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Knee Pain
Published in Benjamin Apichai, Chinese Medicine for Lower Body Pain, 2021
Neurologic examination: Decreased quadriceps motor function.Absent patellar reflex.71
Discussions (D)
Published in Terence R. Anthoney, Neuroanatomy and the Neurologic Exam, 2017
On the other hand, the concept of “a reflex” is very slippery. Let me illustrate with the well- known knee jerk. We tap a patient repeatedly just below one knee with a reflex hammer; and, each time, the patient’s ipsilateral lower leg responds with a sudden brief extension of about 10°. If we decide that we are dealing with a reflex, exactly what is that reflex? Is it the entire phenomenon just described—-namely, tapping below the knee and the resultant extension of the lower leg? Certainly, two common names for the reflex—“knee jerk” and “patellar reflex”—suggest that the site of stimulation is included. Also, the type of stimulation sometimes seems to be included. For example, the knee jerk belongs to a class of reflexes that involve increased activity of extrafusal fibers in a muscle that has been stretched—hence, the generic name “stretch reflex.” When vibration of the tendon is used as a stimulus to stretch the muscle, however, the reflex is specifically called a “vibration reflex” (e.g., K&S, p. 461; W&G, p. 172).
Posterior and anterior epidural and intradural migration of the sequestered intervertebral disc: Three cases and review of the literature
Published in The Journal of Spinal Cord Medicine, 2022
Daphne J. Theodorou, Stavroula J. Theodorou, Yousuke Kakitsubata, Evangelos I. Papanastasiou, Ioannis D. Gelalis
A 72-year-old man presented at an outpatient clinic with progressive pain in the lower extremities for several days. Gradually worsening pain radiated in the anterolateral aspect of the thigh on both sides. He experienced no low back pain, or abnormal bowel or bladder function. Previous history was unremarkable for trauma, lumbar surgery, fever, weight loss, or other constitutional symptoms. On examination, the upper lumbar spine was tender to palpation. The straight leg raising test was negative and there was diminished patellar reflex, which was worse on the left leg than on the right. Motor strength was 3/5 proximally on the left leg and 4/5 on the right leg, and 4/5 distally in both legs. Ill-defined loss of sensation to light touch and pinprick was appreciated on the left thigh. Laboratory values were within normal limits. MR imaging of the lumbar spine revealed a posterior epidural mass lesion at the L2–L3 level, compressing the spinal cord. The lesion was of T1-weighted intermediate and T2-weighted increased signal intensity, relative to the intervertebral disc (Fig. 1A,B). Within the spinal canal at the L2–L3, axial T2-weighted MR images displayed a tract-like structure extending from the intervertebral disc to the posterior epidural mass (Fig. 1C). After administration of gadolinium-containing contrast material, peripheral enhancement of the epidural mass was seen (Fig. 1D). There was linear enhancement of the structure connecting the mass with the disc (Fig. 1E). An extruded disc herniation that enhanced in its periphery also was seen at this interspace.
Presynaptic inhibition in restless legs syndrome
Published in International Journal of Neuroscience, 2021
Şule Aydin Türkoglu, Elif Sultan Bolac, Serpil Yildiz, Oya Kalaycioglu, Nebil Yildiz
PreI is one of the powerful inhibitory mechanism in the spinal circuits and many human studies have shown that this inhibition is modulated centrally [45, 46]. The details of the interaction of both supraspinal descending modulation and peripheral afferent information have not been clarified yet. In a recent study, researchers demonstrated that the plantar reflex response in patients with RLS had a circadian fluctuation compared with healthy controls, and the spinal reflex arc was suggested as being responsible [47]. In another study, it was demonstrated that there was decrease in evening time patellar reflex electromyographic responses comparing to morning but not with the H reflex measurements, and it was suggested that they did not reach any evidence about spinal hyperexcitability [18]. We did all the investigations in the afternoon, so circadian effect was out of question.
Managing hypertensive disorders during pregnancy in low resource settings
Published in Hypertension in Pregnancy, 2019
Ireen T. Ramavhoya, Maria S. Maputle, Rachel T. Lebese, Dorah U. Ramathuba, Lizzy M. Netshikweta
Two hundred (200) professional midwives were sampled from Mopani and Vhembe District. The study assessed their perceived knowledge and skills on the implementation of maternal guidelines when managing women with hypertensive disorders during pregnancy. Most respondents were female because males were reluctant to offer maternal health care services; hence, most were allocated to perform other duties. A number of midwives had more than five years’ experience. The incompetency was also shown by the nearly half (55.5%) of the midwives who indicated that they would not continue with Magnesium Sulphate, even when the patellar reflex was present. Failure to administer the drug predisposes pregnant women to eclampsia. Incompetency in the management of hypertensive disorders in pregnancy was also indicated by Stellenberg and Ngwekazi (10). Pattison (11), indicated that midwives must always be prepared and ready. However, their readiness will be determined by the knowledge, skills and availability of resources they have. Therefore, he recommends continuous education and training of midwives, so that they can manage emergency conditions like Pre-eclampsia. Managers must therefore organize workshops, in-service training, so that midwives can respond and provide immediate medical treatment in an emergency. The knowledge acquired and adherence to maternal guidelines will improve the health of the pregnant women. He added that, improving the skills is difficult to achieve. However, through the use of manikins, where simulation of emergency obstetric conditions is done, midwives were able to practice; hence, slowly acquire the skills needed (11).