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Quiz 25 on Reflexes Theme and Discussion

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Quiz 25 on Reflexes Theme and Discussion preparation completed on 31-08-2009

Quiz 25 on Reflexes Theme and Discussion preparation completed on 31-08-2009

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  • 1. Reflex QuizTheme & Discussion
    Dr. Aswini Kumar. MD
    Professor of Medicine
    Medical College Hospital
    Thiruvananthapuram
  • 2. 1. Normal reflex pattern
    .
    Additional Points:
    Patient Conscious
    Higher Functions N
    Cranial Nerves Normal
    Tone Normal
    No Motor Deficits
    No Sensory Deficits
    No Cerebellar signs
    No Meningeal Signs
    Conjval +
    Corneal +
    Jaw -
    Triceps ++
    Triceps++
    Biceps ++
    Biceps ++
    Abdominal
    + +
    + +
    Supinator ++
    Supinator ++
    + Cremasteric +
    Knee +++
    Knee +++
    Ankle +
    Ankle +
    Plantar 
    Plantar
    01
  • 3. Reflexes
    Superficial and deep tendon reflexes play an important role in arriving at a neurological diagnosis and localization
    Superficial reflexes are designated as present (+) or absent (-). They have perhaps more important in localization
    Deep tendon reflexes are either
    Absent (-)
    present but sluggish (+),
    present normally (++)
    present and brisk (+++)
    present in an exaggerated form (++++)
    Exaggerated and with clonus (+++++)
  • 4. 2. Right HemiplegiaNeuronal Shock
    .
    Additional Points:
    Patient Conscious
    Motor Aphasia
    UMN Facial [Right]
    Hypotonia [Right]
    Grade 0 power [Right]
    No Sensory Deficits
    No Cerebellar signs
    No Meningeal Signs
    Conjval +
    Corneal +
    Jaw -
    Triceps ++
    Triceps-
    Biceps++
    Biceps -
    Abdominal
    - +
    - +
    Spinatore ++
    Supinator -
    - Cremasteric +
    Knee +++
    Knee -
    Ankle +
    Ankle -
    Plantar 
    Plantar
    02
  • 5. Hemiplegia
    Hemiplegia is a condition in which upper limb and lower limb on one side of a patient's body is paralyzed
    It is usually the result of a stroke, although other diseases affecting the hemispheres are also capable of producing it
    Rarely it can follow processes affecting the brainstem (crossed hemiplegia) and spinal cord (without VII palsy)
    It's a pyramidal tract lesion from the origin at the cerebral cortex down to 5th cervical segment of the spinal cord
    During the initial few days there is loss of all neuronal functions – Neuronal shock state- important in prognosis
  • 6. 3. Left HemiplegiaPost shock
    .
    Additional Points:
    Patient Conscious
    Higher Functions N
    Left UMN Facial
    Clasp Knife [Left]
    Grade 2 [Left]
    No Sensory Deficits
    No Cerebellar signs
    No Meningeal Signs
    Conjval +
    Corneal +
    Jaw -
    Triceps +++
    Triceps++
    Biceps +++
    Biceps ++
    Abdominal
    + -
    + -
    Spinatore +++
    Supinator ++
    + Cremasteric -
    Knee ++++
    Knee +++
    Ankle ++
    Ankle +
    Plantar 
    Plantar
    03
  • 7. Causes of Hemiplegia
    1-vascular:- stroke ((the most common cause)
    2-infective:- encephalitis -meningitis - brain abscess
    3-neoplastic:- glioma-meningioma
    4-demylination:- DS disseminated sclerosis
    5-traumatic:- cerebral lacerations
    6-congenital:-cerebral palsy
    7-hysterical:-absence of organic pyramidal lesion
    8-Post-ictal :- Todd’s paralysis
    9-Migraine :- Hemiplegic migraine
  • 8. 4. Old Right Hemiplegia
    .
