esternocleidomastóideo e também a partir da contração de músculos extraoculares em resposta a sons de elevada intensidade. Este estudo apresenta uma técnica combinada ou simultânea de potencial evocado miogênico vestibular cervical e ocular em indivíduos com alterações no sistema vestibular para que possa ser usada no diagnóstico otoneurológico. Objetivo: Caracterizar o registro e analisar os resultados do potencial evocado miogênico vestibular cervical e ocular combinado em indivíduos com hiporreflexia vestibular e em indivíduos com doença de Ménière. Método: Participaram do estudo 120 indivíduos, 30 com hiporreflexia vestibular, 30 com doença de Ménière e 60 com audição dentro dos padrões de normalidade. A coleta de dados foi feita por meio do potencial evocado miogênico vestibular cervical e ocular registrados simultaneamente. Resultados: Houve diferença entre o grupo de estudo (indivíduos com hiporreflexia vestibular e indivíduos com doença de Ménière) e o grupo controle para a maioria dos parâmetros das ondas no potencial evocado miogênico vestibular cervical e ocular combinado. Para o potencial evocado miogênico vestibular cervical observou-se que o prolongamento da latência das ondas P13 e N23 foi a alteração mais encontrada no grupo de indivíduos com hiporreflexia vestibular e no grupo de indivíduos com doença de Ménière. Para o potencial evocado miogênico vestibular ocular o prolongamento da latência das ondas N10 e P15 foi a alteração mais encontrada no grupo de estudo. Conclusão: O potencial evocado miogênico vestibular cervical e ocular combinado apresentou resultados relevantes para os indivíduos com hiporreflexia vestibular e para os indivíduos com doença de Ménière. Houve diferença entre o grupo de estudo e o grupo controle para a maioria dos parâmetros das ondas no potencial evocado miogênico vestibular cervical e ocular combinado.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Young Adult , Reflex, Vestibulo-Ocular/physiology , Cervical Vertebrae/physiopathology , Reflex, Abnormal/physiology , Vestibular Evoked Myogenic Potentials/physiology , Meniere Disease/physiopathology , Vestibular Function Tests
9.
Article in English | WPRIM | ID: wpr-152974

ABSTRACT

The serotonin syndrome is a serioius medical condition due due to an intensive stimulation of setonin receptors. It is a rare, but severe, consequence of interaction between serotomimetic agents. This is a report of a 70-year-old woman steadily in therapy with venlafaxine and rizatriptan for migraine and major depressive syndrome. She was admitted to neurology unit for decreased light reflex with miotic pupils, global hyperreflexia, tremor, anxiety, ataxia and incoordination. The patient was diagnosed as a probable case of serotonin syndrome due to a pharmacological interaction between venlafaxine and rizatriptan trigged by opioid intake. In this paper, the development of syntomatology, the clinical examination and the possible pharmacokinetics explanation were carefully discussed and analysed.


Subject(s)
Aged , Anxiety , Ataxia , Codeine , Depressive Disorder , Depressive Disorder, Major , Female , Humans , Migraine Disorders , Neurology , Pharmacokinetics , Prescription Drug Misuse , Pupil , Reflex , Reflex, Abnormal , Serotonin Syndrome , Serotonin , Tremor , Venlafaxine Hydrochloride
10.
Article in English | WPRIM | ID: wpr-139261

ABSTRACT

Pseudoparalysis is defined as immobility of the extremity due to painful limb infection. However, such conditions may be misdiagnosed as nerve palsy when abnormal neurologic findings are present. We report herein a case with femoral osteomyelitis that was misdiagnosed as lumbosacral plexitis. A 7-month-old male infant was brought by his parents to the clinic who noticed that he did not move his left leg since 4 days prior to admission. Four days prior to admission, the parents noticed that he was not moving his left leg. There were no signs of inflammation in the involved limb. The left leg showed a motor weakness with grade 4/5, and it was hypotonic with decreased deep tendon reflexes. No abnormal findings were shown in studies which included lumbar spine magnetic resonance imaging (MRI), abdominal computed tomography (CT), and nerve conduction studies. Lumbosacral plexitis was diagnosed presumptively and intravenous immunoglobulin (IVIG) was given. The patient's symptom did not improve with the IVIG. After the orthopedic consultation, a hip MRI was performed and it showed acute osteomyelitis involving the proximal metaphysis of the left femur. Surgical debridement and intravenous antibiotics were administered. The patient's symptoms improved with treatment and he was fully recovered by the time of discharge. During the 4-year follow-up, the patient is doing well without any complication in the bone growth. During infancy, limb infection may present with nerve palsy that is characterized by hypotonic weakness with hyporeflexia. Pseudoparalysis may be the sole sign of osteomyelitis. In a unilateral limb weakness, musculoskeletal infection should be an initial diagnosis of exclusion with a thorough evaluation.


