What is the definition of Cacosmia?
Cacosmia is a disorder of the sense of smell. It’s a type of parosmia. It occurs when there’s a problem somewhere along the pathway of smell. When this happens, a person is unable to recognize smells or interpret the odours of different substances. Around in the United States are believed to have a disorder related to the sense of smell.
What are the signs and symptoms of aging?
Some common signs and symptoms of aging include: Increased susceptibility to infection. Greater risk of heat stroke or hypothermia. Slight decrease in height as the bones of our spines get thinner and lose some height. Bones break more easily. Joint changes, ranging from minor stiffness to severe arthritis.
What is Parosmia?
Parosmia is a term used to describe health conditions that distort your sense of smell. If you have parosmia, you may experience a loss of scent intensity, meaning you can’t detect the full range of the scents around you.
What are mirror movements?
Mirror movements are seen in people with neurological disorders that cause them to involuntarily move both sides of the body when initiating a voluntary movement of one side of the body.
What is Ageusia; Dysgeusia?
Dysgeusia, also known as parageusia, is a distortion of the sense of taste. Dysgeusia is also often associated with ageusia, which is the complete lack of taste, and hypogeusia, which is a decrease in taste sensitivity. An alteration in taste or smell may be a secondary process in various disease states, or it may be the primary symptom.
What is Personification of paralyzed limbs?
In some cases, this “foreign part of oneself” may take a consoling role, in others a dispute arises, and physical aggressions like beating or biting the paretic side have been reported. The related sign of misoplegia, ie, hatred of one’s paralyzed limbs, 8 designates the personification of the affected body parts.
What is Anosodiaphoria?
Babinski (1914) used the term anosodiaphoria to describe a disorder of body
schema in which patients verbally acknowledge a clinical problem (e.g. hemiparesis) but fail to be concerned by it. Anosodiaphoria usually follows a stage ofanosognosia.
What is La belle indifference?
La belle indifférence describes a similar lack of concern for acknowledged disabilities which are psychogenic. A condition in which the person is unconcerned with symptoms caused by a conversion disorder. A naive, inappropriate lack of emotion or concern for the perceptions by others of one’s disability, usually seen in persons with conversion disorder.
What is Anosognosia?
Anosognosia refers to a patient’s unawareness or denial of their illness. The term
was first used by von Monakow (1885) and has been used to describe denial
of blindness (Anton’s syndrome), deafness, hemiplegia (Babinski), hemianopia,
aphasia, and amnesia.
What is the cause of Anosognosia?
Anosognosia with hemiplegia most commonly follows right hemisphere injury (parietal and temporal lobes) and may be associated with left hemineglect and left-sided hemianopia; it is also described with right thalamic and basal ganglia lesions. Cerebrovascular disease is the most common pathology associated with anosognosia, although it may also occur with neurodegenerative disease, for example, the cognitive anosognosia in some patients with Alzheimer’s disease.
What is misoplegia?
The term misoplegia was coined by Critchley and refers to the morbid dislike or hatred of paralysed limbs in patients with hemiplegia.
What is extinction in neurology?
Extinction (neurology) Extinction is a neurological disorder that impairs the ability to perceive multiple stimuli of the same type simultaneously. Extinction is usually caused by damage resulting in lesions on one side of the brain.
What is extinction test?
Extinction (Double simultaneous stimuli) Examination Technique: 1. Tactile (sensory) with eyes open demonstrate to the patient that you will touch them on the left side, the right side or both. 2. Visual extinction wiggle a finger in the left, right or both visual fields and ask the patient to report where they see it.
What is Somatoparaphrenia?
Somatoparaphrenia is a type of monothematic delusion where one denies ownership of a limb or an entire side of one’s body. Even if provided with undeniable proof that the limb belongs to and is attached to their own body, the patient produces elaborate confabulations about whose limb it really is, or how the limb ended up on their body.
What is Anserina?
Autonomically mediated piloerection and thermoconstriction may produce ‘goosebumps’, cold and bumpy skin which may be likened to that of a plucked goose. Loss of anserina may be a feature of some autonomic disorders.
What is Antecollis?
Antecollis (anterocollis) is forward flexion of the neck. It may be a feature of multiple system atrophy (cf. retrocollis in progressive supranuclear palsy), a sustained dystonic posture in advanced Parkinson’s disease, and, unusually, in spasmodic torticollis.
What is Dropped head syndrome?
Forward flexion of the head onto the chest is a feature in the ‘dropped head syndrome’. Dropped head syndrome (DHS) is characterized by severe weakness of the cervical paraspinal muscles that results in the passively correctable chin-on-chest deformity. DHS is most commonly associated with neuromuscular disorders. However, it is not always accompanied by electromyographic findings or noticeable changes on muscle biopsy.
What causes dropped head syndrome?
Most of the time, Dropped Head Syndrome is caused by a specific generalized neuromuscular diagnosis. These include amyotrophic lateral sclerosis (ALS) also known as Lou Gehrig’s disease, Parkinson’s disease, myasthenia gravis, polymyositis, and genetic myopathies.
What is the treatment for dropped head syndrome?
Treatment of Dropped Head Syndrome is mainly supportive. The weakness remains localized to the neck extensor muscles; physical therapy may help with this. There are some cases that improve dramatically, but most usually do not improve. The most useful treatment is use of a neck collar.
What causes an exploding head?
Stress and exploding head syndrome. Because there’s been little research into the condition, nobody is certain what causes exploding head syndrome. Some experts have speculated that it’s related to minor seizures in the brain’s temporal lobe; others suggest it might be related to hearing disorders.
What is Torticollis?
Torticollis, also known as wry neck, is a dystonic condition defined by an abnormal, asymmetrical head or neck position, which may be due to a variety of causes. The term torticollis is derived from the Latin words tortus for twisted and collum for neck. The most common case has no obvious cause, and the pain and difficulty with turning the head usually goes away after a few days, even without treatment.
Does torticollis cause neck spasms?
Answer. Neck spasms and torticollis are not the same thing. Torticollis specifically is a condition in which contraction of the muscles on the side of the neck result in pain, discomfort, and turning or tilting of the head to one side that is involuntary.
What is RetroCollis?
Any of the 52 muscles in the neck can be involved in combination to produce involuntary movements in a sustained or spasmodic nature in a combination of anterocollis, laterocollis, rotational torticollis
What is Anteflexion?
Anteflexion is forward flexion of the trunk, as typical of the stooped posture seen
in Parkinson’s disease.
What is Anton’s Syndrome?
Anton’s syndrome is cortical blindness accompanied by denial of the visual
defect (visual anosognosia), with or without confabulation. The syndrome most
usually results from bilateral posterior cerebral artery territory lesions causing
occipital or occipitoparietal infarctions but has occasionally been described with
anterior visual pathway lesions associated with frontal lobe lesions. It may also
occur in the context of dementing disorders or delirium.
What is Anwesenheit?
A vivid sensation of the presence of somebody either somewhere in the room or behind the patient has been labelled as anwesenheit (German: presence), presence hallucination, minor hallucination, or extracampine hallucination. This phenomenon is relatively common in Parkinson’s disease, occurring in isolation or associated with formed visual hallucinations.
