Pre-induction Jerky limb movements on operation table – Is it transient ischemic attack

Transient ischemic attack (TIA) is a diagnostic challenge for all physicians due to the temporariness of symptoms and the absence of any definitive diagnostic test. There is a very high risk of TIA being followed by an ischemic stroke, hence require urgent investigation and preventive strategies. At the same time, it is also important to distinguish TIA from other close differentials, to avoid wrong diagnoses leading to harmful, misdirected medical management. In this report, we will discuss the case of a middle-aged male patient with stable pre-operative vitals who was posted for total parotidectomy and suddenly developed jerky movement of the upper limb and transient aphasia on the operation theater table along with raised blood pressure. This is a very rare presentation of TIA that needs to be differentiated from other close differentials as this form is mostly associated with severe carotid occlusive disease and, hence, carries a high risk of stroke.

Movement Disorders in Non-Wilsonian Hepatic Cirrhotic Patients: The Subgroup Analysis of Various Phenotypes and Associated Risk Factors

OBJECTIVE: The aim of this subgroup analysis was to identify the risk factors associated with the development of various movement disorder phenotypes. METHODS: Eighty-three non-Wilsonian cirrhotic patients with abnormal movements were allocated into the following groups: intention tremor, bradykinesia, Parkinsonism, and abnormal ocular movements. These movement types were considered the primary outcomes as there was a sufficient sample size. Researchers took into consideration the gender, etiologies of cirrhosis, cirrhosis-related complications, hepatic encephalopathy, medical illness, and some neurological deficits as potential factors associated with these movement disorders. RESULTS: The male gender (p = 0.002) and alcoholic cirrhosis (p = 0.005) were significant factors for the prevalence of intention tremors. In bradykinesia, hepatic encephalopathy was highly statistically significant (p < 0.001), and females more commonly developed bradykinesia (p = 0.04). The Parkinsonism features in this study were confounded by hyperlipidemia (p = 0.04) and motor or sensory deficits (p = 0.02). Jerky pursuits and a horizontal nystagmus were detected. Jerky pursuits were significantly related to hepatic encephalopathy (p = 0.003) and bradykinesia, but there were no factors associated with the prevalence of nystagmus other than an intention tremor. CONCLUSIONS: The association of alcoholic cirrhosis with the development of intention tremor indicates that the persistent cerebellar malfunction in cirrhotic patients is due to alcohol toxicity. The slowness of finger tapping and jerky pursuit eye movements are significantly associated with hepatic encephalopathy. Thus, further studies are needed to evaluate the diagnostic value of these two signs for an early detection of mild hepatic encephalopathy.

Potencial uso de espectroscopia de reflectancia en el infrarrojo cercano (NIRS) para identificación de charqui de bovino, llama y caballo / Potential use of near infrared reflectance spectroscopy (NIRS) for the identification of beef, llama and horse jerky

Visible and near infrared reflectance spectroscopy (VIS/NIRS) was evaluated as a tool to discrimínate jerky from different species. Spectra were taken by reflectance in a NIRSystems 6500 monochromator and the software NIRS 3.0 and WinIsi II Version 1.02A were used. Twenty samples of jerky corresponding to beef, llama and horses, respectively, were ground, homogenized and analyzed spectrally. The regression equations (PLS) were developed testing different mathematical treatments. The results for jerky show that NIRS can successfully discriminate 100% of llama, 95% of horses and 80% of beef samples, probably as a consequence of differences in intramuscular fat, protein and water contents of the different species. Thus, NIRS is a fast, inexpensive and non-destructive method that can be used to discriminate jerky from these species.

Se usó espectroscopía visible y de reflectancia en el infrarrojo cercano (VIS/NIRS) como herramienta para discriminar charqui de diferentes especies. Los espectros se tomaron por reflectancia en un equipo monocromador NIRSystems modelo 6500, con un software NIRS 3.0, y WinIsi II Versión 1.02 A. Se molieron, homogenizaron y analizaron espectralmente 20 muestras de charqui correspondientes a bovino, llama y caballo. Se desarrollaron ecuaciones de regresión (PLS) probando diferentes tratamientos matemáticos. Los resultados para charqui muestran que NIRS puede discriminar satisfactoriamente 100% de las muestras de llama, 95% de caballos y 80% de bovino, probablemente como consecuencia de diferencias en el contenido de grasa intramuscular, proteína y agua de las diferentes especies. Así, la técnica NIRS muestra ser un método rápido, económico y no destructivo que puede usarse para discriminar charqui de diferentes especies.

A Case of Atypical Latent Nystagmus Associated with Infantile Nystagmus

The latent nystagmus seems to be absent when both eyes are open, but on covering one eye, bilateral jerky nystagmus is evoked with the fast phase toward the uncovered eye. The confirmed diagnosis of latent nystagmus can be made with the aid of the Electro-oculography (EOG). On EOG recording, we experienced a case of latent nystagmus in light, which showed the characteristics of infantile nystagmus in darkness.