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The Technique of MMECT
Published in Barry M. Maletzky, C. Conrad Carter, James L. Fling, Multiple-Monitored Electroconvulsive Therapy, 2019
Dosages of succinylcholine vary greatly. During the first session, in a patient who has never received ECT before, once a “ready” has been obtained on the MMECTA, 20 mg of succinylcholine is administered as an i.v. bolus. Thereafter, two reflexes are tested: the patellar deep tendon reflex and the Babinski reflex. The latter is more sensitive as scratching the volar surface of the foot usually produces a flexion of the toes, even in patients who show sluggish deep tendon reflexes. Moreover, one reflex can serve as a check on the other. The presence, then disappearance, of muscle fasciculations, while almost always observable, is not a reliable guide to the timing of the action of succinylcholine. Usually the 20 mg starting dose is insufficient to block most of the movement in these two reflexes and an additional 10 to 30 mg of succinylcholine is then infused. Within 1 to 2 min, partial muscle paralysis reaches its height and electric stimulation can then proceed. We do not routinely administer a small test dose of succinylcholine to determine whether a congenital absence of pseudo cholinesterase exists, as this defect is fortunately quite rare; this test dose might be necessary, however, if such a defect is present in family members or has been documented during prior surgeries.
Human development
Published in Bhaskar Punukollu, Michael Phelan, Anish Unadkat, MRCPsych Part 1 In a Box, 2019
Bhaskar Punukollu, Michael Phelan, Anish Unadkat
Birth to 1 month:Hand to mouth reflex.Grasping reflex.Rooting reflex.Moro reflex.Babinski reflex.Responds to mother’s face.
Understanding medications and medical investigations
Published in Ross Balchin, Rudi Coetzer, Christian Salas, Jan Webster, Addressing Brain Injury in Under-Resourced Settings, 2017
Ross Balchin, Rudi Coetzer, Christian Salas, Jan Webster
Various reflexes (involuntary actions or movements in response to stimuli) are assessed, as abnormality suggests possible lesions. Abnormality can be indicated by the occurrence of brisk reflexes or decreased reflexes. Possible reflexes that are examined include the ankle jerk reflex, biceps reflex, plantar/Babinski reflex, jaw jerk reflex and patellar reflex.
Paraplegia following transarterial chemoembolisation for hepatocellular carcinoma: a case report
Published in Acta Chirurgica Belgica, 2021
The patient underwent TACE with the administration of two vials of HepaSphere (30–60 μm) and 2 mL of 100-μm Embozene particles via the right hepatic artery as well as the T10 and T11 intercostal arteries, which were considered the tumour-feeding arteries based on angiography that showed a hypervascular tumour pattern (Figure 2). During TACE, extreme hypertension (216/93 mmHg) was noticed, which persisted even after the oral administration of 30 mg nifedipine. One hour after the procedure, the patient complained about paraplegia and impairment of somatic sensation with the loss of proprioception below the T10 dermatome. Neurological examination revealed a Medical Research Council (MRC) score of 0 over both lower extremities compared with an MRC score of 5 over both upper extremities. There were no deep tendon reflexes, Babinski reflex was present in both lower limbs, and anal sphincter tone was absent. An MRI of the spine performed 5 h after TACE revealed a suspicious restriction of water diffusion at the T9–T12 level of the spinal cord, which did not rule out spinal cord infarction (Figure 3).
Spinal epidural abscess secondary to gram-negative bacteria: case report and literature review
Published in Journal of Community Hospital Internal Medicine Perspectives, 2020
Eric D. Van Baarsel, Yazeed Kesbeh, Huthayfa A. Kahf, Vandan Patel, Bruce Weng, Made Sutjita
Patient 3: A 63-year-old female with past medical history of morbid obesity and degenerative disc disease presented with complaints of bilateral leg weakness and tingling beginning after standing up from a seated position that led to a fall at home. She reported new onset low back pain after falling along with urinary and fecal incontinence. On exam, the patient had positive Babinski reflex and negative anal wink. Lab work included urinalysis demonstrating 2–5 WBCs with positive nitrites. Vital signs, complete blood count with differential, and complete metabolic panel were all within normal limits. CT of the spine without contrast demonstrated multilevel degenerative disc disease without osseous abnormalities. A computed tomography myelogram of the spine showed poor visualization but no obvious cord compression lesion, but MRI was recommended to rule out a potential mass. The patient had to be transferred to an outside facility for MRI secondary to morbid obesity.
Cervical myelopathy causing numbness and paresthesias in lower extremities: A case report identifying the cause of a false positive Sharp–Purser test
Published in Physiotherapy Theory and Practice, 2019
Tests commonly used to assess cervical myelopathy clinically are specific rather than sensitive (Cook et al., 2010). A group of tests specific to the evaluation of myelopathy were analyzed in an effort to identify a cluster of tests that when pooled together could improve the sensitivity (Cook et al., 2010). The cluster of tests included the following: (1) Age greater than 45 years old; (2) gait abnormalities consistent with myelopathy; (3) Hoffman’s sign; (4) inverted supinator sign; and (5) Babinski reflex. If all five items of the cluster are absent this significantly reduces the post-test probability of myelopathy being present. The patient in this case had three of the five items of the cluster, which yields a specificity of 0.99 with a positive likelihood ratio of 30.9. The presence of three out of five items in the cluster significantly increases the post-test probability of cervical myelopathy being present to 94% (Cook et al., 2010). This, in conjunction with the examination, mandated a referral for imaging (Cook et al., 2010; Sizer, Brismée, and Cook, 2007).