    Additional Points:
    Patient Conscious
    UMN Facial [Right]
    Tone [Right]
    Contractures [Right]
    Power Grade 3 [Right]
    Patellar Clonus [Right]
    Ankle Clonus [Right]
    RHD MS Atrial Fib
    Conjval +
    Corneal +
    Jaw -
    Triceps ++
    Triceps++++
    Biceps ++
    Biceps ++++
    Abdominal
    - +
    - +
    Spinatore ++
    Supinator +++
    - Cremasteric +
    Knee +++
    Knee ++++
    Ankle +
    Ankle +++
    Plantar 
    Plantar
    04
  • 9. Causes of Embolic Stroke
    Aorta:- Atheromatous Plaques (Artery to Artery Embolism)
    Aortic Root:- Aortic Aneurysm with thrombus, Aortitis
    Aortic Valve:- Endocarditis, Prosthetic Valve Thrombus
    Left Ventricle:- Mural Thrombus from Post MI dyskinesia
    Mitral Valve:- Stenosis, Endocardittis, MVR with thrombus
    Left Atrium:- Thrombus in MS or AF or both , Myxoma,
    Pulmonary Veins:- Pulmonary Venous Thrombosis,
    Lung Parenchyma,: Lung Abscess, Bronchiectasis, Tumors
    Emboli passing through lungs:- Fat , Air, Amniotic Fluid
    Paradoxical Embolism:- Fallot’sEisenmenger Syndrome
  • 10. 5. Pseudo-bulbarPalsy
    .
    Conjval +
    Corneal +
    Jaw +++
    Triceps +++
    Triceps+++
    Biceps +++
    Biceps +++
    Abdominal
    - -
    - -
    Spinatore +++
    Supinator +++
    - Cremasteric -
    Knee ++++
    Knee ++++
    Ankle ++
    Ankle++
    Plantar
    Plantar
    05
    Additional Points:
    Patient Conscious
    Emotional Incontinence
    Exaggerated Gag reflex
    Hypertonia B/L
    Variable weakness
    Primitive Reflexes +
    No Cerebellar signs
    No Meningeal Signs
  • 11. Pseudo-bulbar palsy
    Pseudo-bulbar palsy is bilateral impairment of the function of the lower cranial nerves 9, 10, 11 and 12 which control the muscles of eating, swallowing and talking
    It is the result of an upper motor neuron lesion to the cortico-bulbar pathways in the pyramidal tract
    Causes
    Vascular causes: Bilateral hemisphere infarction
    Degenerative disorders: motor neuron disease
    Inflammatory disorders: Multiple sclerosis
    Malignancy: High brain stem tumors
    Brain trauma
  • 12. 6. Parkinson’s Disease
    .
    Conjval +
    Corneal +
    Jaw -
    Triceps ++
    Triceps++
    Biceps ++
    Biceps ++
    Abdominal
    + +
    + +
    Spinatore ++
    Supinator ++
    + Cremasteric +
    Knee +++
    Knee +++
    Ankle +
    Ankle +
    Plantar 
    Plantar
    06
    Additional Points:
    Patient Conscious
    Expressionless face
    Cranial Nerves Normal
    Cog wheel rigidity
    Generalized Hypokinesia
    Glabellar Tap
    Resting tremor
    No Meningeal Signs
  • 13. Parkinson's disease
    Parkinson's diseaseis a degenerative disorder of CNS that often impairs the sufferer's motor skills and speech
    Parkinson's disease belongs to a group of conditions called movement disorders
    It is characterized by muscle rigidity, tremor, slowing of physical movements, bradykinesia or akinesia
     The primary symptoms are the results of decreased stimulation of the motor cortex by the basal ganglia
    It is caused by the insufficient formation and action of dopamine, which is produced by dopaminergic neurons
  • 14. 7. Lateral MedullarySyndrome [Left]
    .
    Conjval -
    Corneal +
    Jaw -
    Triceps ++
    Triceps++
    Biceps ++
    Biceps ++
    Abdominal
    + +
    + +
    Spinatore ++
    Supinator ++
    + Cremasteric +
    Knee +++
    Knee +++
    Ankle +
    Ankle +
    Plantar 
    Plantar
    07
    Additional Points:
    Patient Conscious
    Vertigo and ataxia
    Vomiting and hiccups
    Horner’s Syndrome[Left]
    IX & X palsy [Left]
    Pain & Temp lost Lt face
    Pain & Temp lost Rt body
    Cerebellar signs [Left]
  • 15. Lateral Medullary Syndrome
    It is also called Wallenberg's syndrome and posterior inferior cerebellar artery syndrome)
    It is caused by an infarct caused by interrupted blood supply to lateral parts of the medulla
    Symptoms and findings are ataxia, facial pain, vertigo nystagmus, Horner‘s syndrome, diplopia and dysphagia
    Ipsilateral pain and temp loss over face and contralateral pain and temp over body
    The cause of this syndrome is usually the occlusion of the posterior inferior cerebellar artery (PICA) at its origin.