Subject(s)
Anti-Bacterial Agents , Bone Development , Debridement , Diagnosis , Extremities , Femur , Follow-Up Studies , Hip , Humans , Immunoglobulins , Immunoglobulins, Intravenous , Infant , Inflammation , Leg , Magnetic Resonance Imaging , Male , Neural Conduction , Neurologic Manifestations , Orthopedics , Osteomyelitis , Paralysis , Parents , Reflex, Abnormal , Reflex, Stretch , Spine
11.
Article in English | WPRIM | ID: wpr-139256

ABSTRACT

Pseudoparalysis is defined as immobility of the extremity due to painful limb infection. However, such conditions may be misdiagnosed as nerve palsy when abnormal neurologic findings are present. We report herein a case with femoral osteomyelitis that was misdiagnosed as lumbosacral plexitis. A 7-month-old male infant was brought by his parents to the clinic who noticed that he did not move his left leg since 4 days prior to admission. Four days prior to admission, the parents noticed that he was not moving his left leg. There were no signs of inflammation in the involved limb. The left leg showed a motor weakness with grade 4/5, and it was hypotonic with decreased deep tendon reflexes. No abnormal findings were shown in studies which included lumbar spine magnetic resonance imaging (MRI), abdominal computed tomography (CT), and nerve conduction studies. Lumbosacral plexitis was diagnosed presumptively and intravenous immunoglobulin (IVIG) was given. The patient's symptom did not improve with the IVIG. After the orthopedic consultation, a hip MRI was performed and it showed acute osteomyelitis involving the proximal metaphysis of the left femur. Surgical debridement and intravenous antibiotics were administered. The patient's symptoms improved with treatment and he was fully recovered by the time of discharge. During the 4-year follow-up, the patient is doing well without any complication in the bone growth. During infancy, limb infection may present with nerve palsy that is characterized by hypotonic weakness with hyporeflexia. Pseudoparalysis may be the sole sign of osteomyelitis. In a unilateral limb weakness, musculoskeletal infection should be an initial diagnosis of exclusion with a thorough evaluation.


Subject(s)
Anti-Bacterial Agents , Bone Development , Debridement , Diagnosis , Extremities , Femur , Follow-Up Studies , Hip , Humans , Immunoglobulins , Immunoglobulins, Intravenous , Infant , Inflammation , Leg , Magnetic Resonance Imaging , Male , Neural Conduction , Neurologic Manifestations , Orthopedics , Osteomyelitis , Paralysis , Parents , Reflex, Abnormal , Reflex, Stretch , Spine
12.
Article in Korean | WPRIM | ID: wpr-79161

ABSTRACT

STUDY DESIGN: Case report OBJECTIVES: To report a case of Brown-Séquard syndrome after blunt cervical trauma. SUMMARY OF LITERATURE REVIEW: Brown-Séquard syndrome is a rare disease characterized by hemisection of the spinal cord, and it shows the best prognosis of the various types of incomplete spinal cord injuries. MATERIALS AND METHODS: A patient with Brown-Séquard syndrome that occurred after a traffic accident was followed up for 2 years and 6 months. RESULTS: We observed normal recovery of motor strength, but sensory impairment and deep tendon hyperreflexia remained. CONCLUSIONS: Brown-Séquard syndrome is known to have a good prognosis, but in this case, the neurological abnormality did not fully recover; therefore, we report this rare case and present a review of the literature.


Subject(s)
Accidents, Traffic , Cervical Vertebrae , Female , Humans , Prognosis , Rare Diseases , Reflex, Abnormal , Spinal Cord , Spinal Cord Injuries , Tendons
13.
Article in English | WPRIM | ID: wpr-79076

