Cletus
Walter J. Hendelman, Peter Humphreys, Christopher R. Skinner in The Integrated Nervous System, 2017
The clinical examination of Cletus indicated weakness of all muscles on both sides below the umbilicus. A word of caution about describing localization of spinal levels of dysfunction: often, the spinal cord level is used to describe the level of dysfunction based on clinical exam. Using the Expanded Localization Matrix, we see that, in any given patient with a spinal cord lesion, the probable major clinical findings are, variously, loss of sensation to pinprick and temperature; loss of sensation to vibration, proprioception and discriminative touch; weakness, reflex changes and changes in muscle tone. Several terms are used to describe spinal cord injury and level. The observation of fasciculations in the tongue is very significant in that it shows lower motor neuron damage located above the level of the cervical spine. The lateral sclerosis (LS) part of the name refers to the lateral columns or lateral funiculi in which the corticospinal tracts run.
Station 2: History Taking
Saira Ghafur, Parminder K Judge, Richard Kitchen, Samuel Blows, Fiona Moss in The MRCP PACES Handbook, 2017
Neurology cases lend themselves to being spot diagnoses. Neurology is often thought of as being a particularly difficult station, but if the doctors work on the premise that they are trying to find the site of the lesion and then consider the differential diagnosis, they will demonstrate to the examiners that they are organised and pragmatic. When assessing sensation, be sure to check for normal sensation on the chest first. Compare normal sensation with the peripheral sensation. It is important to decide early whether to assess sensation in a dermatomal or a peripheral pattern. This is not always possible. Therefore, start in a dermatomal distribution and move on to test glove and stocking pattern if peripherally confluent. The most likely diagnosis is motor neurone disease (MND). There is generalised wasting and fasciculation. Tone is increased with generalised weakness. Reflexes are brisk/reduced/absent. Leg reflexes are brisk and ankle clonus is present. There are bilateral extensor plantar responses.
Dysphagia
Sherif Gonem, Ian Pavord in Diagnosis in Acute Medicine, 2017
The causes of dysphagia may be classified into neuromuscular and obstructive categories. Disruption of the neuromuscular control of swallowing may occur at the level of the central nervous system, the peripheral nerves or the pharyngeal and oesophageal muscles. Patients with neuromuscular dysphagia may be at risk of aspiration if they are allowed unrestricted oral intake. Examination of the mouth and pharynx should not be performed without anaesthetic support and full resuscitation facilities if airway compromise is a possibility, as it may precipitate complete airway occlusion. Hemiparesis, hemisensory loss, dysphasia, dyspraxia, visual neglect or homonymous hemianopia suggest a cerebral lesion. Abnormal, uncoordinated or involuntary movement may occur with degenerative, demyelinating or inherited disorders of the central nervous system. Bulbar palsy is characterised by nasal speech, tongue wasting and fasciculation, and an absent gag reflex. Pseudobulbar palsy is char-acterised by spastic dysarthria, a brisk gag reflex and jaw jerk, and emotional lability.
Muscle ultrasonography in the diagnosis of amyotrophic lateral sclerosis
Published in Neurological Research, 2020
Wang Juan, Liu Fang, Wen Qi, Ma Jing, Huang Shan, Zhang Jing, Chang Xueli, Zhang Wei, Guo Junhong
Objectives: The aims of this study were to investigate the differences of fasciculations detected by muscle ultrasonography (MUS) among patients with amyotrophic lateral sclerosis (ALS), patients with ALS mimics and healthy controls, and to propose a simplified MUS fasciculation score for the diagnosis of ALS. Methods: We included 16 patients with ALS (ALS group), 10 patients with ALS mimics (disease-control group), and 10 healthy adults (healthy control group). Subjects underwent MUS in 11 muscles, including the tongue, and bilateral upper trapezius, biceps brachii, abductor pollicis brevis, rectus femoris, and tibialis anterior. Results: The number of muscles with fasciculations per person was more in the ALS group (6.44 ± 2.56) than in the disease-control group (1.20 ± 1.87, P = 0.001) and healthy control group (0.50 ± 1.08, P
Successful Improvement of Pain Symptomatology in a Suspected Case of Cramp-Fasciculation Syndrome via Interventional Pain Treatment
Published in Journal of Pain & Palliative Care Pharmacotherapy, 2018
Anita Gupta, Lucas First, Celeste A. Swain
Peripheral nerve hyperexcitability (PNH) syndromes are a rare set of neuromuscular disorders that include cramp-fasciculation syndrome (CFS) and Isaacs syndrome (IS). Successful treatment of these diseases has been achieved with antiepileptic medications; however, chronic pain symptoms can persist. We provide a case report of a 25-year-old female who has suffered from painful severe muscle spasms and fasciculations since childhood. With CFS as our working diagnosis, a treatment regimen using interventional pain techniques, including sympathetic chain blocks, ketamine infusions, and trigger point injections, resulted in a significant decrease in the patient's chronic pain symptoms. This case offers a novel application of interventional pain procedures and may help further our understanding of PNH syndromes.
Benign Fasciculation Syndrome
Published in Journal of Pain & Palliative Care Pharmacotherapy, 2015
Questions from patients about pain conditions, analgesic pharmacotherapy, and responses from authors are presented to help educate patients and make them more effective self-advocates. In reply to a question about benign fasciculation syndrome, the presentation, causes, treatment, and chances of developing amyotrophic lateral sclerosis will be discussed.
Related Knowledge Centers
- Electromyography
- Lower Motor Neuron
- Motor Neuron Disease
- Muscle Contraction
- Skeletal Muscle
- Peripheral Nervous System Diseases
- Neuromuscular Manifestations