The Phenomenon of Multiple Stretch Reflexes

Multiple stretch reflexes occur in muscles adjacent to or remote from the tap. The response may be ipsilateral or bilateral. These reflexes are encountered not only in normal subjects with brisk stretch reflexes but particularly in patients with lesions of the upper motor neuron. The concussion obtained by the blow is conducted along bone to muscle. Muscle spindles are stimulated, and in this manner independent stretch reflexes are produced in these muscles. This mechanism is responsible for the phenomenon of multiple stretch reflexes. The thorax and pelvis play important roles in the contralateral responses by transmitting these mechanical events across the midline

Acute onset of bulbar and ocular paralysis: An isolated case, with differential diagnosis

The diagnosis of botulism should be considered in all patients with the acute onset of cholinergic dysfunction and muscle weakness. The pupils are usually dilated, paralysis of ocular and bulbar muscles invariably occurs along with weakness of limb and axial muscles. This diagnosis is supported by the presence of a neuromuscular block and confirmed by the detection of toxin. Although the clinical presentation in this patient supported this diagnosis and a neuromuscular defect was present, no botulinum toxin was found. Not until Clostridium botulinum, type B organisms were cultured was the diagnosis of probable botulism made in this patient. Myasthenia gravis, atypical Guillain-Barre syndrome and a brain stem vascular lesion were also considered in the differential diagnosis. The anoxic encephalopathy following the cardiorespiratory arrest was an additional complicating factor

The Facioscapulohumeral Syndrome: A Report of Two Cases

Two patients developed progressive muscle weakness in adult life. The initial diagnosis of polymyositis was made in both cases, but subsequent studies and the distribution of muscle involvement suggested facioscapulohumeral myopathy. Other investigators have proposed that this syndrome may result from either genetic or acquired causes. In our patients, the disorder was probably a sequela of polymyositis

Seizures and Brain Tumor in Neurologically Intact Adult Patients: Role of Computerized Tomography (CT Scan)

CT scan of 13 patients with adult onset of seizures who were neurologically intact and otherwise asymptomatic revealed a supratentorial mass in all. Significant EEG abnormalities were recorded in five, and the isotope brain scan was positive in eight. In three patients, both studies were normal. Angiograms confirmed the location of tumor, and histology was established following craniotomy. The value of the CT scan as a screening test for detecting brain tumor in this group of seizure patients is evident

Factors Associated with Revision Surgery after Internal Fixation of Hip Fractures

Background: Femoral neck fractures are associated with high rates of revision surgery after management with internal fixation. Using data from the Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) trial evaluating methods of internal fixation in patients with femoral neck fractures, we investigated associations between baseline and surgical factors and the need for revision surgery to promote healing, relieve pain, treat infection or improve function over 24 months postsurgery. Additionally, we investigated factors associated with (1) hardware removal and (2) implant exchange from cancellous screws (CS) or sliding hip screw (SHS) to total hip arthroplasty, hemiarthroplasty, or another internal fixation device. Methods: We identified 15 potential factors a priori that may be associated with revision surgery, 7 with hardware removal, and 14 with implant exchange. We used multivariable Cox proportional hazards analyses in our investigation. Results: Factors associated with increased risk of revision surgery included: female sex, [hazard ratio (HR) 1.79, 95% confidence interval (CI) 1.25-2.50; P = 0.001], higher body mass index (fo

The clinical variations of hereditary spastic paraplegia in four families

Hereditary spastic paraplegia was diagnosed in 19 patients belonging to four families. All had spastic gait and upper motor neuron signs in lower limbs. In family A, the disease was expressed in this manner, although one member had muscle wasting in an upper limb. There was additional involvement of the posterior columns in six of the eight affected members of family B and cerebellar ataxia was noted in upper limbs of three of them. Posterior columns were also involved in three of the four affected members of family C. The disease was transmitted in these three families by an autosomal dominant gene. With autosomal recessive inheritance in family C, spastic gait and mental retardation were present during early childhood in the three affected members. Abnormalities of feet, vertebrae and other anomalies were also encountered