RESUMO
We herein report a 53-year-old female with repeated transient ischemic attack (TIA) symptoms including 13 instances of right hemiparesis that decreased in duration over 4 days. Two separate examinations using diffusion weighted image (DWI) in magnetic resonance imaging (MRI) revealed normal findings, but we observed that both Babinski and Chaddock signs were completely synchronized with her right hemiparesis. We were only able to diagnose this case of early stage TIA using clinical signs. This diagnosis was confirmed 4 days after the onset by the presence of abnormalities on the MRI. DWI-MRI is generally useful when diagnosing TIA, but a neurological examination may be more sensitive, especially in the early stages.
Assuntos
Ataque Isquêmico Transitório/diagnóstico , Imagem de Difusão por Ressonância Magnética , Diagnóstico Precoce , Reações Falso-Negativas , Feminino , Humanos , Ataque Isquêmico Transitório/complicações , Ataque Isquêmico Transitório/fisiopatologia , Pessoa de Meia-Idade , Paresia/etiologia , Paresia/fisiopatologia , Reflexo de Babinski/diagnóstico , Reflexo de Babinski/fisiopatologiaRESUMO
BACKGROUND: There have been very few studies concerning the Babkin reflex-opening of the mouth and flexion of the arms in response to stimulation of the palms. We attempted to clarify the clinical significance and neural mechanism of the reflex through systematic review. METHODS: Searches were conducted on Medline, Embase, and Google Scholar from their inception through August 2012. RESULTS: In normal term infants, the Babkin reflex can be elicited from the time of birth, becomes increasingly suppressed with age, and disappears in the great majority by the end of the fifth month of age. A marked response in the fourth or fifth month of age and persistence of the reflex beyond the fifth month of age are generally regarded as abnormal. On the other hand, because there are some normal infants showing no response during the neonatal period or early infancy, the absence of the response during these periods is not necessarily an abnormal finding. CONCLUSIONS: Infants with these abnormal findings should be carefully observed for the appearance of neurological abnormalities including cerebral palsy and mental retardation. It is most likely that the Babkin reflex is mediated by the reticular formation of the brainstem, which receives inputs from the nonprimary motor cortices. On the basis of the hand-mouth reflex, more adaptive movement develops as control of the nonprimary motor cortices over the reflex mechanism in the reticular formation increases. Soon it evolves into the voluntary eye-hand-mouth coordination necessary for food intake as the control of the prefrontal cortex over the nonprimary motor cortices becomes predominant.
Assuntos
Reflexo de Babinski/patologia , Encéfalo/patologia , Encéfalo/fisiopatologia , Humanos , Lactente , Vias Neurais/fisiologia , Reflexo de Babinski/fisiopatologiaRESUMO
This study was conducted to investigate the relationship between the pattern of pathological plantar response (Babinski sign), and the focus of the lesions of pyramidal tract. We examined 107 subjects with definite lesions of the pyramidal tract recruited from inpatients at the Neurology Department of the Xuanwu Hospital of Capital Medical University (Beijing, China). We found that patients with sub-cortical lesions (corona radiata to spinal cord) showed different patterns of Babinski sign than those with lesions within the primary motor cortex. Specifically, dorsiflexion of the big toe without recruitment of the other toes was seen in 71.4 % of patients with cortical pyramidal tract lesions, while 93 patients with lesions lower than cortex (corona radiata to spinal cord) showed movement of other toes in addition to the big toe, which showed movement due to contraction of the extensor hallucis longus tendon in all patients. There were no differences in patterns of Babinski sign between the different sub-cortical lesion foci. We conclude that the patterns of Babinski sign can be used to predict cortical lesions of the pyramidal tract.
