Diagnostic value of clinical deep tendon reflexes in diabetic peripheral neuropathy.

Introduction: The aim of the present study was to evaluate the diagnostic efficacy of different tendon reflexes in detecting diabetic peripheral neuropathy (DPN). Material and methods: According to the changes in tendon reflexes, all patients with diabetes were divided into three strata: impaired Achilles reflex only, impaired lower extremity reflexes, and impaired lower and upper extremity reflexes. Taking nerve conduction studies (NCS) as the gold standard, the sensitivity, specificity, and predictive ability of the tendon reflexes of these three strata, as well as the Toronto clinical scoring system (TCSS) and Michigan Neuropathy Screening Instrument (MNSI), were calculated. Then, the electrophysiological characteristics of diabetic patients with different tendon reflexes were analysed. Results: Among the 240 patients studied, 92 (38.3%) presented evidence of neuropathy, which was confirmed by abnormal NCS, while 148 (61.7%) had normal NCS results. Taking NCS as the gold standard, stratum 1 yielded a sensitivity and specificity of 93.5% and 54.7%, respectively, while stratum 3 had higher specificity (96.6%) and lower sensitivity (34.8%) when compared to stratum 1. However, stratum 2 had the highest specificity (75.7%). Conclusions: The assessment of tendon reflexes can be proposed as a test for screening diabetic polyneuropathy.

Can tendon reflexes be elicited by both stretch and vibration in man?

AIM OF STUDY: When the biceps tendon is tapped, a contraction is elicited in the biceps muscle. This also occurs with tapping of the radial bone, and it has been suggested that vibration is a stimulus for deep tendon reflexes. We investigated whether the normal stimulus for the deep tendon reflex is a sudden stretch, a phasic vibration, or both. Furthermore, we investigated the importance of forearm position for the reflex response in controls and stroke patients. METHODS: We investigated 50 neurological outpatients without clinical signs of neurological disorders in the arms. The biceps tendon and distal radius were tapped with the forearm in the midway (90°), supinated, and pronated positions. In 10 of these patients, the two reflexes were also investigated with quantitative electromyography (EMG) measurements in the 3 positions. Another 10 patients were investigated clinically when stretch of elbow was eliminated and 17 patients were examined when prestretching of the biceps tendon was avoided. Finally, we examined 32 patients that had experienced stroke. RESULTS: In 94% (47/50) of patients, after a radial tap, the biceps contraction disappeared in the supinated forearm, and the median peak-to-peak amplitude of the surface EMG response (n = 10) decreased from 1.1 to 0.2 mV (p < .01). Elimination of elbow stretch as well as pressure on the biceps tendon did not change the reflex response. In 84% (27/32) of stroke patients, after a radial tap, the biceps contraction persisted in supination in the arm with hyperreflexia. CONCLUSION: The combined clinical and EMG results are consistent with the concept that the deep tendon reflexes in man can be elicited by both stretch and phasic vibration. Clinicians should be aware that the brachioradial reflex depends on the forearm position.

Role of intraoperative dynamic magnetic resonance myelogram in management of giant dorsolumbar spinal extradural arachnoid cyst: case report.

Giant dorsolumbar spinal arachnoid cysts are a complex, poorly understood, and difficult to manage clinical entity. Traditional CT myelography is technically difficult to use in these cases to detect the site of leakage preoperatively. The authors report a novel technique for detecting the site of the leak by using sequential, dynamic intraoperative MR myelography. To the authors' knowledge, there is no other similar report in the literature.

Reflexes in psychiatry.

Psychiatric patients often do not cooperate fully with the neurologic examination. Reflexes virtually bypass patient effort and are difficult to consciously determine. This article reviews muscle stretch (deep tendon) reflexes, and pathological reflexes including the extensor plantar (Babinski) and primitive release reflexes. Topics include findings in common psychiatric and neurologic conditions and methods for eliciting these signs.