Neuro clinics 58 hypo-reflexia

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Neuro clinics 58 hypo-reflexia

  1. 1. www.thinkoblique.blogspot.com www.drpratyush.hpage.com
  2. 2. Dr Pratyush Chaudhuri Supported by Nirmal Clinics Science comes first Neuro Clinics 58 Hypo reflexia – Deep tendon reflexes
  3. 3. Case 1 <ul><li>35years old female patient was admitted to the hospital following </li></ul><ul><li>Onset of weakness in both lower limbs </li></ul><ul><li>Inability to walk </li></ul><ul><li>Unable to pass urine </li></ul><ul><li>Tingling paraesthesia in both lower limb since 2 hrs </li></ul><ul><li>Mid level back pain </li></ul><ul><li>History of fever 14 days earlier lasted for 2 days </li></ul>
  4. 4. <ul><li>Hypotonic lower limb </li></ul><ul><li>Power 2/5in both lower limb </li></ul><ul><li>Hyporeflexic </li></ul><ul><li>Sensory level at D8 level </li></ul><ul><li>Flaccid bladder </li></ul>
  5. 5. <ul><li>What is the possible etiology </li></ul>
  6. 7. <ul><li>What will be your diagnosis if the reflex was – hyper-reflexia </li></ul>
  7. 8. Case 2 <ul><li>56 yrs old male k/c/o Diabetes mellitus </li></ul><ul><li>presented with Pain in the low back since 3 years </li></ul><ul><li>Increases while lying in supine position </li></ul><ul><li>Associated with radiating pain on the left lower limb </li></ul>
  8. 9. <ul><li>SLR on the left restricted to 30 degree on the left side </li></ul><ul><li>Paraspinal tenderness on the left lowerback </li></ul><ul><li>Hyporeflexia in the left ankle! </li></ul><ul><li>Radiating lancenating pain </li></ul><ul><li>BP 150/100mmHg </li></ul>
  9. 10. <ul><li>What have you thought of? </li></ul><ul><li>What is the next information you will ask for? </li></ul>
  10. 12. <ul><li>What would you think of if the reflexes were hyper-reflexic? </li></ul><ul><li>Diagnosis: </li></ul><ul><li>Left lumbar radiculopathy due to possible degenerative disc disease with early motor deficit. </li></ul>
  11. 13. Case 3 <ul><li>42 yrs old male who was diagnosed as a case of hypothyroidism 2 yrs earlier </li></ul><ul><li>Presented with </li></ul><ul><li>Increased sleep and lathergy </li></ul><ul><li>Fever since 2 days </li></ul><ul><li>Burning micturation </li></ul><ul><li>He was taking his thyroid hormone regularly. </li></ul>
  12. 14. <ul><li>Physical examination </li></ul><ul><li>Normothermic </li></ul><ul><li>Tachycardia, BP 160/100mmHg </li></ul><ul><li>Peripheral oedema </li></ul><ul><li>Central obesity </li></ul><ul><li>Hyporeflexic all over </li></ul>
  13. 15. <ul><li>Any diagnosis in mind? </li></ul><ul><li>Do you want to ask for any other clinical finding? </li></ul>
  14. 16. <ul><li>Woltmann’s sign of hypothyroidism </li></ul><ul><li>Delayed relaxation phase </li></ul>
  15. 17. Other causes of woltmann’s sign <ul><li>Advanced age </li></ul><ul><li>Anorexia nervosa </li></ul><ul><li>Diabetes Mellitus </li></ul><ul><li>Drugs like quinidine, IV dextrose, IN potassium. </li></ul><ul><li>Hypothermia </li></ul><ul><li>Peripheral arterial disease </li></ul><ul><li>Pernicious anemia </li></ul><ul><li>sarcoidosis </li></ul>
  16. 18. <ul><li>What would you think of if the reflex was to be brisk? </li></ul>
  17. 19. Causes of intermittent hyporeflexia <ul><li>Normal variant in some children </li></ul><ul><li>Spinal cord compression </li></ul><ul><li>Spinal cord infarction </li></ul><ul><li>Disc herniation </li></ul><ul><li>Transverse Myelitis </li></ul><ul><li>Occult spina bifida ( type of Spina bifida) </li></ul><ul><li>Neuropathy due to diabetes mellitus </li></ul><ul><li>Neuropathy due to giant axonal neuropathy </li></ul><ul><li>Chronic inflammatory demyelinating polyneuropathy </li></ul><ul><li>Tumor affecting nerves </li></ul><ul><li>Trisomy 21 </li></ul><ul><li>Edward's syndrome </li></ul><ul><li>Spinal muscular atrophy </li></ul><ul><li>Charcot-Marie-Tooth disease </li></ul><ul><li>Hypothyroidism </li></ul><ul><li>Hypokalemia </li></ul><ul><li>Hypoparathyroidism </li></ul>
  18. 20. Case 4 <ul><li>32yrs old female </li></ul><ul><li>Presented with generalised bodyache </li></ul><ul><li>Difficulty in getting up from the sitting position since 3 months </li></ul><ul><li>Loss of confidence in walking </li></ul><ul><li>K/c/o hypercholesterolemia on clofibrate and atorvastatin. </li></ul><ul><li>No other illness </li></ul>
  19. 21. <ul><li>Examination reveals </li></ul><ul><li>Normal vitals </li></ul><ul><li>Weakness in both lower limbs with power in the hip jt 3/5 and knee 4/5 bilateral </li></ul><ul><li>Difficulty in getting up from squatting position or standing on the toes </li></ul><ul><li>Hyporeflexic </li></ul><ul><li>No sensory deficit </li></ul>
  20. 22. <ul><li>Spot diagnosis?? </li></ul>
  21. 23. Drugs that cause myopathy <ul><li>Painless </li></ul><ul><ul><li>With out neuropathy- corticosteroids </li></ul></ul><ul><ul><li>With neuropathy- colchicine , chloroquine, hydroxychloroquin </li></ul></ul><ul><ul><li>Myasthenic syndrome- D penicillamine,antibiotics and betablockers </li></ul></ul><ul><li>Painful </li></ul><ul><ul><li>With myosistis- Zidovudine, D Penicillamine,cemetidine </li></ul></ul><ul><ul><li>Without polymyosistis- clofibrate, statin, cyclosporin </li></ul></ul><ul><li>Eosinophilia –myalgia syndrome – L-tryptophan </li></ul>

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