What is apallic syndrome?
Apallic syndrome is a type of coma, more commonly understood as a vegetative state. In this condition, a breakdown occurs in the function of the brain’s cortex.
Can Aphallic Syndrome go to medical institutions?
The majority of patients with aphallic syndrome go to medical institutions after severe craniocerebral injuries – while the syndrome is one of the stages of regeneration of consciousness after a coma. Risk factors are not causing of the syndrome, but can serve as an impetus to its development.
What is unresponsive wakefulness syndrome?
Unresponsive Wakefulness Syndrome (UWS) is a very serious brain damage, when cortical parts of the brain are disconnected from brainstem. Brainstem is a center of respiration, gastrointestinal coordination, heartbeat and cranial nerves.
What is a vegetative state?
A vegetative state, or unaware and unresponsive state, is a specific neurological diagnosis in which a person has a functioning brain stem but no consciousness or cognitive function. Individuals in an unaware and unresponsive state alternate between sleep and wakefulness.
What is persistent vegetative state (PVS)?
Jump to navigation Jump to search. A persistent vegetative state (PVS) is a disorder of consciousness in which patients with severe brain damage are in a state of partial arousal rather than true awareness. After four weeks in a vegetative state (VS), the patient is classified as in a persistent vegetative state.
What is the difference between coma and vegetative state?
This condition differs from a coma: a coma is a state that lacks both awareness and wakefulness. Patients in a vegetative state may have awoken from a coma, but still have not regained awareness. In the vegetative state patients can open their eyelids occasionally and demonstrate sleep-wake cycles.
What is Apathy?
Apathy is a neurobehavioral disorder which may be characterized by:
(1) A lack of motivation relative to the patient’s previous level of functioning or
the standards of age and culture.
(2) Presence of at least one of the following:
(a) Diminished goal-directed behaviour: lack of effort, dependency on others to
structure activity;
(b) Diminished goal-directed cognition: lack of interest, concern about personal
problems;
(c) Diminished concomitants of goal-directed behaviour: unchanging affect,
lack of emotional responsiveness.
The diminished motivation of apathy should not be attributable to impaired level of consciousness, emotional distress, or cognitive impairment although it may coexist with the latter, as in Alzheimer’s disease. Apathy is a specific neuropsychiatric syndrome, distinct from depression.
What is the cause of Apathy?
Apathy may be observed in diseases affecting frontal–subcortical structures, for example, in the frontal lobe syndrome affecting the frontal convexity, or following multiple vascular insults to paramedian diencephalic structures (thalamus, subthalamus, posterior lateral hypothalamus, mesencephalon) or the posterior limb of the internal capsule; there may be associated cognitive impairment of the so-called subcortical type in these situations (e.g. in Huntington’s disease). Apathy is also described following amphetamine or cocaine withdrawal, in neuroleptic-induced akinesia and in psychotic depression. Selective serotonin-reuptake inhibitors may sometimes be helpful in the treatment of apathy.
What is Abulia?
Abulia, also known as aboulia, is a state of diminished motivation. In general, abulia refers to a type of apathy that develops as a result of disease, specifically disease that affects the brain.
What is Aphasia?
Aphasia, or dysphasia, is an acquired loss or impairment of language function
Language is distinguished from speech (oral communication), disorders of which are termed
dysarthria or anarthria. Dysarthria and aphasia may coexist but are usually
separable.
Clinical assessment of aphasia requires analysis of the following features,
through listening to the patient’s spontaneous speech, asking questions or giving
commands, and asking the patient to repeat, name, read and write:
• Fluency: is output effortful, laboured, with agrammatism and dysprosody
(non-fluent); or flowing, with paraphasias and neologisms (fluent)?
• Comprehension: spared or impaired?
• Repetition: preserved or impaired?
• Naming: preserved or impaired?
• Reading: evidence of alexia?
• Writing: evidence of agraphia?
What is the cause of aphasia?
Aphasias most commonly follow a cerebrovascular event: the specific type of aphasia may change with time following the event, and discrepancies may be observed between classically defined clinicoanatomical syndromes and the findings of everyday practice. Aphasia may also occur with space-occupying lesions and in neurodegenerative disorders, often with other cognitive impairments (e.g. Alzheimer’s disease) but sometimes in isolation (primary non-fluent aphasia, semantic dementia).
What is Transcortical sensory aphasia (TSA)?
Transcortical sensory aphasia (TSA) is a kind of aphasia that involves damage to specific areas of the temporal lobe of the brain, resulting in symptoms such as poor auditory comprehension, relatively intact repetition, and fluent speech with semantic paraphasias present.
What does neologian mean?
A neologian is an individual who coins, creates, or crafts brand new words. A neologian is a creator of neologisms (i.e. brand-new words), whenever existing words are insufficient into the task of adequately revealing an idea or need awkward combinations of words.
What is Aphemia?
Aphemia was the name originally given by Broca to the language disorder subsequently named ‘Broca’s aphasia’. The term is now used to describe a motor
disorder of speech production with preserved comprehension of spoken and written language. This syndrome has also been called phonetic disintegration (cf. phonemic disintegration), pure anarthria, apraxic dysarthria, cortical dysarthria, verbal apraxia, subcortical motor aphasia, alalia, pure motor aphasia, small or mini-Broca’s aphasia, and kinetic speech production disorder, reflecting the differing views as to the nature of the underlying disorder (aphasia, dysarthria, apraxia).
What is Phonemic disintegration?
It is a failure to correctly produce phonemes, which may be associated with injury to the opercular primary motor cortex or efferent projections from this area. (4) Defects of lexical access—patients who struggle to find words and are impaired at timed word-generation tasks
What is Aphonia?
Aphonia is loss of the sound of the voice, necessitating mouthing or whispering
of words. As for dysphonia, this most frequently follows laryngeal inflammation, although it may follow bilateral recurrent laryngeal nerve palsy. Aphonia of functional or hysterical origin is also recognized.
Aphonia should be differentiated from mutism, in which patients make no effort to speak, and anarthria in which there is a failure of articulation.
What is Applause Sign?
To elicit the applause sign, also known as the clapping test or three clap tests,
the patient is asked to clap the hands three times. The tendency to clap more
than three times, even when demonstrated by the examiner, is said to be specific
to striatal dysfunction and is seen in progressive supranuclear palsy to a greater
extent than in Parkinson’s disease, but not in frontotemporal dementia.
What is Aposiopesis?
Critchely used this term to denote a sentence which is started but not finished, as
in the aphasia associated with dementia.
What causes being mute?
Those who are physically mute may have problems with the parts of the human body required for human speech (vocal cords, lungs, trachea, oesophagus, mouth, or tongue, etc.). Trauma or injury to Broca’s area, located in the left inferior frontal cortex of the brain, can cause muteness.
What is Apraxia?
Apraxia or dyspraxia is a disorder of movement characterized by the inability
to perform a voluntary motor act despite an intact motor system (i.e. no ataxia,
weakness) and without impairment in level of consciousness. Automatic/reflex
actions are preserved, hence there is a voluntary–automatic dissociation; some
authors see this as critical to the definition of apraxia.