  • 16. 8. QuadriplegiaC3 Level
    .
    Conjval +
    Corneal +
    Jaw -
    Triceps +++
    Triceps+++
    Biceps +++
    Biceps +++
    Abdominal
    - -
    - -
    Supinator ++
    Supinator ++
    - Cremasteric -
    Knee ++++
    Knee ++++
    Ankle +++
    Ankle +++
    Plantar 
    Plantar 
    08
    Additional Points:
    Patient Conscious
    Respiratory distress
    Weakness all 4 limbs
    HypertoniaBilateral
    Distal > proximal weakness
    Total sensory loss below C3
    Pectoral&Trapezius Jerk+++
    UMN Bladder
  • 17. Quadriplegia
    Also known as tetraplegia, it is paralysis caused by illness or injury to spinal cord resulting in weakness of all 4 limbs
    A loss or impairment in controlling bowel and bladder, sexual function, digestion, breathing, autonomic functions
    Sensation is usually involved in affected areas, manifesting as numbness, reduced sensation, or neuropathic pain
    Complications: Pressure sores, osteoporosis and fractures, frozen joints, spasticity, respiratory complications and infections, autonomic dysreflexia, deep vein thrombosis
  • 18. 9. Right C5Radiculomyelopathy
    .
    Conjval +
    Corneal +
    Jaw -
    Triceps +++
    Triceps+++
    Biceps ++
    Biceps -
    Abdominal
    - -
    - -
    Supinator ++
    Supinator Inverted
    - Cremasteric -
    Knee ++++
    Knee ++++
    Ankle +++
    Ankle +++
    Plantar 
    Plantar 
    09
    Additional Points:
    Patient Conscious
    Higher Functions N
    Cranial Nerves Normal
    Hypertonia Lower limbs
    Shoulder abduction 
    Elbow flexion 
    Sensory loss along C5 C6
    UMN Bladder
  • 19. Cervical Spondylosis
    It is degenerative arthritis of the joints between the centra of spinal vertebrae; the interfacetal joints are not involved
    When the space between two adjacent vertebrae narrows, compression of a nerve root result in radiculopathy
    Sensory and motor disturbances, such as severe pain in the neck, shoulder, arm, back, and/or leg, & muscle weakness
    Less commonly, direct pressure on the cervical spinal cord may result in clinical features of quadriparesis (myelopathy)
    Here there is global weakness, gait dysfunction, loss of balance, and loss of bowel and/or bladder control
  • 20. 10.SyringomyeliaC-8,T-1 Level
    .
    Conjval +
    Corneal +
    Jaw -
    Triceps ++
    Triceps++
    Biceps ++
    Biceps ++
    Abdominal
    - -
    - -
    Supinator ++
    Supinator ++
    - Cremasteric -
    Knee ++++
    Knee ++++
    Ankle +++
    Ankle +++
    Plantar 
    Plantar
    10
    Additional Points:
    Patient Conscious
    HMF and Cranial Normal
    Hypotoniadistally both ULs
    Small muscle wasting ULs
    Handgrip weakness B/L
    Motor weakness both LL
    Suspended sensory loss C8T1
    Sensory Dissociation
  • 21. Syringomyelia
    A cyst or cavity, called a syrinx forms within the spinal cord, expand and elongate over time, destroying the cord
    This damage may result in pain, weakness, and stiffness in the back, shoulders, and extremities
    The disorder generally leads to a cape-like loss of pain and temperature sensation along the back and arms
    Some patients experience paralysis or paresis of the lower limbs temporarily or permanently
    The symptoms typically vary depending on the extent and, the location of the syrinx within the spinal cord
  • 22. 11. ParaplegiaT-10 Level
    .