ABSTRACT

Syringomyelia is a disorder in which a cavity has formed within the spinal cord. Idiopathic syringomyelia is not associated with identifiable causes such as Chari type 1 malformation, spinal cord tumor, vascular malformation, tethered cord, arachnoiditis, hydrocephalus, or previous spinal surgery. The main neurologic symptoms of idiopathic syringomyelia are toe-walking, constipation, incontinence, abnormal reflexes, and lower extremity weakness. Patients may present with various symptoms such as scoliosis, cutaneous markers, pain in the lower extremities or back, or may be asymptomatic. Herein, we report a young child with idiopathic syringomyelia presenting with subtle neck pain. A 23-month-old boy visited the neurologic clinic after 3 months of right occipital area neck pain. He had no history of trauma or central nervous system infection, and neurologic examination results were normal except for right posterior neck hyperesthesia. Brain and spinal magnetic resonance imaging showed an ovoid intramedullary cystic lesion (9.7×5.0×4.7 mm) at C6/7 of the spinal cord. There was no evidence of Chiari malformation or other lesions that can be primary pathologies of syringomyelia. Electromyogram/nerve conduction velocity results were normal. The subject was diagnosed as idiopathic syringomyelia. His symptoms and neurologic/radiologic indications showed no change at a 1-year follow-up. Idiopathic syringomyelia symptoms are varied and may be overlooked by physicians. Pediatricians may consider syringomyelia if patients complain about persistent sensory abnormality. All patients who present with syringomyelia should undergo detailed neuroimaging of the entire neuraxis to elucidate the proximate cause of the lesion.


Subject(s)
Arachnoid , Arachnoiditis , Brain , Central Nervous System Infections , Child , Constipation , Follow-Up Studies , Humans , Hydrocephalus , Hyperesthesia , Infant , Lower Extremity , Magnetic Resonance Imaging , Male , Neck , Neck Pain , Neuroimaging , Neurologic Examination , Neurologic Manifestations , Pathology , Reflex, Abnormal , Scoliosis , Spinal Cord , Spinal Cord Neoplasms , Syringomyelia , Vascular Malformations
14.
Yonsei Medical Journal ; : 467-470, 2017.
Article in English | WPRIM | ID: wpr-117393

ABSTRACT

In this report, the patient was pre-diagnosed as meningioma before surgery, which turned out to be meningeal melanocytoma. Hence, we will discuss the interpretation of imaging and neurological statuses that may help avoid this problem. A 45-year-old man had increasing pain around the neck 14 months prior to admission. His cervical spine MR imaging revealed a space-occupying, contrast-enhancing mass within the dura at the level of C1. The neurologic examination revealed that the patient had left-sided lower extremity weakness of 4+, decreased sensation on the right side, and hyperreflexia in both legs. Department of Neuroradiology interpreted CT and MR imaging as meningiom. The patient underwent decompression and removal of the mass. We confirmed diagnosis as meningeal melanocytoma through pathologic findings. Afterwards, we reviewed the patient's imaging work-up, which showed typical findings of meningeal melanocytoma. However, it was mistaken as meningioma, since the disease is rare.


Subject(s)
Decompression , Diagnosis , Humans , Leg , Lower Extremity , Magnetic Resonance Imaging , Melanoma , Meningioma , Middle Aged , Neck , Neurologic Examination , Reflex, Abnormal , Sensation , Spine
15.
Arq. neuropsiquiatr ; 74(1): 22-28, Jan. 2016. tab, graf
Article in English | LILACS | ID: lil-772608

ABSTRACT

Migraine and vertigo are common disorders, with lifetime prevalences of 16% and 7% respectively, and co-morbidity around 3.2%. Vestibular syndromes and dizziness occur more frequently in migraine patients. We investigated bedside clinical signs indicative of vestibular dysfunction in migraineurs. Objective To test the hypothesis that vestibulo-ocular reflex, vestibulo-spinal reflex and fall risk (FR) responses as measured by 14 bedside tests are abnormal in migraineurs without vertigo, as compared with controls. Method Cross-sectional study including sixty individuals – thirty migraineurs, 25 women, 19-60 y-o; and 30 gender/age healthy paired controls. Results Migraineurs showed a tendency to perform worse in almost all tests, albeit only the Romberg tandem test was statistically different from controls. A combination of four abnormal tests better discriminated the two groups (93.3% specificity). Conclusion Migraine patients consistently showed abnormal vestibular bedside tests when compared with controls.


Enxaqueca e vertigem são desordens comuns, com prevalência de 16% e 7% respectivamente, e comorbidade em torno de 3,2%. Síndromes vestibulares e tonturas ocorrem mais frequentemente em enxaquecosos. Pesquisamos alterações vestibulares utilizando testes de beira-de-leito em enxaquecosos. Objetivo Verificar se as respostas dos reflexos vestíbulo-ocular, vestíbulo-medular e risco de quedas medidas por 14 testes de beira-de-leito são diferentes comparando-se enxaquecosos sem vertigem, e controles. Método Estudo transversal com sessenta pessoas, 30 enxaquecosos; 25 mulheres, 19-60 anos; e trinta controles saudáveis pareados por sexo e idade. Resultados Houve tendência de pior desempenho entre enxaquecosos em quase todos testes, porém apenas o teste de Romberg tandem foi estatisticamente diferente dos controles. Uma combinação de quatro testes anormais discrimina os grupos com especificidade de 93,3%. Conclusão O grupo de enxaquecosos mostrou consistentemente testes vestibulares de beira-de-leito anormais quando comparados a controles.


