The Neurological Exam of a Comatose Patient: Original Article an Essential Practical Guide
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Correlation of Electrodiagnostic and Clinical Findings in Unilateral S1 Radiculopathy
Neurol. Croat. Vol. 65, 1-4, 2016 Correlation of electrodiagnostic and clinical findings in unilateral S1 radiculopathy Seyed Mansoor Rayegani, Navid Rahimi, Elham Loni, Shahram Rahimi Dehgolan, Leyla Sedighipour ABSTRACT – Objectives: Lumbosacral radiculopathy is a challenging diagnosis and electrodiagnostic study (EDX) is a good complementary test to magnetic resonance imaging (MRI). Physical examination, MRI and electrodiagnosis have different diagnostic value in this regard. MRI can provide anatomical evidence and is 3 useful in choosing the treatment procedure, but it may also yield false-positive results. In this study, we as- 1-4, 2016 Number sessed the correlation of clinical and EDX findings in patients with L5-S1 disc herniation on MRI.Methods: EDX was performed in 87 patients referred for clinical and MRI diagnosis of S1 radiculopathy. The consist- ency of EDX results with MRI and clinical findings was evaluated by Pearson 2χ -test and odds ratio. Results: Disc protrusion was present in 58% and disc extrusion in 42% of patients. Physical examination revealed absent Achilles reflex in 83% and decreased S1 dermatome sensation in 65% of patients. In this study, EDX sensitivity was about 92%. The highest consistency between EDX parameters and physical examination find- ings was recorded between absent H-reflex and decreased Achilles reflex (OR=6.20; p=0.014), but there was no significant consistency between H-reflex and either muscular weakness or straight leg raising test result (p>0.05). There was no relationship between the type of disc herniation on MRI and H-reflex either. There was correlation between H-reflex abnormalities and absent ankle reflex in patients with unilateral L5-S1 disc herniation on MRI. -
Theoretical Part Recruitment and Summation in Skeletal Muscle
name number study group Theoretical part Recruitment and summation in skeletal muscle Myography and electromyography Myography is a method for recording skeletal muscle contractions. On the contrary, electromyography (EMG) is a method registering the electric activity produced by skeletal muscle. Muscle fibre Each individual skeletal muscle cell (or myocyte or fiber) contains a dense parallel array of smaller, cylindrical elements called myofibrils that have the diameter of a Z disk (Figure 1). Each of these myofibrils comprises repeating units, or sarcomeres, that consist of smaller interdigitating filaments called myofilaments. These myofilaments come in two types, thick filaments composed primarily of myosin and thin filaments composed primarily of actin. The sarcomere extends from one Z disk to another. Sarcomeres stacked end to end make up a myofibril. The repeating sarcomeres are most highly organized within skeletal and cardiac muscle and impart a striped appearance. Thin filaments are 5 to 8 nm in diameter and, in striated muscle, 1 μm in length. In striated muscle, the thin filaments are tethered together at one end, where they project from a dense disk known as the Z disk. The Z disk is oriented perpendicular to the axis of the muscle fibre; thin filaments project from both its faces. Not only do Z disks tether the thin filaments of a single myofibril together, but connections between the Z disks also tether each myofibril to its neighbours. These interconnections align the sarcomeres and give skeletal and, to a lesser extent, cardiac muscle its striated appearance. The thick filaments are 10 nm in diameter and, in striated muscle, 1.6 μm in length. -
Blink Reflex, H-Reflex and Nerve-Conduction Alterations In