Assuntos
Encéfalo/patologia , Tratos Piramidais/lesões , Reflexo de Babinski/patologia , Reflexo de Babinski/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estimulação Física/métodosRESUMO
The aim of this work was to determine the value of stroking the lateral dorsal border of the foot, in addition to stroking the sole in patients with a suspected pyramidal tract lesion. In addition, we studied the differences in interpretation between neurologists, residents, and medical students. We included subjects who had weakness of at least one leg and in whom a pyramidal tract lesion was suspected. After testing muscle power, tone, reflexes, and foot tapping, a decision on the presence of a pyramidal syndrome had to be made by each observer. After stimulating the sole as well as the lateral border of the foot, observers made a decision about the presence of a pyramidal syndrome again. Twenty-two legs of 18 patients were examined. Testing the plantar reflex (according to both methods) led to a change of opinion on the presence of a pyramidal syndrome in 45 of 69 (65 %) observations. On analysis according to level of experience, a change of opinion occurred in 19 (86 %) observations by medical students, 15 (65 %) by residents, and 11 (46 %) by neurologists. On eight occasions, the change was prompted by stimulation of the lateral border; in five of these cases the examiner (three medical students and two residents) found a new pathological response. Consecutively stroking the sole and the lateral border may be of added value, especially for less-experienced physicians. It seems that more-experienced physicians need fewer tests in the physical examination in order to identify a pyramidal syndrome of the leg.
Assuntos
Competência Clínica/normas , Pé , Internato e Residência/normas , Médicos/normas , Reflexo de Babinski/diagnóstico , Estudantes de Medicina , Idoso , Feminino , Pé/fisiologia , Humanos , Masculino , Reflexo de Babinski/fisiopatologia , Dedos do Pé/fisiologiaRESUMO
It is often difficult to identify signs of upper motor neuron lesion in the limbs of patients with amyotrophic lateral sclerosis, in whom there is neurogenic muscle wasting of varying severity. The reasons for this are complex and not related simply to the degree of lower motor neuron muscle wasting but, rather, depend on the pathophysiological abnormalities that develop in response to damage to descending motor pathways and to motor neurons and interneurons in the ventral horns of the spinal cord. The different mechanisms underlying the clinical phenomenology of the functional motor defect in amyotrophic lateral sclerosis, that lead to difficulty in detecting classical upper motor neuron signs, are discussed.
Assuntos
Esclerose Lateral Amiotrófica/diagnóstico , Esclerose Lateral Amiotrófica/fisiopatologia , Neurônios Motores gama/fisiologia , Medula Espinal/fisiopatologia , Humanos , Interneurônios/fisiologia , Espasticidade Muscular/fisiopatologia , Degeneração Neural/fisiopatologia , Reflexo de Babinski/fisiopatologia , Reflexo de Estiramento/fisiologiaAssuntos
Anafilaxia/complicações , Hemorragia Cerebral/etiologia , Epinefrina/efeitos adversos , Vasoconstritores/efeitos adversos , Adulto , Anafilaxia/tratamento farmacológico , Ataxia/etiologia , Gânglios da Base/diagnóstico por imagem , Gânglios da Base/patologia , Encéfalo/diagnóstico por imagem , Angiografia Cerebral , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/patologia , Epinefrina/uso terapêutico , Feminino , Humanos , Hipertensão Intracraniana/complicações , Angiografia por Ressonância Magnética , Imageamento por Ressonância Magnética , Exame Neurológico , Paresia/etiologia , Reflexo de Babinski/fisiopatologia , Tomografia Computadorizada por Raios X , Vasoconstritores/uso terapêuticoAssuntos
Infarto Cerebral/complicações , Infarto Cerebral/diagnóstico , Deslocamento do Disco Intervertebral/diagnóstico , Anamnese , Debilidade Muscular/etiologia , Dor/etiologia , Reflexo de Babinski , Transtorno Conversivo/diagnóstico , Transtorno Conversivo/história , Diagnóstico Diferencial , Feminino , História do Século XIX , História do Século XX , Humanos , Deslocamento do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/cirurgia , Pessoa de Meia-Idade , Doença dos Neurônios Motores/diagnóstico , Doença dos Neurônios Motores/história , Exame Neurológico/métodos , Reflexo de Babinski/história , Reflexo de Babinski/fisiopatologiaRESUMO