Different types of apraxia have been delineated, the standard classification being that of Liepmann (1900):
• Ideational apraxia, conceptual apraxia:
A deficit in the conception of a movement; this frequently interferes
with daily motor activities and is not facilitated by the use of objects;
there is often an associated aphasia.
• Ideomotor apraxia (IMA):
Apraxia is more common and severe with left hemisphere lesions.
Difficulties with the clinical definition of apraxia persist, as for the agnosias.
For example, ‘dressing apraxia’ and ‘constructional apraxia’ are now considered
visuospatial problems rather than true apraxias. Likewise, some cases labelled
as eyelid apraxia or gait apraxia are not true ideational apraxias. The exact
nosological status of speech apraxia also remains tendentious.
What is Dysdiadochokinesia?
Dysdiadochokinesia, dysdiadochokinesis, dysdiadokokinesia, dysdiadokokinesis, often abbreviated as DDK, is the medical term for an impaired ability to perform rapid, alternating movements (i.e. diadochokinesia). Complete inability is called adiadochokinesia.
How is dysdiadochokinesia treated?
If a metabolic disorder is causing the dysdiadochokinesia, then patient is treated with appropriate medications and diet. Dysdiadochokinesia due to vitamin deficiency is treated with vitamin therapy.
What is Aprosexia?
Aprosexia is a syndrome of psychomotor inefficiency, characterized by complaints of easy forgetting, for example, of conversations as soon as they are finished, material just read, or instructions just given. There is difficulty keeping the mind on a specific task, which is forgotten if the patient happens to be distracted by another task. These difficulties, into which the patient has insight
and often bitterly complains of, are commonly encountered in the memory clinic.
They probably represent a disturbance of attention or concentration, rather than being a harbinger of dementia. These patients generally achieve normal scores on formal psychometric tests (and indeed may complain that these assessments do not test the function they are having difficulty with). Concurrent sleep disturbance, irritability, and low mood are common and may reflect an underlying affective disorder (anxiety, depression) which may merit specific treatment.
What is Aprosodia, Aprosody?
Aprosodia or aprosody (dysprosodia, dysprosody) is a defect in or absence of the
ability to produce or comprehend speech melody, intonation, cadence, rhythm,
and accentuations, in other words the non-linguistic aspects of language which
convey or imply emotion and attitude, this may occur
in isolation with right-sided anterior lesions or in association with
linguistic aspects of aphasia such as agrammatism with anterior left
hemisphere damage.
What is Visual extinction?
Visual extinction is a neurological disorder which occurs following damage to the parietal lobe of the brain. It is similar to, but distinct from, hemispatial neglect. Visual extinction has the characteristic symptom of difficulty to perceive contralesional stimuli when presented simultaneously with an ipsilesional stimulus, but the ability to correctly identify them when not presented simultaneously.
What is opisthotonos?
The person is usually rigid and arches their back, with their head thrown backward. If a person with opisthotonos lies on their back, only the back of their head and heels touch the surface they are on. Opisthotonos is much more common in infants and children than in adults.
What is opisthotonos in infants?
Opisthotonos is much more common in infants and children than in adults. It is also more extreme in infants and children because of their less mature nervous systems. Opisthotonos may occur in infants with meningitis. This is an infection of the meninges, the membranes that cover the brain and spinal cord.
What is Arcuate Scotoma?
An arcuate scotoma suggests retinal or optic nerve disease, such as glaucoma,
acute ischaemic optic neuropathy, or the presence of drusen.
What does central scotoma mean?
Central scotoma. It refers to a region of reduced or lost vision that impedes central vision. It is likely to affect the activities of daily life of patients. Those having this form of the condition may have problems in seeing details and colours.
What does scintillating scotoma mean?
It is a localized area of diminished vision edged by shimmering coloured lights; in many people it indicates the onset of migraine.
What is Retinopathy?
How many stages of diabetic retinopathy development are there?
There two main stages of diabetic retinopathy: nonproliferative diabetic retinopathy and proliferative diabetic retinopathy.
What are the treatments for retinopathy?
For diabetic retinopathy that is threatening or affecting your sight, the main treatments are: laser treatment – to treat the growth of new blood vessels at the back of the eye (retina) in cases of proliferative diabetic retinopathy, and to stabilise some cases of maculopathy.
What is Areflexia?
Areflexia is an absence or a loss of tendon reflexes. This may be physiological, in
that some individuals never demonstrate tendon reflexes; or pathological, reflecting an anatomical interruption or physiological dysfunction at any point along
the monosynaptic reflex pathway which is the neuroanatomical substrate of phasic stretch reflexes. Sudden tendon stretch, as produced by a sharp blow from a
tendon hammer, activates muscle spindle Ia afferents which pass to the ventral
horn of the spinal cord, there activating α-motor neurones, the efferent limb of
the reflex, so completing the monosynaptic arc. Hence, although reflexes are typically regarded as part of the examination of the motor system, reflex loss may
also occur in ‘sensory’ disorders, affecting the afferents from the muscle spindle. It is often possible to ‘hear’ that reflexes are absent from the thud of tendon hammer on tendon.
Areflexia is most often encountered in disorders of lower motor neurones, specifically radiculopathies, plexopathies, and neuropathies (axonal and demyelinating). Areflexia may also occur in neuromuscular junction disorders, such as the Lambert–Eaton myasthenic syndrome, in which condition the reflexes may
be ‘restored’ following forced muscular contraction (facilitation). Transient areflexia may be seen in central nervous system disorders, such as cataplexy, and in acute spinal cord syndromes (‘spinal shock’, e.g. acute compression, acute inflammatory myelopathy).
What is Lambert-Eaton myasthenic syndrome (LEMS)?
Lambert-Eaton myasthenic syndrome (LEMS) is a rare presynaptic disorder of neuromuscular transmission in which quantal release of acetylcholine (ACh) is impaired, causing a unique set of clinical characteristics, which include proximal muscle weakness, depressed tendon reflexes, post tetanic potentiation, and autonomic changes.
How is Lambert Eaton diagnosed?
A special blood test may show that you have this condition. You may also undergo a test called electromyography, which shows how well your muscles are working. Because Lambert-Eaton syndrome is associated with lung cancer, your provider may order X-rays or a CT scan of your lungs.
What is Lambert Eaton myasthenic syndrome?
Lambert Eaton myasthenic syndrome (LEMS) is a rare neuromuscular disorder that weakens and fatigues the body’s voluntary muscles (those we can move at will). Unlike myasthenia gravis, it may also cause mild involvement of the autonomic nervous system, a part of the nervous system that is beyond the ability of the individual to control.
What is Lambert-Eaton syndrome?
Lambert-Eaton syndrome, also known as Lambert-Eaton myasthenic syndrome, is a condition in which the immune system attacks the neuromuscular junctions — the areas where your nerves and muscles connect.
What is myasthenic syndrome?
Lambert-Eaton myasthenic syndrome (LEMS) is an autoimmune disease — a disease in which the immune system attacks the body’s own tissues. The attack occurs at the connection between nerve and muscle (the neuromuscular junction) and interferes with the ability of nerve cells to send signals to muscle cells.