Lepr Rev (2006) 77, 114–120 Blink reflex, H-reflex and nerve-conduction alterations in leprosy patients ANA BERTHA MORA-BRAMBILA*, BENJAMI´N TRUJILLO-HERNA´ NDEZ**, RAFAEL COLL-CARDENAS***, MIGUEL HUERTA***, XO´ CHITL TRUJILLO***, CLEMENTE VA´ SQUEZ***, BERTHA ALICIA OLMEDO-BUENROSTRO*, REBECA O. MILLAN-GUERRERO** & ALEJANDRO ELIZALDE*** *Facultad de Enfermerı´a, Universidad de Colima, Colima, Me´xico **Unidad de Investigacio´n en Epidemiologı´a Clı´nica, Hospital General de Zona y Medicina Familiar No. 1, Instituto Mexicano del Seguro Social, Colima, Colima, Me´xico ***Centro Universitario de Investigaciones Biome´dicas, Universidad de Colima, Colima, Me´xico Accepted for publication 14 February 2006 Summary Peripheral nerve lesions are the most important cause of disability in leprosy patients. Electrophysiological studies are used in the diagnosis and prognosis of neuropathy. Nerve conduction is the most frequently used electrophysiological test method to detect neuropathy, although it evaluates only a part of the peripheral nervous system. Blink reflex and H-reflex are electrophysiological tests which evaluate facial and trigeminal nerve function. This study determined the frequencies of blink reflex, H-reflex and motor and sensory nerve conduction alterations in twenty five heterogeneous, clinic patients with lepromatous leprosy and a control group of 20 healthy subjects. Study results showed a decrease in motor and sensory nerve conduction in 40% and 30%, respectively. In blink reflex (BR), right R1 was altered in latency. in 20% of patients, left R1 in 20%, right ipsilateral R2 in 16%, left ipsilateral R2 in 20%, and right and left contralateral R2 were altered in 32% of patients. There was an absence of H-reflex in 16% (n ¼ 4) and prolonged latency in 4% (n ¼ 1). -
Territorial and Extraterritorial Trigeminocardiac Reflex: a Review for the Neurosurgeon and a Type IV Reflex Vignette
Open Access Review Article DOI: 10.7759/cureus.11646 Territorial and Extraterritorial Trigeminocardiac Reflex: A Review for the Neurosurgeon and a Type IV Reflex Vignette Daniel S. Leon-Ariza 1 , Juan S. Leon-Ariza 2 , Mayra A. Gualdron 3 , Jaime Bayona-Prieto 4 , Fidias E. Leon- Sarmiento 5, 6, 7 1. School of Medicine, Santander University-UDES, Bucaramanga, COL 2. Neuroscience, Mediciencias Research Group, Miami, USA 3. Faculty of Medicine, Unicolsanitas, Bogota, COL 4. Cirineo Research Group, Unicolciencias, Bucaramanga, COL 5. Environmental Health, Florida International University, Miami, USA 6. Neurology, Baptist Health South Florida, Miami Neuroscience Institute, Miami, USA 7. Internal Medicine, National University, Bogota, COL Corresponding author: Fidias E. Leon-Sarmiento, [email protected] Abstract The trigeminocardiac reflex (TCR) is a complex and, sometimes, fatal event triggered by overstimulation of the trigeminal nerve (TN) and its territorial and spinal cord branches. We reviewed and compiled for the neurosurgeon key aspects of the TCR that include a novel and straightforward classification, as well as morphophysiology, pathophysiology, neuromonitoring and neuromodulation features. Further, we present intraoperative data from a patient who developed extraterritorial, or type IV, TCR while undergoing a cervical surgery. TCR complexity, severity and unwanted outcomes indicate that this event should not be underestimated or overlooked in the surgical room. Timely TCR recognition in surgical settings is valuable for applying effective intraoperative management to prevent catastrophic outcomes. Categories: Otolaryngology, Neurosurgery, Anatomy Keywords: trigeminocardiac reflex trigeminal nerve, spinal cord, neurophysiology, neuromonitoring, neuromodulation Introduction And Background The trigeminocardiac reflex (TCR) is a complex neurovascular reflex triggered by overstimulating the trigeminal nerve (TN) and its anastomosis. -
Brainstem Dysfunction in Critically Ill Patients
Benghanem et al. Critical Care (2020) 24:5 https://doi.org/10.1186/s13054-019-2718-9 REVIEW Open Access Brainstem dysfunction in critically ill patients Sarah Benghanem1,2 , Aurélien Mazeraud3,4, Eric Azabou5, Vibol Chhor6, Cassia Righy Shinotsuka7,8, Jan Claassen9, Benjamin Rohaut1,9,10† and Tarek Sharshar3,4*† Abstract The brainstem conveys sensory and motor inputs between the spinal cord and the brain, and contains nuclei of the cranial nerves. It controls the sleep-wake cycle and vital functions via the ascending reticular activating system and the autonomic nuclei, respectively. Brainstem dysfunction may lead to sensory and motor deficits, cranial nerve palsies, impairment of consciousness, dysautonomia, and respiratory failure. The brainstem is prone to various primary and secondary insults, resulting in