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Neurogenic Shock
Published in Kelechi Eseonu, Nicolas Beresford-Cleary, Spine Surgery Vivas for the FRCS (Tr & Orth), 2022
Kelechi Eseonu, Nicolas Beresford-Cleary
This patient is likely to have a complete spinal cord injury (SCI) related to an injury at the C5 level. His haemodynamic compromise with the pattern of injury is likely to be a sign of neurogenic shock. The presence of the bulbocavernosus reflex excludes spinal shock. Other causes of circulatory shock classically cause hypotension and tachycardia rather than bradycardia and hypotension.
Considerations for the Focused Neuro-Urologic History and Physical Exam
Published in Jacques Corcos, Gilles Karsenty, Thomas Kessler, David Ginsberg, Essentials of the Adult Neurogenic Bladder, 2020
Laura L. Giusto, Patricia M. Zahner, Howard B. Goldman
Next, test the genital reflexes including the bulbocavernosus and anal reflex while the patient is in the lithotomy position, since the exam should flow from least to most invasive. In the male patient, we can also check the cremasteric reflex first. The bulbocavernosus reflex is important to assess since it is one of the first reflexes to return in patients with spinal shock after their injury (Table 19.9).8
Neurourology
Published in Manit Arya, Taimur T. Shah, Jas S. Kalsi, Herman S. Fernando, Iqbal S. Shergill, Asif Muneer, Hashim U. Ahmed, MCQs for the FRCS(Urol) and Postgraduate Urology Examinations, 2020
The bulbocavernosus reflex (anal sphincter contraction in response to squeezing the glans penis or tugging on the urethral catheter) involves the S2, S3 nerve roots and is a spinal cord mediated reflex. Initial management of spinal shock involves urethral catheterisation with the aim of converting the patient over to intermittent catheterisation (self or by carer) as soon as possible.
Physiotherapeutic assessment and management of overactive bladder syndrome: a case report
Published in Physiotherapy Theory and Practice, 2023
Bartlomiej Burzynski, Tomasz Jurys, Karolina Kwiatkowska, Katarzyna Cempa, Andrzej Paradysz
The physiotherapist next carried out per vaginum examination of the patient in the same position. The examination began with an observation of perineal area, during which the physiotherapist observed skin color and the appearance of the vaginal orifice and checked for the existence of scar tissue. There were no visible pathological changes in the perineal area or vaginal orifice. Thereafter, the bulbocavernosus reflex was tested by squeezing the clitoral glans (Previnaire, 2018), and a correct reflex response was observed suggesting proper innervation from the S2-S4 level. The physiotherapist also assessed the flexibility of and prevalence of pain in the central tendon of the perineum by means of palpation. The patient did not report any painful symptoms, and the central tendon of her perineum was flexible. In addition, the dynamic function of the central tendon of the perineum was evaluated during coughing. The patient was asked to cough and the physiotherapist observed a correct reflex response and correct timing, which is to say that the central tendon first moved upward and then downward. The perineal behavior was visually assessed, excluding possible external pathologies.
What is the best treatment option for cervical spinal cord injury by os odontoideum in a patient with athetoid dystonic cerebral palsy?
Published in The Journal of Spinal Cord Medicine, 2021
Sungche Lee, Dong Hyun Kim, Yoon-Hee Choi
Neurologic examination revealed bilateral upper and lower limb weakness, and the left upper limb was more severely affected than other limbs (right upper limb, grade 2–3; left upper, grade 1–2; both lower, grade 2–3 on MRC grading scale). Hypesthesia was shown below the C2/C3 dermatome and hypoalgesia was shown below the C4/C4 dermatome (ASIA impairment scale D). A modified Ashworth Scale (MAS) of 1+ was checked on both elbow flexor and extensor muscles. The right and left knee extensor muscles were MAS 1+ and 1 each with ankle clonus. The bulbocavernosus reflex, perianal, and deep anal sensations were preserved. The patient scored 2 on the Berg balance scale (BBS) and 25 on the Spinal Cord Independence Measure III (SCIM III). Jebsen-Taylor hand function test (JHFT) was not performed due to poor trunk control ability and impaired fine motor skills of the patient. The patient also suffered from severe orthostatic hypotension symptoms.
The importance of the clinical examination of the lower sacral segments: Four case reports
Published in The Journal of Spinal Cord Medicine, 2019
Maria João Andrade, Tiago Felix Soares
Initially, the inability to void was attributed to the exaggerated bladder distension that was seen on the sixth postoperative day. When we examined the patient, he complained of pain in his left hip and lumbosacral region, with bilateral radiation. The physical examination revealed proximal muscle atrophy and pain during range of motion testing of the left hip, according to the postoperative status. He also had pain on lumbosacral palpation. The muscle examination not only demonstrated diminished strength in the proximal muscles of the left lower limb, including L2, not testable (NT) because of the pain, but also in the ipsilateral plantar flexors (grade 4 Medical Research Council Scale [MRCS]). Tendon reflexes were present and symmetrical in the upper limbs but absent in the lower limbs. The sensory examination was normal. In the sacral segmental examination, he had a weak voluntary anal contraction and absent anal reflex, despite normal anal sensation and tone, and the presence of the bulbocavernosus reflex. This S1-S4 lesion raised the suspicion of a lumbosacral lesion, of probable traumatic origin given his fall history. Owing to the pacemaker’s incompatibility with the MRI machine, a CT was performed and revealed osteoporotic vertebral fractures in L1, L2 and L3 vertebrae, a narrow spinal canal between L3-L5 and narrowing of the intervertebral foramina bilaterally L3-L4, L4-L5, L5-S1, in addition to generalised degenerative changes. The patient thus had a previously undiagnosed spinal cord injury, of neurological level of injury (NLI): unable to determine (UTD), AIS D.