STUDY DESIGN: A retrospective imaging study of 73 patients who underwent surgery for cervical spondylotic myelopathy (CSM) between April 2005 and July 2007. OBJECTIVE: To investigate whether magnetic resonance (MR) T2 image signal intensity (SI) ratio and clinical manifestation can assess the prognosis in patients with CSM. SUMMARY OF BACKGROUND DATA: The association between intramedullary high SI on T2-weighted MR images and surgical outcome in CSM remains controversial. The means of quantizing SI ratio for the disease has not been discussed. METHODS: A total of 73 patients with cervical compressive myelopathy were retrospectively enrolled and were treated with anterior, posterior, and posterior-anterior united decompression. A total of 1.5-T magnetic resonance imaging was performed in all patients before surgery. T2-weighted images of sagittal increased SI on the cervical spinal cord were obtained, and the regions of interest (ROIs) are taken by 0.05 cm. T2-weighted MR images of sagittal normal cord SI on the cervical between C7-T1 disc levels were obtained, and the ROIs are taken by 0.3 cm. SI value is measured by computer, and the SI ratio between the regions 0.05 cm and 0.3 cm has been calculated. If no intramedullary high SI was noted on T2-weighted MR images, the ROIs were taken by 0.05 cm of the severe compression cord. All patients had been divided into 3 groups by hierarchical clustering analysis with SI ratio (Group 1: low SI ratio, Group 2: middle SI ratio, and Group 3: high SI ratio). Statistical analyses were performed with SPSS 11.0. RESULTS: There are significant differences between 3 groups by comparing the recovery rate (P < 0.001), age (P = 0.003), duration of disease (P = 0.001), Babinski sign (P < 0.001), preoperative JOA score (P = 0.006), and postoperative JOA score (P < 0.001). There are no significant differences on sex among 3 groups (P = 0.387). By using the multiple comparison analysis, the above results are further shown. CONCLUSION: Patients with low SI ratio who were not too old and had a shorter duration of disease experienced a good surgical outcome. However, with the increase of SI ratio and the occurrence of pyramidal sign, a poor prognosis after surgery will show. SI ratio and clinical manifestation can be a predictor of surgical outcome.
Assuntos
Imageamento por Ressonância Magnética/métodos , Compressão da Medula Espinal/patologia , Compressão da Medula Espinal/cirurgia , Medula Espinal/patologia , Espondilose/patologia , Espondilose/cirurgia , Adulto , Idoso , Biomarcadores , Vértebras Cervicais/patologia , Vértebras Cervicais/fisiopatologia , Vértebras Cervicais/cirurgia , Descompressão Cirúrgica/métodos , Feminino , Humanos , Processamento de Imagem Assistida por Computador/métodos , Disco Intervertebral/patologia , Disco Intervertebral/fisiopatologia , Disco Intervertebral/cirurgia , Masculino , Pessoa de Meia-Idade , Exame Neurológico , Procedimentos Neurocirúrgicos/métodos , Valor Preditivo dos Testes , Cuidados Pré-Operatórios/métodos , Prognóstico , Reflexo de Babinski/etiologia , Reflexo de Babinski/fisiopatologia , Estudos Retrospectivos , Canal Medular/patologia , Canal Medular/fisiopatologia , Canal Medular/cirurgia , Medula Espinal/fisiopatologia , Compressão da Medula Espinal/fisiopatologia , Espondilose/fisiopatologiaRESUMO
OBJECTIVE: This paper investigates efferent and afferent conductions of the central nervous system by various evoked potentials in patients with adrenomyeloneuropathy (AMN). PATIENTS AND METHODS: Ten pure AMN patients without cerebral involvement were studied. Motor evoked potentials (MEPs), somatosensory evoked potentials (SEPs), auditory brainstem response (ABR), and pattern reversal full-field visual evoked potentials (VEPs) were recorded. For MEP recording, single-pulse or double-pulse magnetic brainstem stimulation (BST) was also performed. RESULTS: Abnormal MEP was observed in all ten patients, abnormal SEP in all ten, abnormal ABR in nine, and abnormal VEP in only one. Brainstem latency was measured in three of the seven patients with central motor conduction time (CMCT) prolongation. The cortical-brainstem conduction time was severely prolonged along the normal or mildly delayed brainstem-cervical conduction time in those three patients. CONCLUSIONS: The pattern of normal VEP and abnormal MEP, SEP, ABR is a clinically useful electrophysiological feature for the diagnosis. BST techniques are helpful to detect, functionally, intracranial corticospinal tract involvement, probably demyelination, in pure AMN patients.