acute or chronic dysfunction. Of particular importance for characterizing brainstem dysfunction and identifying the underlying etiology are a detailed clinical examination, MRI, neurophysiologic tests such as brainstem auditory evoked potentials, and an analysis of the cerebrospinal fluid. Detection of brainstem dysfunction is challenging but of utmost importance in comatose and deeply sedated patients both to guide therapy and to support outcome prediction. In the present review, we summarize the neuroanatomy, clinical syndromes, and diagnostic techniques of critical illness-associated brainstem dysfunction for the critical care setting. Keywords: Brainstem dysfunction, Brain injured patients, Intensive care unit, Sedation, Brainstem -
The Neurological Exam
The Neurological Exam Introduction to the Neurological Exam The neurological exam consists of the following components: 1. Higher cognitive function as assessed by the mental status examination. (This will be addressed elsewhere in the course.) 2. Cranial nerves 3. Motor system 4. Sensory systems 5. Stance and gait I Olfactory Nerve Examination Technique: stimulant should be non-irritating test one nostril at a time with the opposite side occluded patient should not be able to see the stimulus cloves ideal stimulant since it preserves it’s scent improvise at bedside with soap, toothpaste, or perfume Normal Response: to perceive the scent with either nostril Abnormal Response: a unilateral loss is more likely to be significant and may imply a structural brain lesion affecting the olfactory bulb or tract, but could also be due to local causes such as a deviated septum or blocked nasal passage bilateral loss can occur with rhinitis or damage to the cribriform plate II Optic Nerve - Visual Acuity Examination Technique: each eye is tested separately. test best corrected vision using eyeglasses. any patient with uncorrected visual acuity of less than 20/20 should be examined with a pinhole. Improvement of vision through a pinhole indicates that the error is refractive. test distant vision using a Snellen chart at 10 or 20 feet. II Optic Nerve - Visual Fields A. Peripheral visual field (a) wiggling fingers (b) counting fingers (c) white pin B. Central visual field (a) red pin Examination Technique: visual fields are assessed by confrontation , i.e. the examiner compares the patient’s visual field to their own and assumes that theirs is normal. -
Cortex Brainstem Spinal Cord Thalamus Cerebellum Basal Ganglia
Harvard-MIT Division of Health Sciences and Technology HST.131: Introduction to Neuroscience Course Director: Dr. David Corey Motor Systems I 1 Emad Eskandar, MD Motor Systems I - Muscles & Spinal Cord Introduction Normal motor function requires the coordination of multiple inter-elated areas of the CNS. Understanding the contributions of these areas to generating movements and the disturbances that arise from their pathology are important challenges for the clinician and the scientist. Despite the importance of diseases that cause disorders of movement, the precise function of many of these areas is not completely clear. The main constituents of the motor system are the cortex, basal ganglia, cerebellum, brainstem, and spinal cord. Cortex Basal Ganglia Cerebellum Thalamus Brainstem Spinal Cord In very broad terms, cortical motor areas initiate voluntary movements. The cortex projects to the spinal cord directly, through the corticospinal tract - also known as the pyramidal tract, or indirectly through relay areas in the brain stem. The cortical output is modified by two parallel but separate re entrant side loops. One loop involves the basal ganglia while the other loop involves the cerebellum. The final outputs for the entire system are the alpha motor neurons of the spinal cord, also called the Lower Motor Neurons. Cortex: Planning and initiation of voluntary movements and integration of inputs from other brain areas. Basal Ganglia: Enforcement of desired movements and suppression of undesired movements. Cerebellum: Timing and precision of fine movements, adjusting ongoing movements, motor learning of skilled tasks Brain Stem: Control of balance and posture, coordination of head, neck and eye movements, motor outflow of cranial nerves Spinal Cord: Spontaneous reflexes, rhythmic movements, motor outflow to body. -