    Conjval +
    Corneal +
    Jaw -
    Triceps ++
    Triceps++
    Biceps ++
    Biceps ++
    Abdominal
    + +
    - -
    Supinator ++
    Supinator ++
    - Cremasteric -
    Knee ++++
    Knee ++++
    Ankle +++
    Ankle +++
    Plantar 
    Plantar
    11
    Additional Points:
    Patient Conscious
    Higher Functions N
    Cranial Nerves Normal
    Hypertonia both LLs
    Grade 0 both LLs
    Beevor’s sign +
    Sensory level at Umbilicus
    UMN Bladder
  • 23. Acute Transverse Myelitis
    Neurological disorder caused by an inflammatory process of the spinal cord, which can result in axonal demyelination
    This demyelination arises idiopathically following infection, vaccination or multiple sclerosis
    Symptoms include weakness and numbness of the limbs as well as motor, sensory, and sphincter deficits
    A major differentiation or distinction to be made is a compression of the spinal cord in the spinal canal
    Treatment is usually symptomatic only, corticosteroids being used with limited success
  • 24. 18.Right T11 Brown- Sequard
    .
    Conjval +
    Corneal +
    Jaw -
    Triceps ++
    Triceps++
    Biceps ++
    Biceps ++
    Abdominal
    + +
    - +
    Supinator ++
    Supinator ++
    - Cremasteric +
    Knee +++
    Knee -
    Ankle +
    Ankle-
    Plantar 
    Plantar
    12
    Additional Points:
    Patient Conscious
    Higher Functions N
    Right lower limb grade 2
    Tone reduced right LL
    Pain and temp lost left LL
    Vibration and joint position lost right LL
    Right T11 hyperaesthesia
  • 25. Brown- Sequard Syndrome
    Loss of sensation and motor function (paralysis and ataxia) that is caused by the lateral hemi-section of the spinal cord
    Features of a motor loss on the same side of spinal injury and loss of pain and temperature sensation on opposite side
    Caused by a spinal cord tumor or trauma (such as a gunshot wound or puncture wound to the neck or back),
    Other causes: ischemia (obstruction of a blood vessel), or infectious or inflammatory diseases such as tuberculosis
    The syndrome was first described in 1850 by the British / Mauritian neurologist Charles-Édouard Brown Séquard
  • 26. 13. ParaplegiaL-1 Level - Shock
    .
    Conjval +
    Corneal +
    Jaw -
    Triceps ++
    Triceps++
    Biceps ++
    Biceps ++
    Abdominal
    + +
    + +
    Supinator ++
    Supinator ++
    -Cremasteric -
    Knee -
    Knee -
    Ankle -
    Ankle -
    Plantar 
    Plantar
    13
    Additional Points:
    Patient Conscious
    Higher Functions N
    Cranial Nerves Normal
    Hypotonia LLs
    Power grade 0 both LL
    Total sensory loss below L1
    No Cerebellar signs
    UMN Bladder
  • 27. Flaccid Paraplegia
    The area of the spinal canal which is affected in paraplegia is either the thoracic, lumbar, or sacral regions.
    The causes range from trauma (acute spinal cord injury: transsection or compression of the cord, vertebral fractures
    The most common cause of paraplegis (and all spinal cord injuries) is motor vehicle accidents
    Other causes include violence, sports, cancer involving the epidural or dural space, vertebral fractures and myelitis
    Sometimes paralysis of both legs can result from injury to the brain, or tumors like a para-sagitalmeningioma
  • 28. 14. CaudaEquinaSyndrome
    .
    Conjval +
    Corneal +
    Jaw -
    Triceps ++
    Triceps++
    Biceps ++
    Biceps ++
    Abdominal
    + +
    + +
    Supinator++
    Supinator ++
    + Cremasteric +
    Knee+
    Knee -
    Ankle -
    Ankle -
    Plantar -
    Plantar-
    14
    Additional Points:
    Patient Conscious
    Higher Functions N
    Asymmetric Wasting of LL
    Hypotonia both LL
    Weakness below L3
    Patchy sensory loss below L3
    No Cerebellar signs
    Late Bladder involvement
  • 29. Caudaequina syndrome
    is a condition in which there is acute loss of function of the nerve roots of the spinal canal below the termination conus
    Caudaequina contains the nerve roots from L1-5 and S1-5. The nerve roots from L4-S4 join in the sacral plexus
    Signs: weakness of the muscles innervated by the compressed roots, often an asymetrical paraplegia
    Sphincter weaknesses causing urinary retention decreased anal tone; sexual dysfunction & saddle anesthesia
    Bilateral leg pain and weakness; and bilateral absence of ankle reflexes. Pain and weakness may, however, be absent
  • 30. 15.Amyotrophic Lateral Sclerosis
    .