Assuntos
Adrenoleucodistrofia/fisiopatologia , Vias Aferentes/fisiologia , Vias Eferentes/fisiologia , Potenciais Evocados/fisiologia , Membro 1 da Subfamília D de Transportadores de Cassetes de Ligação de ATP , Transportadores de Cassetes de Ligação de ATP/genética , Adrenoleucodistrofia/genética , Adulto , Idade de Início , Tronco Encefálico/fisiopatologia , Estimulação Elétrica , Potenciais Somatossensoriais Evocados/fisiologia , Potenciais Evocados Visuais/fisiologia , Lateralidade Funcional , Humanos , Pessoa de Meia-Idade , Mutação , Reconhecimento Fisiológico de Modelo , Reflexo de Babinski/fisiopatologiaRESUMO
The pyramidal signs in the lower extremity can be divided into three groups: (1) Babinski's group characterised by dorsoflexion of the great toe, (2) pyramidal signs marked by plantar flexion of the toes (e.g. Rossolimo's sign), and (3) synkinetic movements such as Strümpell's phenomenon. Puusepp's sign described by the Estonian neurologist and neurosurgeon Ludvig Puusepp belongs to none of these three groups. Its eliciting does not differ from that of Babinski's sign. The response, however, is different and consists of a tonic slow abduction of the little toe. We showed its relevance on the basis of clinical examination of six patients: four females aged 29, 50, 43 and 57 years and two males aged 42 and 49 years. The diagnoses were as follows: a new relapse of multiple sclerosis, a secondary progressive multiple sclerosis, a left middle cerebral artery stroke, a lumbago resulting in L3-L4 fusion surgery, an amyotrophic lateral sclerosis and a left intracerebral haemorrhage respectively. Puusepp's sign was the only elicitable pyramidal sign in all the patients but two. The 50-year-old female patient revealed on neurological examination Babinski's sign on the left side and Puusepp's sign on the right side. The testing of pyramidal signs in the 57-year-old woman displayed a bilateral Strümpell's sign and a left Puusepp's sign. These six cases showed that although rarely recognized in the clinical practice Puusepp's sign contributed to establishing the diagnosis of a central motor neuron involvement in the case of an absent Babinski's sign. Thus, its testing does not differ from that of Babinski's sign which requires only a little attention from the examiner, but provides an important piece of clinical information.
Assuntos
Transtornos dos Movimentos/diagnóstico , Transtornos dos Movimentos/patologia , Exame Neurológico , Tratos Piramidais/patologia , Adulto , Esclerose Lateral Amiotrófica/complicações , Esclerose Lateral Amiotrófica/fisiopatologia , Hemorragia Cerebral/complicações , Hemorragia Cerebral/fisiopatologia , Feminino , Humanos , Infarto da Artéria Cerebral Média/complicações , Infarto da Artéria Cerebral Média/fisiopatologia , Dor Lombar/complicações , Dor Lombar/fisiopatologia , Extremidade Inferior , Masculino , Pessoa de Meia-Idade , Doença dos Neurônios Motores/fisiopatologia , Esclerose Múltipla/complicações , Esclerose Múltipla/fisiopatologia , Reflexo/fisiologia , Reflexo de Babinski/fisiopatologia , Tomografia Computadorizada por Raios XAssuntos
Esclerose Lateral Amiotrófica/diagnóstico , Encéfalo/patologia , Imageamento por Ressonância Magnética , Debilidade Muscular/fisiopatologia , Paraparesia Espástica/fisiopatologia , Língua/patologia , Esclerose Lateral Amiotrófica/patologia , Esclerose Lateral Amiotrófica/fisiopatologia , Atrofia , Diagnóstico Diferencial , Eletromiografia , Extremidades/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Debilidade Muscular/etiologia , Paraparesia Espástica/etiologia , Reflexo de Babinski/fisiopatologia , Extremidade Superior/fisiopatologiaAssuntos