Prenatal Origin of Behavior Hibited When Its Development Is Complete
Tne Prenatal Origin of Behavior The Prenatal Origin of Beliavior ty Davenport Hooker, Pli.D., Sc.D. Professor of Anatomy and Chairman of the Department University of Pittsburgh School of Medicine Porter Lectures, Series 18 University of Kansas Press, Lawrence, Kansas, 1952 COPYRIGHT, 1952, BY THE UNIVERSITY OF KANSAS PRESS Physiological and morphological studies on human prenatal de• velopment, publication no. 20. These studies have been aided by- grants from the Penrose Fund of the American Philosophical So• ciety, from the Carnegie Corporation of New York, from the University of Pittsburgh, and from the Sarah Mellon Scaiie Foundation. Preface o BE INVITED to fill the Porter Lectureship in Medi• cine is indeed an honor and one for which this lec• T turer is most grateful. Quite aside from my personal gratification at being invited to lecture on this foundation, I am especially pleased because of my long friendship with Dr. George Ellett Coghill, the founder in America of work on embryonic movements, who served the University of Kansas School of Medicine from 1913 to 1925. It has also been my privilege to know for a long time both Dr. Henry Carroll Tracy, his successor as Chairman of the Depart• ment at Kansas, and the present Chairman, Dr. Paul Gib• bons Roofe. I am indebted for many things to many people too numerous to name here, but it would be falling short of both justice and courtesy were I to omit expressing my debt to many colleagues, past and present, including Dr. Tryphena Humphrey, Dr. Ira D. Hogg, and the staff of the Elizabeth Steel Magee Hospital. -
In the Name of God the Compassionate and the Merciful
In the Name of God the Compassionate and the Merciful Cutaneomuscular Reflexes in the Lower Limbs in Man A Thesis Submitted for the Degree of Doctor of Philosophy in the Faculty of Medicine by Hossein-Bagheri BSc and MSc in Physiotherapy April 1995 Division of Neuroscience and Biomedical Systems, Institute of Biomedical Life Sciences, University of Glasgow ProQuest Number: 11007741 All rights reserved INFORMATION TO ALL USERS The quality of this reproduction is dependent upon the quality of the copy submitted. In the unlikely event that the author did not send a com plete manuscript and there are missing pages, these will be noted. Also, if material had to be removed, a note will indicate the deletion. uest ProQuest 11007741 Published by ProQuest LLC(2018). Copyright of the Dissertation is held by the Author. All rights reserved. This work is protected against unauthorized copying under Title 17, United States C ode Microform Edition © ProQuest LLC. ProQuest LLC. 789 East Eisenhower Parkway P.O. Box 1346 Ann Arbor, Ml 48106- 1346 g la s s o w r DNivEfiajr? library Dedicated to my wife and children Dedicated to my father who passed away during my Ph.D course i Contents Page List of contents i List of figures vi List of tables ix Abbreviations xi Acknowledgement xiii Declaration and list of publications xiv Summary xv 1. Introduction 1 1.1 General history 1 1.2 Techniques for identifying spinal reflexes 3 Monosynaptic testing 3 H-reflex 3 Spinal proprioceptive reflexes 4 Single motor unit EMG recording 4 Peristimulus time histogram 5 Surface -
Development of the Flexion Withdrawal Reflex
Spinal sensory processing in the human infant: Development of the flexion withdrawal reflex Laura Louise Cornelissen Thesis submitted for the degree of Doctor of Philosophy University College London 2011 1 Declaration The work in this thesis was conducted in the Department of Neuroscience, Physiology and Pharmacology at University College London, and in the Elizabeth Anderson and Obstetrics Wing at University College Hospital. I, Laura Louise Cornelissen, confirm that the work presented in this thesis is my own. Where other information has been derived from other sources, I confirm that this has been indicated in the thesis. Laura Louise Cornelissen March 2011 2 Abstract Immature spinal sensory reflexes have lower mechanical thresholds and are poorly coordinated and exaggerated compared to adult reflexes. However, little quantitative data is available on how these