    Conjval +
    Corneal +
    Jaw ++
    Triceps +++
    Triceps+++
    Biceps +++
    Biceps +++
    Abdominal
    + +
    + +
    Spinator +++
    Supinator +++
    + Cremasteric +
    Knee ++++
    Knee ++++
    Ankle +++
    Ankle +++
    Plantar 
    Plantar 
    15
    Additional Points:
    Patient Conscious
    Higher Functions N
    Wasting hands & calf
    Tone Increased B/L
    Variable Weakness
    No Sensory Deficits
    Fasciculations present
    No bladder involvement
  • 31. Amyotrophic lateral sclerosis
    Amyotrophic lateral sclerosis is a form of motor neuron disease. ALS, sometimes is called Maladie de Charcot
    It is a progressive, fatal, neurodegenerative disease caused by the degeneration of motor neurons
    The disorder causes muscle weakness and atrophy throughout the body as both the UMN & LMN degenerate
    The muscles gradually weaken, develop fasciculations because of denervation, and eventually atrophy 
    Cognitive function is generally spared except when ALS is associated with frontotemporal dementia
  • 32. 16. GullianBarreSyndrome
    .
    Conjval +
    Corneal +
    Jaw -
    Triceps -
    Triceps-
    Biceps -
    Biceps -
    Abdominal
    - -
    - -
    Supinator-
    Supinator -
    -Cremasteric -
    Knee -
    Knee -
    Ankle-
    Ankle -
    Plantar --
    Plantar --
    16
    Additional Points:
    Patient Conscious
    Higher Functions N
    Acute Ascending paralysis
    Markedly reduced tone
    No Sensory Deficits
    Single Breath Count < 20
    Bilateral LMN Facial
    No Bladder involvement
  • 33. GullianBarre Syndrome
    An acute inflammatory demyelinating polyneuropathy, also an autoimmune disorder affecting peripheral nervous system
    It is frequently severe and usually exhibits as an ascending paralysis in the legs that spreads to the upper limbs
    The face may be affected in a bilateral upper motor neuron paralysis along with complete loss of deep tendon reflexes.
    With plasmapheresis or IVIg and supportive care, the majority of patients will regain full functional capacity
    However, death may occur if severe pulmonary complications arise and dysautonomia are present
  • 34. 16.Peripheral Neuropathy
    .
    Conjval +
    Corneal +
    Jaw -
    Triceps ++
    Triceps++
    Biceps ++
    Biceps ++
    Abdominal
    + +
    + +
    Supinator -
    Supinator -
    + Cremasteric +
    Knee+
    Knee+
    Ankle -
    Ankle -
    Plantar /
    Plantar/
    17
    Additional Points:
    Patient Conscious
    Higher Functions N
    Cranial Nerves Normal
    Tone Normal
    Distal weakness UL & LL
    Glove & Stocking sensory
    No Cerebellar signs
    No Meningeal Signs
  • 35. Peripheral neuropathy 
    It is the term for damage to nerves of the peripheral nervous system, either by diseases of the nerve or
    The causes are broadly grouped as follows:
    Genetic diseases: Charcot-Marie-Tooth syndrome
    Metabolic/Endocrine: diabetes, porphyria, amyloidosis
    Toxic causes: alcoholism, phenytoin, isoniazid, metals
    Inflammatory diseases: GBS, SLE, Leprosy,  Sjögren's
    Vitamin deficiency states: Vitamin B12, Vitamin B1
    Others: Malignant disease, HIV, radiation, chemotherapy
  • 36. 18. MyastheniaGravis
    .
    Additional Points:
    Patient Conscious
    Higher Functions N
    Bilateral Partial Ptosis
    Tone Normal
    Fatigability
    No Sensory Deficits
    No Cerebellar signs
    No Meningeal Signs
    Conjval +
    Corneal +
    Jaw -
    Triceps ++
    Triceps++
    Biceps ++
    Biceps ++
    Abdominal
    + +
    + +
    Supinator++
    Supinator ++
    + Cremasteric +
    Knee +++
    Knee +++
    Ankle +
    Ankle +
    Plantar 
    Plantar
    18
  • 37. Myasthenia gravis 
    It is a neuromuscular disease leading to fluctuating muscle weakness and fatiguability
    It is anautoimmune disorder, in which weakness is caused by circulating antibodies
    These block acetylcholine receptors at the post-synaptic neuromuscular junction
    Thus inhibiting the stimulative effect of the neurotransmitter acetylcholine.