What is slow channel syndrome?
A rare disorder involving progressive muscle wasting and weakness of variable severity depending on the exact origin of the genetic defect. The problem arises from defective processes at the junction of nerve and muscle cells.
What is Cataplexy?
Cataplexy is a sudden and transient episode of muscle weakness accompanied by full conscious awareness, typically triggered by emotions such as laughing, crying, or terror. Cataplexy affects approximately 70% of people who have narcolepsy, and is caused by an autoimmune destruction of hypothalamic neurons that produce the neuropeptide hypocretin (also called orexin), which regulates arousal and has a role in stabilization of the transition between wake and sleep states.
What are the first signs of narcolepsy?
The four most common symptoms/signs of narcolepsy are:
Excessive daytime sleepiness: This is usually the first sign of narcolepsy.
Cataplexy: Cataplexy is a sudden, brief loss of muscle control triggered by stress.
Sleep paralysis: Sleep paralysis is a brief loss of muscle control either when falling asleep…
Hypnagogic hallucinations.
What is Sodium oxybate?
Sodium oxybate is a central nervous system depressant. It is used to treat cataplexy (sudden loss of muscle strength) and reduce daytime sleepiness in patients with narcolepsy. Sodium oxybate is also known as GHB, a known street drug of abuse.
What is the use of sodium oxybate?
The major use of sodium oxybate is in treating two of the symptoms of narcolepsy – cataplexy (sudden muscle weakness) and excessive daytime sleepiness.
Does sodium oxybate help with cataplexy?
Sodium oxybate can decrease daytime sleepiness and also reduce the number of sudden short attacks of weak/paralyzed muscles (known as cataplexy) that can occur in patients with narcolepsy. Sodium oxybate is a central nervous system depressant.
What is LMN lesion?
A lower motor neuron lesion is a lesion which affects nerve fibers traveling from the lower motor neuron(s) in the anterior horn/anterior grey column of the spinal cord, or in the motor nuclei of the cranial nerves, to the relevant muscle(s).
What is a lower motor neuron Syndrome?
Lower motor neuron (LMN) syndromes are clinically characterised by muscle atrophy, weakness and hyporeflexia without sensory involvement. They may arise from disease processes affecting the anterior horn cell or the motor axon and/or its surrounding myelin.
What are the causes lower motor neuron Syndrome?
The most common causes of lower motor neuron injuries are trauma to peripheral nerves that serve the axons, and viruses that selectively attack ventral horn cells. Disuse atrophy of the muscle occurs i.e., shrinkage of muscle fibre finally replaced by fibrous tissue (fibrous muscle) Other causes include Guillain–Barré syndrome, C. botulism, polio, and cauda equina syndrome; another common cause of lower motor neuron degeneration is amyotrophic lateral sclerosis.
What is Amyotrophic lateral sclerosis?
It causes death of motor neurons, although exact cause is unknown it has been suggested that abnormal build-up of proteins proves toxic for the neurons.
What is Myasthenia gravis?
Here synaptic transmission at motor end-plate is impaired.
What is Upper motor neuron syndrome (UMNS)?
It is the motor control changes that can occur in skeletal muscle after an upper motor neuron lesion. Following upper motor neuron lesions, affected muscles potentially have many features of altered performance including: Such signs are collectively termed the “upper motor neuron syndrome”.
Are upper motor neurons in the spinal cord?
Upper motor neurons are located in your brain and spinal cord. They send signals to lower motor neurons. Lower motor neurons are in your brain stem and spinal cord.
What are upper motor neuron syndrome?
The upper motor neuron syndrome signs are seen in conditions where motor areas in the brain and/or spinal cord are damaged or fail to develop normally. These include spinal cord injury, cerebral palsy, multiple sclerosis and acquired brain injury including stroke. The impact of impairment of muscles for an individual is problems with movement, and posture, which often affects their function.
What is neural facilitation?
Neural facilitation, also known as paired pulse facilitation (PPF), is a phenomenon in neuroscience in which postsynaptic potentials (PSPs) (EPPs, EPSPs or IPSPs) evoked by an impulse are increased when that impulse closely follows a prior impulse. PPF is thus a form of short-term synaptic plasticity.
What is proprioceptive neuromuscular facilitation?
Proprioceptive Neuromuscular Facilitation (PNF) is a set of stretching techniques commonly used in clinical environments to enhance both active and passive range of motion in order to improve motor performance and aid rehabilitation.
Is facilitation possible at neuromuscular junction?
Early experiments by Del Castillo & Katz in 1954 and Dudel & Kuffler in 1968 showed that facilitation was possible at the neuromuscular junction even if transmitter release does not occur, indicating that facilitation is an exclusively presynaptic phenomenon.
What is the neuromuscular and functional re-education technique?
NDT as a neuromuscular and functional re-education technique now includes neuroplasticity as a basis how the brain can change and reorganize itself and its processes based on practice and experience. facilitation of normal postural alignment and movement patterns.
What is hyporeflexia and hyperreflexia?
Hyporeflexia is generally associated with a lower motor neuron deficit (at the alpha motor neurons from spinal cord to muscle), whereas hyperreflexia is often attributed to upper motor neuron lesions (along the long, motor tracts from the brain).
What is plexus disorder?
A brachial plexus disorder characterized by regional paraesthesia, pain and muscle weakness, and limited movement in the arm or hand. A condition marked by numbness, tingling, pain, weakness, or limited movement in the arm or hand.
What is Plexopathy?
It is a disorder affecting a network of nerves, blood vessels, or lymph vessels. The region of nerves it affects are at the brachial or lumbosacral plexus.
What is lumbar plexus injury?
Lumbosacral plexopathy is a relatively rare peripheral nerve problem that results from injury to the lumbar or sacral plexuses. These are interwoven networks of nerves arising from nerve roots in the lumbar spine or the pelvis, respectively. Plexus injury can result from diabetes, tumour, radiation and obstetrical injury.
What are symptoms of cervical nerve compression?
The symptoms of cervical nerve compression or pinched cervical nerves occur at the site of distribution of the nerve and may be in the shoulders, arms or hands. Pain occurs in the affected area of nerve distribution, such as shoulders, arms or hands. Burning sensation. Tingling or “pins and needles” sensation. Numbness or decreased sensation.
What does nerve pain feel like?
Regardless of the cause, nerve pain can feel like any of the following: Burning. Tingling. Shooting. Sharp. Stabbing.
What is the treatment for radiation induced optic neuropathy?
The most invasive therapy tried for radiation-induced optic neuropathy has been optic nerve sheath fenestration.
What is radiculopathy?
Radiculopathy is a condition due to a compressed nerve in the spine that can cause pain, numbness, tingling, or weakness along the course of the nerve. Radiculopathy can occur in any part of the spine, but it is most common in the lower back (lumbar radiculopathy) and in the neck (cervical radiculopathy).
What is Argyll Robertson Pupil (ARP)?
The Argyll Robertson pupil is small (miosis) and irregular.
What are the causes of Argyll Robertson Pupil (ARP)?