Transtornos dos Movimentos/fisiopatologia , Reflexo Anormal/fisiologia , Reflexo de Babinski/fisiopatologia , Dedos do Pé/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Córtex Motor/fisiologia , Doença dos Neurônios Motores/diagnóstico , Doença dos Neurônios Motores/fisiopatologia , Transtornos dos Movimentos/etiologia , Músculo Esquelético/fisiopatologia , Tratos Piramidais/fisiologia , Dedos do Pé/inervaçãoRESUMO
OBJECT: The Hoffmann sign is commonly used in clinical practice to assess cervical spine disease. It is unknown whether the sign correlates with the severity of myelopathy, and no consensus exists regarding the significance of a positive sign in asymptomatic individuals. METHODS: In a retrospective review of cervical spine surgeries for myelopathy due to cervical spondylosis, ossification of the posterior longitudinal ligament, or disc herniation performed at a tertiary center, the authors compiled data on the presence of hyperreflexia, the Hoffmann and Babinski signs, and modified Japanese Orthopaedic Association (mJOA) scale scores. Then, in a prospective evaluation, new patients with lumbar spine complaints were examined for the presence of a Hoffmann sign, and, if present, a cervical MR imaging study was assessed for cord compression. RESULTS: Of the 225 surgically treated patients, a Hoffmann sign occurred in 68%, hyperreflexia in 60%, and a Babinski sign in 33%. In patients with milder disability (mJOA Scores 14-16), the Hoffmann sign was present in 46%, whereas a Babinski sign occurred in 10%; in those with severe myelopathy and mJOA scores of < or =10, the Hoffmann sign was present in 81% and the Babinski sign in 83%. Of 290 patients presenting exclusively with lumbar spine-related complaints, 36 (12%) had a positive Hoffmann sign. Magnetic resonance imaging demonstrated spinal cord compression in 91% when the sign was present bilaterally and 50% when positive unilaterally. CONCLUSIONS: In patients surgically treated for cervical myelopathy, the Hoffmann sign is more prevalent and more likely to be seen in individuals with less severe neurological deficits than the Babinski sign. In patients with lumbar symptoms, a bilateral Hoffmann sign was a highly sensitive marker for occult cervical cord compression, whereas a unilateral Hoffmann sign correlated with similar disease in about one-half of patients.
Assuntos
Reflexo Anormal/fisiologia , Doenças da Medula Espinal/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Pescoço , Estudos Prospectivos , Reflexo de Babinski/fisiopatologia , Estudos Retrospectivos , Doenças da Medula Espinal/diagnóstico , Doenças da Medula Espinal/cirurgia , Osteofitose Vertebral/complicaçõesAssuntos
Morte Encefálica/fisiopatologia , Músculo Esquelético/fisiopatologia , Reflexo Anormal/fisiologia , Medula Espinal/fisiopatologia , Adolescente , Apneia/etiologia , Apneia/fisiopatologia , Morte Encefálica/diagnóstico , Eletroencefalografia , Humanos , Masculino , Músculo Esquelético/inervação , Mudanças Depois da Morte , Reflexo de Babinski/fisiopatologia , Fatores de Tempo , Dedos do Pé/fisiopatologiaRESUMO
Hiking trails have been growing in popularity in the health and well-being promotion. Consequently, the foot became an object of study in order to understand the discomfort and pain in the lower limb. The aims of the work were: 1) to detect tendencies for behaviour of maximum values of plantar pressure (MaxP) during the walk on different slopes, 2) to contribute to the methodology of the difficulty level of hiking trails. Equations show strong tendencies (R2 > 0.8) of behaviour of MaxP in the lateral zones of the heel, 4th and 5th metatarsus as well as in the plantar zone of the hallux. The analysis of the difficulty level of the hiking trails branches deserves a separate presentation, including the technical difficulty analysis (with a compulsory emphasis on the biomechanics) and information on the caloric consumption and on the slopes of each branch.