    Myasthenia is treated with cholinesterase inhibitors or immunosuppressants and in selected cases, thymectomy
  • 38. 19. Friedrichsataxia
    .
    Conjval +
    Corneal +
    Jaw -
    Triceps +
    Triceps+
    Biceps +
    Biceps +
    Abdominal
    + +
    + +
    Spinatore -
    Supinator -
    + Cremasteric +
    Knee ++
    Knee ++
    Ankle -
    Ankle -
    Plantar
    Plantar
    19
    Additional Points:
    Symptomatic before 20 years
    Higher Functions N
    Pescavus, kyphoscoliosis
    H/o ataxia in family
    Power grade 4 all limbs
    Ataxia
    Vibration, joint position impaired distally
  • 39. Friedrichs ataxia
    An inherited disease that causes progressive damage to the nervous system
    It results in symptoms ranging from gait disturbance and speech problems to heart disease
    Ataxia results from degeneration of nerve tissue in spinal cord, in particular sensory neurons connection with cerebellum
    The condition is named after the German physician NicholausFriedreich, who first described it in the 1860s
    is caused by a mutation in gene FXN (formerly known as X25) that codes for frataxin, located on chromosome 9
  • 40. .
    Conjval +
    Corneal +
    Jaw -
    Triceps ++
    Triceps++
    Biceps ++
    Biceps ++
    Abdominal
    + +
    + +
    Spinatore -
    Supinator -
    + Cremasteric +
    Knee +++
    Knee +++
    Ankle -
    Ankle -
    Plantar
    Plantar
    20
    Additional Points:
    Patient Conscious
    Higher Functions irritable
    Optic atrophy
    Grade 4 power all 4 limbs
    Loss of vibration and joint position sense
    Megaloblastic anemia in peripheral smear
    20. Subacute combined degeneration of spinal cord
  • 41. Subacute combined degeneration of spinal cord
    Degeneration of the posterior and lateral columns of the spinal cord as a result of vitamin B12 deficiency
    Also known as Lichtheim's disease, it is usually associated with pernicious anemia.
    Patients present with weakness of legs , arms, trunk, tingling and numbness that progressively worsens
    Bilateral spastic paresis may develop and pressure, vibration and touch sense are diminished
    Therapy with vitamin B12 results in partial to full recovery, depending on the duration and extent of neuro-degeneration
  • 42. 21.Facioscapulo humeral dystrophy
    .
    Conjval +
    Corneal +
    Jaw -
    Triceps -
    Triceps-
    Biceps -
    Biceps -
    Abdominal
    + +
    + +
    Spinatore +
    Supinator+
    + Cremasteric +
    Knee +
    Knee +
    Ankle +
    Ankle +
    Plantar 
    Plantar
    21
    Additional Points:
    Facial weakness, shoulder girdle weakness,winging of scapula,deltoid preserved, pseudohypertrophy present
    Tone reduced
    Wrist extensors grade 2, flexors grade 3
    No Sensory Deficits
    No Cerebellar signs
    No Meningeal Signs
  • 43. Facioscapulo humeral dystrophy
    Also known as Landouzy-Dejerine Disease, it is an autosomal dominant form of muscular dystrophy
    It initially affects the skeletal muscles of the face (facio), scapula(scapulo) and upper arms (humeral)
    Symptoms may develop in early childhood and are usually noticeable in the teenage years with 95% by age 20 years
    A progressive skeletal muscle weakness usually develops in areas of the body; often the weakness is asymmetrical
    Non-muscular symptoms associated with FSHD include subclinical sensorineural hearing loss & retinal telangectasias
  • 44. 22. Cerebral palsy
    .