There are, however, a number of recognized causes of ARP besides
neurosyphilis, including
• Multiple sclerosis;
• Encephalitis;
• Diabetes mellitus;
• Syringobulbia;
• Sarcoidosis;
• Lyme disease;
• Pinealoma;
• Herpes zoster;
• Hereditary motor and sensory neuropathies (Charcot–Marie Tooth disease; Dejerine–Sottas hypertrophic neuropathy).
Miosis and pupil irregularity are inconstant findings in some of these situations, in which case the term ‘pseudo-Argyll Robertson pupil’ may be preferred.
The neuroanatomical substrate of the Argyll Robertson pupil is uncertain.
A lesion in the tectum of the (rostral) midbrain proximal to the oculomotor
nuclei have been suggested. In multiple sclerosis and sarcoidosis, magnetic resonance imaging has shown lesions in the periaqueductal grey matter at the level
of the Edinger–Westphal nucleus, but these cases lacked miosis and may therefore be classified as pseudo-Argyll Robertson pupil.
What is Charcot–Marie–Tooth disease (CMT)?
It is a hereditary motor and sensory neuropathy of the peripheral nervous system characterized by progressive loss of muscle tissue and touch sensation across various parts of the body. This disease is the most commonly inherited neurological disorder affecting about one in 2,500 people.
What is Dejerine–Sottas disease?
It is also known as, Dejerine–Sottas neuropathy, progressive hypertrophic interstitial polyneuropathy of childhood and onion bulb neuropathy (and, hereditary motor and sensory polyneuropathy type III and Charcot–Marie–Tooth disease type 3), is a hereditary neurological disorder characterised by damage to the peripheral nerves and resulting progressive muscle wasting.
What is Anisocoria?
It is a condition characterized by an unequal size of the eyes’ pupils. Affecting 20% of the population, it can be an entirely harmless condition or a symptom of more serious medical problems.
What is pseudo-Argyll Robertson pupil?
A pseudo-Argyll Robertson pupil is a neurological sign indicating a normal near reflex but the absence of a light reflex (light-near dissociation), a lack of miosis, and pupil irregularity.
What is Light-near dissociation (LND)?
Light-near dissociation (LND) is a pupillary sign that occurs when the pupillary light reaction is impaired while the near reaction (accommodative response) remains intact. LND can occur unilaterally or bilaterally
What is Abadie’s sign of exophthalmic goitre?
It is a medical sign characterized by spasm of the levator palpebrae superioris muscle with retraction of the upper lid (so that sclera is visible above cornea) seen in Graves-Basedow disease which, together with exophthalmos causes the bulging eyes appearance. It is named for Jean Marie Charles Abadie.
What is Arm Drop?
‘Arm drop’, or the ‘face–hand test’, has been suggested as a useful diagnostic
test if hemiparesis or upper limb monoparesis is suspected to be psychogenic: the
examiner lifts the paretic hand directly over the patient’s face and drops it. It is
said that in organic weakness the hand will hit the face, whereas patients with
functional weakness avoids this consequence. However, the validity and reliability
of this ‘avoidance testing manoeuvre’ has never been examined; its clinical value
is therefore doubtful.
What does Babinski sign mean?
Babinski sign – (1) extension of the great toe and abduction of the other toes instead of normal flexion reflex to plantar stimulation. Synonym(s) are Babinski phenomenon; Babinski reflex; Babinski test; – (2) in hemiplegia, weakness of platysma muscle on affected side.
What is the purpose of Babinski reflex?
The plantar reflex is a nociceptive segmental spinal reflex that serves the purpose of protecting the sole of the foot. The clinical significance lies in the fact that the abnormal response reliably indicates metabolic or structural abnormality in the corticospinal system upstream from the segmental reflex.
What are non- neurological Causes of Extensor Plantar Response?
In children up to the age of 1 year
Deep sleep
Coma
General anaesthesia
Electroconvulsive therapy
Post-ictal stage of epilepsy
Apnoeic phase of Cheyne Stokes breathing
Narcosis
Alcohol intoxication
Hypoglycemia
Hypnosis
Physical exhaustion and marathon walking
Drugs-scopolamine, barbiturates
What is the diagnosis of functional weakness?
In the diagnosis of functional weakness and sensory disturbance, positive physical signs are as important as absence of signs of disease. Motor signs, particularly Hoover’s sign, are more reliable than sensory signs, but none should be used in isolation and must be interpreted in the overall context of the presentation.
What is generalized sensory disturbance?
Generalized sensory disturbance is most commonly due to lesions in the peripheral nerves. Polyneuropathy is most common. Focal sensory disturbance can be due to a lesion at any level.
What is the crossed sensory deficit?
Crossed sensory deficit: ipsilateral facial and contralateral body. Pain and temperature disturbance of the ipsilateral face and contralateral body due to Infarction, haemorrhage, demyelinating disease, tumour, infection.
What is Proximal diabetic neuropathy?
It is also known as diabetic amyotrophy, is a complication of diabetes mellitus that affects the nerves that supply the thighs, hips, buttocks and/or lower legs. Proximal diabetic neuropathy is a type of diabetic neuropathy characterized by muscle wasting, weakness, pain, or changes in sensation/numbness of the leg. It is caused by damage to the nerves of the lumbosacral plexus.
What is hoovers sign?
Involuntary extension of the “normal” leg occurs when flexing the contralateral leg against resistance. To perform the test, the examiner should hold one hand under the heel of the “normal” limb and ask the patient to flex the contralateral hip against resistance (while the patient is supine), asking the patient to keep the weak leg straight while raising it.
What is ‘Around the Clock’ Paralysis?
High tetraplegia can result from the most severe SCIs as it damages the higher cervical nerves (C1-C4) which affect most if not all your body. With this kind of paralysis, you require around-the-clock assistance with daily living.
What is Bilateral facial paralysis?
It is a rare condition and therefore represents a diagnostic challenge. We report the case of a 34-year-old healthy woman with sequential bilateral facial paralysis as a sole manifestation of sarcoidosis.
What is Arthrogryposis?
Arthrogryposis multiplex congenita (AMC), or simply arthrogryposis, describes congenital joint contracture in two or more areas of the body.
What is contracture in the skin?
Lesson Summary. Contracture is the shortening or tightening of tissues that reduces movement in an area. It can affect skin, muscles, or connective tissues and often causes pain in addition to decreased range of motion.
What does Dupuytren’s contracture look like?
Dupuytren’s contracture is a condition that gradually causes connective tissue (fascia) under the skin of your palm to thicken and become scar-like. Although Dupuytren’s isn’t always painful, it does restrict movement. The thickened tissue forces several fingers — usually your ring and pinky fingers — to curl in toward your palm.
What is Asemasia?
Asemasia is an inability to indicate by signs or spoken language. The term was
invented in the nineteenth century (Hamilton) as an alternative to aphasia, since
in many cases of the latter there is more than a loss of speech, including impaired
pantomime (apraxia) and in symbolizing the relationships of things. Hughlings
Jackson approved of the term but feared it was too late to displace the word
aphasia.
What is Asomatognosia?