Assuntos
Traumatismos do Pé/prevenção & controle , Traumatismos do Pé/fisiopatologia , Caminhada/lesões , Caminhada/fisiologia , Adulto , Fenômenos Biomecânicos , Promoção da Saúde , Humanos , Modelos Lineares , Masculino , Músculo Esquelético/fisiologia , Projetos Piloto , Pressão , Reflexo de Babinski/fisiopatologia , Reflexo de Babinski/prevenção & controle , Fatores de Risco , Software , Suporte de Carga/fisiologiaAssuntos
Músculos Faciais/fisiopatologia , Espasmo Hemifacial/diagnóstico , Espasmo Hemifacial/fisiopatologia , Reflexo de Babinski/diagnóstico , Reflexo de Babinski/fisiopatologia , Idoso , Blefarospasmo/diagnóstico , Blefarospasmo/fisiopatologia , Diagnóstico Diferencial , Sobrancelhas/fisiopatologia , Pálpebras/fisiopatologia , Músculos Faciais/inervação , Nervo Facial/fisiopatologia , Doenças do Nervo Facial/diagnóstico , Doenças do Nervo Facial/fisiopatologia , Feminino , Testa/fisiopatologia , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Osteocartilaginous exostoses are benign bone tumors frequently found in the metaphysis of long bones but rarely in the spine. Four patients with acute spinal cord decompensation due to vertebral exostoses spinal cord compression have been previously described in the literature. We report an additional case of rapidly evolving spinal cord compression due to a cervical osteochondroma in a patient with hereditary multiple exostoses (HME), also known as Bessel Hagen disease. Careful analysis of the 5 cases suggested to us that patients with HME should have a systematic spinal imaging screening, in order to prevent rapid neurological decompensation. A minimal risk surgical procedure can be performed at a time of election.
Assuntos
Vértebras Cervicais/patologia , Exostose Múltipla Hereditária/complicações , Compressão da Medula Espinal/etiologia , Medula Espinal/patologia , Neoplasias da Coluna Vertebral/complicações , Adulto , Vértebras Cervicais/irrigação sanguínea , Vértebras Cervicais/fisiopatologia , Exostose Múltipla Hereditária/diagnóstico , Exostose Múltipla Hereditária/fisiopatologia , Feminino , Transtornos Neurológicos da Marcha/etiologia , Transtornos Neurológicos da Marcha/fisiopatologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Paraparesia/etiologia , Paraparesia/fisiopatologia , Reflexo de Babinski/etiologia , Reflexo de Babinski/fisiopatologia , Transtornos de Sensação/etiologia , Transtornos de Sensação/fisiopatologia , Fatores Sexuais , Medula Espinal/fisiopatologia , Compressão da Medula Espinal/diagnóstico , Compressão da Medula Espinal/fisiopatologia , Isquemia do Cordão Espinal/etiologia , Isquemia do Cordão Espinal/fisiopatologia , Neoplasias da Coluna Vertebral/diagnóstico , Neoplasias da Coluna Vertebral/fisiopatologia , Veias/patologia , Veias/fisiopatologiaRESUMO
Stimulation of the sural nerve of healthy subjects induced short latency inhibition in the ipsilateral tibialis anterior muscle and facilitation in peroneal muscle. We examined lower limb muscle responses after stimulation of the sural nerve in 19 patients with hemiplegia caused by cerebro-vascular disease and compared them with the control responses. The sural nerve was stimulated electrically (3 or 5 square wave pulses of 0.5 ms repeated at 250 Hz) during weak tonic contraction. Stimulation was triggered to average the rectified surface electromyography (EMG) of the test muscle. Usually 100 - 200 sweeps were averaged. After stimulation, the tibialis anterior muscle on the affected side of the hemiplegic patients showed the patterns of inhibition, facilitation, and no response, whereas all responses on the unaffected side, except those of one patient, were inhibition. The peroneal muscle on both sides showed only facilitation as in the controls. Abnormal responses of the tibialis anterior muscle on the affected side were present in many patients who had the Babinski sign. Abnormal responses in the tibialis anterior muscle of the affected side may have been due to contributions by disinhibition of the flexor reflex, late-recruited motor units or both.