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Motor Neurological Examination of the Hand and Upper Limb
Published in J. Terrence Jose Jerome, Clinical Examination of the Hand, 2022
NINDS scale:Grade 0: Reflex absent: No evidence of contraction.Grade 1: Reflex small, less than normal; includes a trace response or a response brought out only with reinforcement: Decreased, but still present (hypo-reflexic). Hyporeflexia is generally associated with a lower motor neuron deficit (at the alpha motor neurons from spinal cord to muscle) e.g., Guillain–Barré syndrome.Grade 2: Reflex in the lower half of the normal range.Grade 3: Reflex in the upper half of the normal range: Super-normal (hyper-reflexic). Hyperreflexia is often attributed to upper motor neuron lesions e.g., multiple sclerosis.Grade 4: Reflex enhanced, more than normal; includes clonus if present, which optionally can be noted in an added verbal description of the reflex [7]. Clonus: Repetitive shortening of the muscle after a single stimulation.
Nutritional Deficiencies
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Deepa Bhupali, Fernando D. Testai
Characterized by a spinocerebellar syndrome with peripheral nerve involvement (similar to Friedreich's ataxia): Cerebellar ataxia.Hyporeflexia.Proprioception and vibratory sensory loss with sensory ataxia.Extensor plantar responses.Acanthocytosis.Hemolytic anemia (mainly in premature infants).Retinitis pigmentosa.Specific findings can be seen in association with inherited conditions (Table 17.1).
Body fluids and electrolytes
Published in Peate Ian, Dutton Helen, Acute Nursing Care, 2020
If the patient develops acute hypercalcaemia, the signs and symptoms are more severe. The patient may complain of fatigue and lethargy or exhibit confusion. Muscle weakness, hyporeflexia and decreased muscle tone may occur. Hypercalcaemia can also alter myocardial muscle function, causing rhythm disturbances, such as bradycardia, heart block and a shortened QT interval. Severe hypercalcaemia can lead to ventricular arrhythmias and cardiac arrest.
Atypical Guillain-Barré syndrome presenting with fluctuating weakness
Published in Baylor University Medical Center Proceedings, 2023
Lauren L. Crowther, Amarjyot K. Randhawa, Robert W. Plambeck
This case highlights the difficulty in recognizing atypical GBS that does not present with early areflexia and symptom nadir within 1 to 2 weeks. Hyporeflexia is a stringent requirement in the NINDS diagnostic criteria.6,7 The Brighton criteria include cerebrospinal fluid ACD, but less than half of patients present with this finding within the first day, and it reaches only 80% sensitivity after 1 week.7 Preserved reflexes and waxing-waning weakness are rare, as are pure motor variants.4,6,12 Urinary retention is also uncommon.14 Unfortunately, these patterns have been shown to prolong the time between symptom onset and treatment initiation.15 Regarding prognosis, diagnosis and treatment delays worsen outcomes including clinical status at time of discharge and residual weakness.15
Neurological complications of Zika virus infection
Published in Expert Review of Anti-infective Therapy, 2018
In a Colombian study that recruited 68 GBS cases (mean age, 47 years; 56% males) from 6 hospitals, the 97% had a clinical picture compatible with ZIKV infection preceding the onset of GBS. The mean period between ZIKV infection and initial GBS symptoms was around 7 days. Mean duration of ZIKV disease was short, around 4 days, and was characterized by fever (69%), rash (59%), headache (34%), muscle pain (34%), and conjunctivitis (25%). Half of patients had bilateral facial palsy [18]; 6% had Miller–Fisher syndrome (ataxia, areflexia, and ophthalmoplegia), and 3% other GBS variants (bilateral facial palsy with areflexia; pure sensory syndrome) [18]. Most common symptoms at GBS presentation included lower limb weakness (97%), paresthesias (76%), and facial palsy (32%). Around 80% had a progressing and ascending weakness pattern. Autonomic dysfunction was observed in one-third of patients, and areflexia/hyporeflexia was noted in 94%. Near 60% were admitted to ICU and 31% required mechanical ventilation [18].
Vitamin B12 deficiency in the setting of nitrous oxide abuse: diagnostic challenges and treatment options in patients presenting with subacute neurological complications
Published in Acta Clinica Belgica, 2022
Yasmine Sluyts, Pieternel Vanherpe, Rizvana Amir, Filip Vanhoenacker, Pieter Vermeersch
A 30-year-old male presented to the emergency department with subacute progressive sensory disturbances and subjective weakness in both upper and lower limbs and progressed over 1 week. Nitrous oxide abuse was denied. He did admit to attending parties where nitrous oxide was inhaled. Upon examination, there was a hyporeflexia in upper and areflexia in lower limbs. Superficial as well as deep sensory testing was affected. His gait was normal. Romberg’s sign was negative.