Asomatognosia is a lack of regard for a part, or parts, of the body, most typically
failure to acknowledge the existence of a hemiplegic left arm. Asomatognosia
may be verbal (denial of limb ownership) or non-verbal (failure to dress or
wash limb). All patients with asomatognosia have hemispatial neglect (usually
left).
What does confabulation mean?
In psychiatry, confabulation (verb: confabulate) is a memory error defined as the production of fabricated, distorted, or misinterpreted memories about oneself or the world, without the conscious intention to deceive.
What is Astasia–Abasia?
Astasia–abasia is the name which has sometimes been given to a disorder of gait
characterized by impaired balance (disequilibrium), wide base, shortened stride,
start/turn hesitation, and freezing.
A transient inability to sit or stand despite normal
limb strength may be seen after an acute thalamic lesion (thalamic astasia).
What is the difference between Astasia and abasia?
Astasia-abasia refers to the inability to either stand or walk in a normal manner. Astasia refers to the inability to stand upright unassisted. Abasia refers to lack of motor coordination in walking.
What is Astereognosis?
Astereognosis is the failure to recognize a familiar object, such as a key or a coin,
palpated in the hand with the eyes closed, despite intact primary sensory modalities. Description of qualities such as the size, shape, and texture of the object
may be possible. Hence, this is a failure of higher-order (i.e. cortical) processing
and is associated with lesions of the posterior parietal lobe (postcentral gyrus)
association cortex.
What are the symptoms of central retinal artery occlusion?
The primary symptom of retinal vascular occlusion is a sudden change in vision. This could include blurry vision, or a partial or complete loss of vision. The vision symptoms usually only occur in one eye. Physical pain is not a symptom of retinal vascular occlusion.
What are the Symptoms retinal vein occlusion?
The usual symptom of retinal artery occlusion is a sudden, painless, persistent, substantial loss of vision in one eye. In about 10% of those affected, this loss of vision is preceded by one or more episodes of a condition called amaurosis fugax. Amaurosis fugax is a temporary episode of decreased vision.
What does optic atrophy stand for?
Optic atrophy is the final common morphologic endpoint of any disease process that causes axon degeneration in the retinogeniculate pathway. Clinically, optic atrophy manifests as changes in the colour and the structure of the optic disc (cupping) associated with variable degrees of visual dysfunction.
What are the symptoms of optic neuritis?
Optic neuritis occurs when swelling (inflammation) damages the optic nerve — a bundle of nerve fibers that transmits visual information from your eye to your brain. Common symptoms of optic neuritis include pain with eye movement and temporary vision loss in one eye.
Signs and symptoms of optic neuritis can be the first indication of multiple sclerosis (MS), or they can occur later in the course of MS. MS is a disease that causes inflammation and damage to nerves in your brain as well as the optic nerve.
What is Asterixis?
Asterixis is a sudden, brief, arrhythmic lapse of sustained posture due to involuntary interruption in muscle contraction. It is most easily demonstrated by observing the dorsiflexed hands with arms outstretched (i.e. the motion to indicate ‘stop’), lapses being seen as flicking or flapping movements of the hands (‘flapping tremor’). Movement is associated with EMG silence in antigravity muscles for 35–200 milliseconds. These features distinguish asterixis from tremor and myoclonus; the phenomenon has previously been described as negative myoclonus or negative tremor. Asterixis may be bilateral or unilateral.
What are causes of Asterixis?
Recognized causes of asterixis include
• Hepatic encephalopathy (‘liver flap’);
• Hypercapnia;
• Uraemia;
• Drug-induced, e.g. anticonvulsants, levodopa;
• Structural brain lesions: thalamic lesions (haemorrhage, thalamotomy).
Unilateral asterixis has been described in the context of stroke, contralateral to lesions of the midbrain (involving corticospinal fibres, medial lemniscus), thalamus (ventroposterolateral nucleus), primary motor cortex, and parietal lobe; and ipsilateral to lesions of the pons or medulla.
What Myoclonus?
It is a brief, involuntary, irregular (lacking rhythm) twitching (different from clonus, which is rhythmic/ regular) of a muscle or a group of muscles. It describes a medical sign and, generally, is not a diagnosis of a disease.
What is a tremor?
A tremor is an involuntary, somewhat rhythmic, muscle contraction and relaxation involving oscillations or twitching movements of one or more body parts. It is the most common of all involuntary movements and can affect the hands, arms, eyes, face, head, vocal folds, trunk, and legs. Most tremors occur in the hands. In some people, a tremor is a symptom of another neurological disorder. A very common tremor is the teeth chattering, usually induced by cold temperatures or by fear.
What is Asthenopia?
Asthenopia, literally ‘weak vision’, is frequently used to describe ‘eye strain’
due to uncorrected or incorrectly corrected refractive errors, such as hyperopia
(far-sightedness) or overcorrected myopia. Such refractive errors are sometimes
blamed for headache.
What is Asynergia?
Asynergia or dyssynergia is lack or impairment of synergy of sequential muscular
contraction in the performance of complex movements, such that they seem to
become broken up into their constituent parts, so-called decomposition of movement. This may be evident when performing rapid alternating hand movements.
Dyssynergy of speech may also occur, a phenomenon sometimes termed scanning speech or scanning dysarthria.
What causes Asynergia?
This is typically seen in cerebellar syndromes,
most often those affecting the cerebellar hemispheres, and may coexist with other
signs of cerebellar disease such as ataxia, dysmetria, and dysdiadochokinesia.
What is a scanning speech?
Scanning speech is a type of ataxic dysarthria in which spoken words are broken up into separate syllables, often separated by a noticeable pause, and spoken with varying force.
What is neurology speech?
Neurology Speech characterized by sliding and stretching of words, and slurring of phonation, which is associated with cerebellar defects, often accompanied by inappropriate rate, range, force, and direction of voluntary movements.
What is the cerebellum responsible for?
At the back of the brain, near the brainstem, lies the cerebellum, which is responsible for maintaining balance and posture and coordinating movement. The cerebellum’s role is crucial.
What are the clinical features of cerebellar disorders?
The main clinical features of cerebellar disorders include incoordination, imbalance, and troubles with stabilizing eye movements. There are two distinguishable cerebellar syndromes — midline and hemispheric. Midline cerebellar syndromes are characterized by imbalance.
What are the common causes of cerebellum damage?
A growth on the brain, cancerous (malignant) or noncancerous (benign), can damage the cerebellum.
Ataxia is a potential side effect of certain medications, especially barbiturates, such as phenobarbital; sedatives, such as benzodiazepines; and some types of chemotherapy.
What causes a shrinking cerebellum?
The cerebellum is a posterior area of the brain important in balance and coordination. Atrophy implies this area is shrinking in size. Some causes could include alcohol abuse, hereditary spinocerebellar degenerations.
What are the causes of cerebellar disorders?
The most common cause of cerebellar disorders is Alcoholic cerebellar degeneration
Congenital malformations
Such malformations are almost always sporadic, often occurring as part of complex malformation syndromes (eg, Dandy-Walker malformation) that affect other parts of the central nervous system (CNS). Malformations manifest early in life and are nonprogressive. Manifestations vary markedly depending on the structures involved; ataxia is usually present.