Subject(s)
Adult , Female , Humans , Male , Middle Aged , Young Adult , Migraine Disorders/physiopathology , Reflex, Abnormal/physiology , Vestibular Function Tests , Vestibular Diseases/diagnosis , Accidental Falls , Cross-Sectional Studies , Dizziness/diagnosis , Head Impulse Test , Migraine Disorders/complications , Nystagmus, Physiologic , Point-of-Care Systems , Risk Factors , Reflex, Vestibulo-Ocular/physiology , Statistics, Nonparametric , Visual Acuity , Vestibular Diseases/complications
16.
Article in English | WPRIM | ID: wpr-81679

ABSTRACT

Serotonin syndrome, an adverse drug reaction, is a consequence of excess serotonergic agonism of central nervous system receptors and peripheral serotonergic receptors. Serotonin syndrome has been associated with large numbers of drugs and drug combinations, and serotonin-norepinephrine reuptake inhibitor-induced serotonin syndrome is rare. It is often described as a sign of excess serotonin ranging from tremor in mild cases to delirium, neuromuscular rigidity, and hyperthermia in life-threatening cases. Diagnosis is based on the symptoms and patient's history, and several diagnostic criteria have been developed. We experienced a rare case of fibromyalgia accompanied by tremor, hyperreflexia, spontaneous clonus, muscle rigidity, and diaphoresis after 10 days of single use of duloxetine 30 mg. Only one case of serotonin syndrome resulting from administration of duloxetine has been reported in Korea, however that case resulted from co-administration of fluoxetine. We report here on this case along with a review of the relevant literature.


Subject(s)
Central Nervous System , Delirium , Diagnosis , Drug Combinations , Drug-Related Side Effects and Adverse Reactions , Duloxetine Hydrochloride , Felodipine , Fever , Fibromyalgia , Fluoxetine , Humans , Korea , Muscle Rigidity , Reflex, Abnormal , Serotonin Syndrome , Serotonin , Tremor
17.
Asian Spine Journal ; : 65-69, 2016.
Article in English | WPRIM | ID: wpr-28512

ABSTRACT

STUDY DESIGN: This was a retrospective study. PURPOSE: The purpose of this study was to study the relationship between prevalence of pyramidal signs and the severity of cervical myelopathy. The study is focused on patients having increased signal intensity in T2-weighted magnetic resonance imaging. OVERVIEW OF LITERATURE: Cervical spondylotic myelopathy is the most common cause of spinal cord dysfunction in elderly population. It is the consequence of spondylotic changes leading to cervical cord injury with resulting clinical deficits. Diagnosis in such patients is made based on clinical and radiographic features. A patient must have both symptoms and signs consistent with cervical cord injury as well as radiographic evidence of damage to spondylotic cord. METHODS: Forty-six patients with complaint of cervical spondylotic myelopathy with increased signal intensity in T2-weighted magnetic resonance imaging were included in the study. The neurological finding of the patients was reviewed for the presence of pyramidal signs. The prevalence of each pyramidal sign was calculated and correlated to severity of cervical myelopathy. The motor function scores of the upper and lower extremities for cervical myelopathy set by the Japanese Orthopedic Association (motor Japanese Orthopaedic Association score, m-JOA) scores were used to assess severity of myelopathy. RESULTS: The most prevalent signs were hyperreflexia (89.1%), Hoffmann reflex (80.4%), Babiniski sign (56.5%), and ankle clonus (39.1%). Babiniski sign, ankle clonus, and Hoffmann reflex showed significant association with the lower m-JOA score. CONCLUSIONS: In patients with cervical myelopathy, hyperreflexia exhibited highest sensitivity whereas ankle clonus demonstrated lowest sensitivity. The prevalence of the pyramidal signs is correlated with increasing severity of myelopathy.


Subject(s)
Aged , Ankle , Asians , Diagnosis , Humans , Lower Extremity , Magnetic Resonance Imaging , Orthopedics , Prevalence , Reflex , Reflex, Abnormal , Retrospective Studies , Spinal Cord , Spinal Cord Diseases
18.
Article in English | WPRIM | ID: wpr-26934

ABSTRACT

Biotinidase deficiency is a disorder inherited autosomal recessively showing evidence of hearing loss and optic atrophy in addition to seizures, hypotonia, and ataxia. In the present study, a 2-year-old boy with Biotinidase deficiency is presented in which clinical symptoms have been reported with auditory neuropathy/auditory dyssynchrony (AN/AD). In this case, transient-evoked otoacoustic emissions showed bilaterally normal responses representing normal function of outer hair cells. In contrast, acoustic reflex test showed absent reflexes bilaterally, and visual reinforcement audiometry and auditory brainstem responses indicated severe to profound hearing loss in both ears. These results suggest AN/AD in patients with Biotinidase deficiency.