spinal sensory circuits develop in the human infant. This thesis investigates the development of cutaneous flexion withdrawal reflexes in preterm and full- term human infants following noxious and non-noxious stimulation of the heel, and tests whether flexion withdrawal reflex activity is modulated by the commonly administered analgesic, oral sucrose, in a randomised controlled trial. The studies were undertaken in infants aged 28-45 weeks gestation (GA), in-patients at University College Hospital, London. The noxious stimulus was a clinically required heel lance; non-noxious stimulation was either a light touch of the heel or application of calibrated von Frey hairs to the heel. Flexion withdrawal reflex activity was recorded with surface EMG electrodes placed over the biceps femoris muscle. Video recordings of facial expression were recorded for clinical pain assessment. -
Brainstem Dysfunction in Critically Ill Patients
Benghanem et al. Critical Care (2020) 24:5 https://doi.org/10.1186/s13054-019-2718-9 REVIEW Open Access Brainstem dysfunction in critically ill patients Sarah Benghanem1,2 , Aurélien Mazeraud3,4, Eric Azabou5, Vibol Chhor6, Cassia Righy Shinotsuka7,8, Jan Claassen9, Benjamin Rohaut1,9,10† and Tarek Sharshar3,4*† Abstract The brainstem conveys sensory and motor inputs between the spinal cord and the brain, and contains nuclei of the cranial nerves. It controls the sleep-wake cycle and vital functions via the ascending reticular activating system and the autonomic nuclei, respectively. Brainstem dysfunction may lead to sensory and motor deficits, cranial nerve palsies, impairment of consciousness, dysautonomia, and respiratory failure. The brainstem is prone to various primary and secondary insults, resulting in acute or chronic dysfunction. Of particular importance for characterizing brainstem dysfunction and identifying the underlying etiology are a detailed clinical examination, MRI, neurophysiologic tests such as brainstem auditory evoked potentials, and an analysis of the cerebrospinal fluid. Detection of brainstem dysfunction is challenging but of utmost importance in comatose and deeply sedated patients both to guide therapy and to support outcome prediction. In the present review, we summarize the neuroanatomy, clinical syndromes, and diagnostic techniques of critical illness-associated brainstem dysfunction for the critical care setting. Keywords: Brainstem dysfunction, Brain injured patients, Intensive care unit, Sedation, Brainstem -
Caregiver-Handbook-06-Health-1
Health Communicable Diseases What is a Communicable Disease? A communicable disease is one that is spread from one person to another through a variety of ways that include: contact with blood and bodily fluids, breathing in an airborne virus, or by having contact with a little bug called lice. For the most part, communicable diseases are spread through viruses and bacteria that live in blood and body fluids. For instance, hepatitis and human immunodeficiency virus (HIV) are examples of infections that can be carried in blood and bodily fluids. On the other hand, tuberculosis is an airborne disease. A person with tuberculosis (TB) can spread tiny germs that float in the air if they cough or sneeze without covering their nose or mouth. And, there are some communicable diseases like head lice that are caused by a live lice bug that is spread by using an infected comb or wearing a hat that is infested with lice. For more information about how to reduce potential exposure to communicable diseases, see Section 7. Let’s take a closer look at some communicable diseases. Page 6-2 - 53 - Head Lice How is Head Lice Spread? Head lice can infest people of all ages and economic standing. Head to head contact or simple exchange of hats, clothing, combs and other personal items can lead to the transmission of lice from one person to another. Head lice are contagious. If someone you know has head lice, do not panic. Caregiving Tips: 1. Inspect for Lice and Nits Using a magnifying glass and natural light, carefully examine hair, scalp, sideburns, eyebrows, beards and mustaches of all household members for lice and their eggs, called “nits.” Nits, which are yellowish-white in color and oval shaped, can be easier to locate than lice.