What are Hereditary ataxias?
Hereditary ataxias may be autosomal recessive or autosomal dominant. Autosomal recessive ataxias include Friedreich ataxia (the most prevalent), ataxia-telangiectasia, abetalipoproteinemia, ataxia with isolated vitamin E deficiency, and cerebrotendinous, xanthomatosis.
Friedreich ataxia results from a gene mutation causing abnormal repetition of the DNA sequence GAA in the FXN gene on the long arm of chromosome 9; the FXN gene codes for the mitochondrial protein frataxin. The GAA sequence is repeated 5 to 38 times within the FXN gene in people who do not have Friedreich ataxia; however, in people with Friedreich ataxia, the GAA sequence may be repeated 70 to > 1000 times . Inheritance is autosomal recessive. Decreased frataxin levels lead to mitochondrial iron overload and impaired mitochondrial function.
In Friedreich ataxia, gait unsteadiness begins between ages 5 and 15; it is followed by upper-extremity ataxia, dysarthria, and paresis, particularly of the lower extremities. Mental function often declines. Tremor, if present, is slight. Reflexes and vibration and position senses are lost. Talipes equinovarus (clubfoot), scoliosis, and progressive cardiomyopathy are common. By their late 20s, patients may be confined to a wheelchair. Death, often due to arrhythmia or heart failure, usually occurs by middle age.
Spinocerebellar ataxias (SCAs) are the main autosomal dominant ataxias. Classification of these ataxias has been revised many times recently as knowledge about genetics increases. Currently, at least 43 different gene loci are recognized; about 10 involve expanded DNA sequence repeats. Some involve a repetition of the DNA sequence CAG that codes for the amino acid glutamine, similar to that in Huntington disease.
Manifestations of SCAs vary. Some of the most common SCAs affect multiple areas in the central and peripheral nervous systems; neuropathy, pyramidal signs, and restless leg syndrome, as well as ataxia, are common. Some SCAs usually cause only cerebellar ataxia.
SCA type 3, formerly known as Machado-Joseph disease, may be the most common dominantly inherited SCA worldwide. Symptoms include ataxia, parkinsonism, and possibly dystonia, facial twitching, ophthalmoplegia, and peculiar bulging eyes.
What are Acquired ataxia conditions?
Acquired ataxias may result from nonhereditary neurodegenerative disorders (eg, multiple system atrophy), systemic disorders, multiple sclerosis, cerebellar strokes, repeated traumatic brain injury, or toxin exposure, or they may be idiopathic. Systemic disorders include alcoholism (alcoholic cerebellar degeneration), thiamine deficiency, celiac disease, heatstroke, hypothyroidism, and vitamin E deficiency.
Toxins that can cause cerebellar dysfunction include carbon monoxide, heavy metals, lithium, phenytoin, and certain solvents. Toxic levels of certain drugs (eg, antiseizure drugs, sedatives in high doses) can cause cerebellar dysfunction and ataxia.
Rarely, subacute cerebellar degeneration occurs as a paraneoplastic syndrome in patients with breast cancer, ovarian cancer, small cell carcinoma of the lung, or other solid tumors. Cerebellar degeneration may precede the discovery of the cancer by weeks to years. Anti-Yo, now called PCA-1 (Purkinje cell cytoplasmic antibody type 1) is a circulating autoantibody that occurs in the serum or cerebrospinal fluid (CSF) of some patients, especially women with breast or ovarian cancer.
In children, primary brain tumors (medulloblastoma, cystic astrocytoma) may be the cause; the midline cerebellum is the most common site of such tumors. Rarely, in children, reversible diffuse cerebellar dysfunction follows viral infections.
What is Dysmetria?
is a lack of coordination of movement typified by the undershoot or overshoot of intended position with the hand, arm, leg, or eye? It is a type of ataxia. It can also include an inability to judge distance or scale. Hypermetria and hypometria are, respectively, overshooting and undershooting the intended position.
What is Dysarthria?
Difficulty in speech due to weakness of speech muscles.
What is Dysdiadochokinesia?
Dysdiadochokinesia, dysdiadochokinesis, dysdiadokokinesia, dysdiadokokinesis, often abbreviated as DDK, is the medical term for an impaired ability to perform rapid, alternating movements (i.e. diadochokinesia). Complete inability is called adiadochokinesia.
What is Ataxia?
Ataxia or dystaxia refers to a lack of coordination of voluntary motor acts,
impairing their smooth performance. The rate, range, timing, direction, and
force of movement may be affected. Ataxia is used most frequently to refer to
a cerebellar problem, but sensory ataxia, optic ataxia, and frontal ataxia are also
described, so it is probably best to qualify ataxia rather than to use the word in
isolation.
• Cerebellar ataxia:
Defective timing of agonist and antagonist muscle contraction (asynergia) produces jerking, staggering, inaccurate movements (decomposition of movement), which may manifest as intention tremor, dysmetria (past pointing), dysdiadochokinesia, ataxic dysarthria (sometimes
known as scanning speech, although this also has other connotations), excessive rebound phenomenon, macrographia, head tremor (titubation), gait ataxia, and abnormal eye movements (nystagmus, square wave jerks, saccadic intrusions). There may be concurrent limb
hypotonia. Cerebellar hemisphere lesions cause ipsilateral limb ataxia
(hemiataxia; ataxia on finger-to-nose, finger chase, and/or heel–shin
testing) whereas midline cerebellar lesions involving the vermis produce
selective truncal and gait ataxia.
• Sensory ataxia:
Results from impaired proprioception and may be seen in disease of the
dorsal (posterior) columns of the spinal cord (hence ‘spinal ataxia’),
sensory neuropathies, and neuronopathies affecting the dorsal root
ganglia. It is markedly exacerbated by removal of visual cues (e.g. as
in Romberg’s sign), unlike the situation with cerebellar ataxia, and may
also lead to pseudoathetosis.
• Optic ataxia:
Mis reaching for visually presented targets, with dysmetria, due to a
parieto-occipital lesion, as seen in Balint’s syndrome.
• ‘Frontal ataxia’:
Similar to, and sometimes indistinguishable from, cerebellar ataxia, but
results from lesions of the contralateral frontal cortex or frontopontine
fibres, often from tumours invading the frontal lobe or corpus callosum.
Triple ataxia, the rare concurrence of cerebellar, sensory, and optic types of
ataxia, may be associated with an alien limb phenomenon (sensory type).
What are the causes of cerebellar ataxia?
There are many causes of cerebellar ataxia, including
• Inherited:
Autosomal recessive: Friedreich’s ataxia, ataxia with isolated vitamin E
deficiency, ataxia with oculomotor apraxia (types 1 and 2);
Autosomal dominant: clinically ADCA types I, II, and III, now reclassified genetically as spinocerebellar ataxias: types 1–31 now described;
Episodic ataxias: channelopathies involving potassium (type 1) and
calcium (type 2) ion channels;
Mitochondrial disorders;
Huntington’s disease;
Dentatorubropallidoluysian atrophy (DRPLA);
Inherited prion diseases, especially Gerstmann–Straussler–Scheinker
(GSS) syndrome.