Subject(s)
Ataxia , Audiometry , Biotinidase Deficiency , Biotinidase , Child, Preschool , Ear , Evoked Potentials, Auditory, Brain Stem , Hair , Hearing Loss , Humans , Male , Muscle Hypotonia , Optic Atrophy , Reflex, Abnormal , Reflex, Acoustic , Seizures
19.
Article in English | WPRIM | ID: wpr-166337

ABSTRACT

PURPOSE: A limited number of studies have examined the link between F-wave abnormalities and clinical presentation in pediatric Guillain-Barré syndrome (GBS). Therefore, this study examined the importance of F-wave abnormalities as a prognostic factor in pediatric GBS patients. METHODS: The records and electrodiagnostic studies (EDS) of 70 GBS patients were retrospectively evaluated, and divided into 2 groups according to the results of EDS. Group A (n=33) presented with F-wave abnormalities, and group B (n=26) exhibited normal findings. We compared laboratory reports, clinical features, response to treatment, and prognosis between the 2 groups. RESULTS: Motor weakness was the most frequently observed symptom for either group. Clinically, the incidence of fever and upper respiratory symptoms differed between the 2 groups, while the prevalence of abnormal deep tendon reflex (DTR) was significantly higher in group A than B (P<0.05). Patients diagnosed with GBS had received intravenous immunoglobulin treatment: 94% in group A and 58% in group B. Furthermore, significantly greater numbers of patients in group A showed H-reflex abnormalities and poor prognosis compared with group B (P<0.05). CONCLUSION: This study demonstrated that F-waves are a clinically important prognostic factor in GBS. F-wave abnormalities were associated with abnormal DTR and poor prognosis in patients. Limited studies have examined the link between F-wave abnormalities and clinical results; therefore, further randomized controlled studies are needed to confirm the clinical characteristics and efficacy of treatments.


Subject(s)
Child , Fever , Guillain-Barre Syndrome , H-Reflex , Humans , Immunoglobulins , Incidence , Prevalence , Prognosis , Reflex, Abnormal , Retrospective Studies
20.
Int. braz. j. urol ; 41(5): 959-966, Sept.-Oct. 2015. tab, graf
Article in English | LILACS | ID: lil-767048

ABSTRACT

ABSTRACT Erectile dysfunction (ED) is a common complication of pelvic fractures. To identify the vascular and neurogenic factors associated with ED, 120 patients admitted with ED after traumatic pelvic fracture between January 2009 and June 2013 were enrolled in this study. All patients answered the International Index of Erectile Function (IIEF-5) questionnaire. Nocturnal penile tumescence (NPT) testing confirmed the occurrence of ED in 96 (80%) patients on whom penile duplex ultrasound and neurophysiological testing were further performed. Of these ED patients 29 (30%) were demonstrated only with vascular abnormality, 41 (42.7%) were detected only with neural abnormality, 26 (27.1%) revealed mixed abnormalities. Of the 55 patients (29+26) with vascular problems, 7 patients (12.7%) with abnormal arterial response to intracavernous injection of Bimix (15mg papaverine and 1mg phentolamine), 31 (56.4%) with corporal veno-occlusive dysfunction and 17 (30.9%) had both problems. Of the 67 (41+26) patients with abnormal neurophysiological outcomes, 51 (76.1%) with abnormal bulbocavernosus reflex (BCR), 20 (29.9%) with pathological pudendal nerve evoked potentials (PDEPs) and 25 (37.3%) with abnormal posterior tibial somatosensory nerve evoked potentials (PTSSEPs). Our observation indicated that neurogenic factors are important for the generation of ED in patients with pelvic fracture; venous impotence is more common than arteriogenic ED.


Subject(s)
Adult , Humans , Male , Middle Aged , Young Adult , Fractures, Bone/complications , Fractures, Bone/physiopathology , Impotence, Vasculogenic/etiology , Impotence, Vasculogenic/physiopathology , Pelvic Bones/injuries , Evoked Potentials, Somatosensory/physiology , Hormones/blood , Impotence, Vasculogenic , Penile Erection/physiology , Penis/blood supply , Penis/innervation , Reflex, Abnormal/physiology , Self Report , Severity of Illness Index , Ultrasonography, Doppler, Duplex , Urethra/injuries , Urethra/physiopathology
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