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Evaluation of the Spine in a Child
Published in Nirmal Raj Gopinathan, Clinical Orthopedic Examination of a Child, 2021
Ashish Dagar, Sarvdeep Singh Dhatt, Deepak Neradi, Vijay G Goni
With a bluntly pointed object, the patient’s foot is stroked along the lateral aspect of the sole starting from the heel and continuing along the lateral aspect reaching up to but not touching the base of the big toe. Normally, there is plantarflexion of the toes. In an abnormal reflex, there is an extension of the big toe with extension and fanning out of all other toes. An abnormal reflex indicates an upper motor neuron lesion. In children, Babinski’s reflex can normally be present for up to 2 years of age. Various named methods of eliciting plantar reflex are: Oppenheim’s sign: To perform the Oppenheim’s test, run a thumb pressing down along the crest of the tibia.Gordon’s reflex: Squeeze the patient’s calf.Chaddock reflex: Scratch the skin along the region of the lateral malleolus.
Hysteria
Published in Francis X. Dercum, Rest, Suggestion, 2019
Not infrequently the plantar reflex is slight or lost. This reaction, however, loses much of its significance when we realize that in many adult persons it is normally absent. When, in a hemianesthesia, the plantar reflex is diminished or lost on the anesthetic side, and not on the sound side, we must bear in mind that the patient is very much alive to the reflexes on the normal side and that these may be, by contrast with the affected side, unusually pronounced, and finally the ever-present element of suggestion must be borne in mind. If the patient believes that his side is "dead," that he has lost power in it, which to his mind means both loss of motion and sensation, it stands to reason that the examiner will have great difficulty in eliciting any sensory or motor reactions into which psychic influences enter.
The neurological examination
Published in Michael Y. Wang, Andrea L. Strayer, Odette A. Harris, Cathy M. Rosenberg, Praveen V. Mummaneni, Handbook of Neurosurgery, Neurology, and Spinal Medicine for Nurses and Advanced Practice Health Professionals, 2017
Assess the plantar reflex for the Babinski sign. Stroke the sole of the foot firmly. If present, the big toe will move upward and the other toes fan out. This reflex is only normal in children up to 2 years old. An abnormal finding can be indicative of a central nervous system problem.
Thoracal arachnoiditis ossificans associated with multifocal motor neuropathy: a case report
Published in British Journal of Neurosurgery, 2023
Vladimir Baščarević, Dragoslav Sokić, Aleksandar J. Ristić
On clinical examination, she had normal cranial nerves. She had interosseal atrophy, atrophy of the thenar and hypothenar muscles and diminished reflexes in the right arm. In the right arm, weakness of the interosseal, hypothenar and thenar muscles as well as of the finger flexors and wrist and finger dorsiflexors was observed with normal sensory findings. Mild weakness of the hypothenar and interosseal muscles and of the wrist dorsiflexors without trophic changes and sensory impairment, but with brisk reflexes was found in the left arm. She exhibited mild, mainly proximal lower limb weakness, while knee and ankle reflexes were brisk. Extensor plantar reflex and mild spasticity were noted bilaterally. Pinprick and light touch sensations were significantly decreased below T4/5. Vibration sense was impaired below the costal margin.
Acute presentation of papillary glioneuronal tumor due to intra-tumoral hemorrhage in a toddler: an odd presentation of a rare pathology
Published in British Journal of Neurosurgery, 2023
Amin Tavallaii, Ehsan Keykhosravi, Hamid Rezaee
A two years old male toddler was transferred to our center from a small town in the province with history of sudden onset left hemiparesis and lowering of consciousness since morning of admission day. There were no history of seizure attack or trauma. Patient was admitted to our center with Glasgow Coma Scale (GCS) of 13, agitated and without appropriate cooperation. Vital signs were within normal range and no abnormality was seen in initial laboratory testing which was performed in referring hospital. Physical examination revealed left hemiparesis with muscle forces of 2/5 and 3/5 in left upper and lower limbs respectively in the Medical Research Council (MRC) scale. Muscle spasticity or hyperreflexia was not present but left plantar reflex was upward. All cranial nerves examinations were intact as far as patient cooperation allowed. Head circumference was within normal range. Fundoscopic examination was not possible and not performed due to patient agitation. Because, there were no history of seizure and patient hemiparesis did not improve over time, a possibility of post ictal tod’s paralysis was unlikely.
Synovial sarcoma mimicking a thoracic dumbell schwannoma- a case report*
Published in British Journal of Neurosurgery, 2020
Susanth Subramanian, Gandham Edmond Jonathan, Bimal Patel, Krishna Prabhu
A forty-six-year-old lady presented with mid back pain without any radiation and progressive tightness and weakness of both lower limbs for six months duration. There was no history of any bowel or bladder involvement. There was graded sensory loss below T10 level with no sacral sparing. Deep tendon reflexes were exaggerated in lower limbs. Beevor’s sign was positive and plantar reflex was extensor bilaterally. She was bedridden at the time of presentation. Routine haematological and biochemical parameters were normal. X-ray of thoracic spine was normal. MRI spine with gadolinium showed a well-defined dumbbell shaped intradural extramedullary tumour with a large extradural component at T7-T8 level with extension through the neural foramina on left side. The tumour was isointense in both T1, and T2 weighted imaging with homogeneous enhancement in the post-gadolinium imaging. The tumour was compressing and displacing the thoracic spinal cord to the right side. The tumor eroded the lamina and the left T8 pedicle (Figures 1 and 2). Based on the MRI findings a possibility of an intra and extradural nerve sheath tumour was considered.