    Additional Points:
    H/O hypoxia at the time of birth
    Non progressive weakness of LL more than UL
    Tone Increased
    Scissoring gait
    No Sensory Deficits
    Conjval +
    Corneal +
    Jaw+
    Triceps +++
    Triceps+++
    Biceps +++
    Biceps +++
    Abdominal
    - -
    - -
    Spinatore+ ++
    Supinator+ ++
    - Cremasteric -
    Knee ++++
    Knee ++++
    Ankle ++
    Ankle ++
    Plantar
    Plantar
    22
  • 45. Cerebral palsy
    Non-progressive motor,non-contagious conditions that cause physical disability in human development
    Caused by damage to the motor control centers of the developing brain and can occur during pregnancy (75%)
    Can also occur during childbirth (5%) or after birth (about 15 %) up to about age three
    Accompanied by disturbances of sensation, perception cognition, communication, and behaviour, & by epilepsy
    There is no known cure for CP. Medical intervention is limited to the treatment and prevention of complications
  • 46. 23. CIDP
    .
    Additional Points:
    Chronic history
    Relapsing remitting
    Patient Conscious
    Higher Functions N
    Proximal and distal weakness
    Tone reduced
    Sensory loss distally
    Conjval +
    Corneal +
    Jaw -
    Triceps -
    Triceps-
    Biceps -
    Biceps -
    Abdominal
    - -
    - -
    Spinatore -
    Supinator -
    -Cremasteric -
    Knee -
    Knee -
    Ankle-
    Ankle -
    Plantar 
    Plantar
    23
  • 47. Chronic inflammatory demyelinating polyneuropathy
    It is an acquired immune-mediated inflammatory disorder of the peripheral nervous system but may be CNS involvement
    Closely related to Guillain-Barré syndrome and it is considered the chronic counterpart of that acute disease
    The pathologic hallmark is loss of the myelin sheath (the fatty covering that protects nerve fibers) of peripheral nerves
    Numbing, tingling, pain, progressive muscle weakness, loss of deep tendon reflexes, fatigue, and abnormal sensations
    Though conventional electrophysiological diagnostic criteria are not met, patient may still respond to immunomodulation
  • 48. 24. Anterior spinal artery occlusion
    .
    Conjval +
    Corneal +
    Jaw -
    Triceps ++
    Triceps++
    Biceps ++
    Biceps ++
    Abdominal
    + +
    + +
    Supinator ++
    Supinator ++
    -Cremasteric -
    Knee -
    Knee -
    Ankle -
    Ankle -
    Plantar 
    Plantar
    24
    Additional Points:
    Hyper acute onset
    Patient Conscious
    Higher Functions N
    Hypotonia both LL
    Grade 0 power LL
    Pain and temperature lost both LL
    Vibration and joint position preserved
  • 49. Anterior spinal artery occlusion
    Ischemia or infarction of the spinal cord in the distribution of the anterior spinal artery, which supplies the ventral 2/3
    Causes: Atherosclerosis of the aorta; dissection of Aortic aneurysm; dissection of the anterior spinal artery or Arteritis
    Clinical features include weakness and loss of pain and temperature sensation below the level of injury to cord
    It is an abrupt onset flaccid paralysis of the legs with relative sparing of position and vibratory sensation
    It is also known as "Beck's syndrome“, Sphincter control and sexual disorders are usually present
  • 50. 25. Myotonic dystrophy
    .
    Conjval +
    Corneal +
    Jaw -
    Triceps+-
    Triceps+
    Biceps +
    Biceps +
    Abdominal
    + +
    + +
    Supinator+
    Supinator+
    + Cremasteric +
    Knee +
    Knee +
    Ankle +
    Ankle +
    Plantar 
    Plantar
    25
    Additional Points:
    Patient Conscious
    Frontal balding
    Bilateral Partial Ptosis
    Hatchet facies
    Testicular atrophy
    Grade 4 power proximally and grade 2 distally
    Myotonia
    No Sensory Deficits
  • 51. Myotonic dystrophy 
    Dystrophiamyotonica, is a chronic, slowly progressing, highly variable inherited multi-systemic disease
    It is characterized by wasting of the muscles (muscular dystrophy), and myotonia (difficulty relaxing a muscle)
    Posterior subcapsular iridescent cataracts (opacity of the lens of the eyes), conduction defects & endocrine changes
    DM1 also known as Steinert's disease is a congenital form; DM2 also as PROMM or proximal myotonicmyopathy
    Most notably, the disease shows at an earlier age in successive generations, a phenomenon termed anticipation
  • 52. Thank You