• Acquired:
Cerebrovascular events (infarct, haemorrhage): usually cause hemiataxia; postanoxic cerebellar ataxia;
Inflammatory: demyelination: multiple sclerosis, Miller Fisher variant of Guillain–Barré syndrome, central pontine and extrapontine myelinolysis;
Inflammatory: infection: cerebellitis with Epstein–Barr virus; encephalitis with Mycoplasma; HIV;
Neoplasia: tumours, paraneoplastic syndromes;
Neurodegeneration: one variant of multiple system atrophy (MSA-C);
prion diseases (Brownell–Oppenheimer variant of sporadic
Creutzfeldt–Jakob disease, kuru); idiopathic late-onset cerebellar ataxia;
Drugs/toxins, e.g. alcohol, phenytoin.
Metabolic: vitamin E deficiency, thiamine deficiency (Wernicke’s
encephalopathy), gluten ataxia,
What is a gait analysis?
Gait is the way in which we move our whole body from one point to another. Most often, this is done by walking, although we may also run, skip, hop etc. Gait analysis is a method used to assess the way we walk or run to highlight biomechanical abnormalities.
What is Tandem gait?
It is a gait (method of walking or running) where the toes of the back-foot touch the heel of the front foot at each step. Neurologists sometimes ask patients to walk in a straight line using tandem gait as a test to help diagnose ataxia, especially truncal ataxia, because sufferers of these disorders will have an unsteady gait.
What is the heel test?
heel-shin test. a cerebellar test for assessing coordination of movements of the extremities. In the test, the patient, lying supine, is asked to pass the heel of one leg slowly down the shin of the other leg from the knee to the ankle.
What are saccadic intrusions?
In contrast, saccadic intrusions are involuntary conjugate saccades that interrupt fixation. Several types of saccadic intrusions exist including square wave jerks (SWJ), square wave pulses (SWP), macrosaccadic oscillations, saccadic pulses, ocular flutter, and opsoclonus.
What is the effect of intrusions on cerebellar volume?
Imaging studies may demonstrate variable findings in patients with saccadic intrusions. Magnetic resonance imaging (MRI) may show cerebellar atrophy or decrease in cortical and subcortical gray matter volume. Single photon emission computerized tomography (SPECT) has shown involvement of deep cerebellar nuclei in some patients.
What are Square-Wave Jerks (SWJ)?
They are inappropriate saccades that take the eye off the target, followed by a nearly normal intersaccadic interval (approximately 200 millisecond), and then a corrective saccade that brings the eye back to the target.
What are treatments for nystagmus and saccadic intrusions?
Treatments for nystagmus and saccadic intrusions are summarized, including pharmacological treatments, optical treatments, procedures to weaken the extraocular muscles (e.g., Kestenbaum-Anderson procedure), and measures such as biofeedback and vibration.
What is Ataxic Hemiparesis?
Ataxic hemiparesis is a syndrome of ipsilateral hemiataxia and hemiparesis, the
latter affecting the leg more severely than the arm (crural paresis). There may be
additional dysarthria, nystagmus, paraesthesia, and pain.
What is the cause of Ataxic Hemiparesis?
This syndrome is caused by lacunar (small deep) infarcts in the contralateral
basis pons at the junction of the upper third and lower two-thirds. It may also be
seen with infarcts in the contralateral thalamocapsular region, posterior limb of
the internal capsule (anterior choroidal artery syndrome), red nucleus, and the
paracentral region (anterior cerebral artery territory). Sensory loss is an indicator of capsular involvement; pain in the absence of other sensory features is an indicator of thalamic involvement.
What is pseudo choreoathetosis?
The involuntary movements of choreoathetotic type are commonly regarded as a sign of basal ganglia lesion. However, such movements can also occur in pathological processes involving the cervical spinal cord.
What is episodic ataxia?
Typically, episodic ataxia presents as bouts of ataxia induced by startle, stress, or exertion. Some patients also have continuous tremors of various motor groups, known as myokymia. Other patients have nystagmus, vertigo, tinnitus, diplopia or seizures. The various symptoms of EA are caused by dysfunction of differing areas.
What are types of nystagmus?
The oscillations may occur in the vertical, horizontal or torsional planes, or in any combination. The resulting nystagmus is often named as a gross description of the movement, e.g. downbeat nystagmus, upbeat nystagmus, seesaw nystagmus, periodic alternating nystagmus.
What is X linked infantile nystagmus?
X-linked infantile nystagmus is associated with mutations of the gene FRMD7, which is located on the X chromosome. Infantile nystagmus is also associated with two X-linked eye diseases known as complete congenital stationary night blindness (CSNB) and incomplete CSNB.
What does Physiological nystagmus mean?
Physiological nystagmus is a form of involuntary eye movement that is part of the vestibulo-ocular reflex (VOR), characterized by alternating smooth pursuit in one direction and saccadic movement in the other direction.
What is Rebound nystagmus?
Rebound nystagmus is also frequently found in conjunction with gaze-paretic nystagmus and is characteristic of cerebellar malfunction. These abnormal eye movements are often the earliest indicators of the disorder and may appear during childhood. The time of full onset of symptoms, including motor abnormalities, ranges from age 30 to age 60.
What is Athetosis?
Athetosis is the name sometimes given to an involuntary movement disorder
characterized by slow, sinuous, purposeless, writhing movements, often more
evident in the distal part of the limbs. Athetosis often coexists with the more
flowing, dance-like movements of chorea, in which case the movement disorder may be described as choreoathetosis. Indeed, the term athetosis is now
little used except in the context of ‘athetoid cerebral palsy’. Athetoid-like movements of the outstretched hands may also be seen in the presence of sensory
ataxia (impaired proprioception) and are known as pseudoathetosis or pseudo choreoathetosis.
What is cause of Athetosis?
Choreoathetoid movements result from disorders of the basal ganglia.
What is Internuclear ophthalmoplegia (INO)?
Internuclear ophthalmoplegia (INO) is a disorder of conjugate lateral gaze in which the affected eye shows impairment of adduction. When an attempt is made to gaze contralaterally (relative to the affected eye), the affected eye adducts minimally, if at all.
What is full recovery from internuclear ophthalmoplegia?
When the cause of the internuclear ophthalmoplegia is MS, infection, or trauma, people show a complete recovery. Full recovery is if the cause is a stroke or other cerebrovascular problem. But full recovery is if INO is the only neurological symptom.
What is Athymhormia?
Athymormia, also known as the robot syndrome, is a name given to a form of abulia or akinetic mutism in which there is loss of self-autoactivation.
It is associated with bilateral deep lesions of the frontal white matter or of the basal ganglia, especially the globus pallidus. Athymhormia is thus environment-dependent, patients normalizing initiation and cognition when stimulated, an important differentiation from apathy and akinetic mutism.
What is Atrophy?
Atrophy is a wasting or thinning of tissues. The term is often applied to wasted
muscles, usually in the context of lower motor neurone pathology (in which case
it may be synonymous with amyotrophy), but also with disuse. Atrophy develops
more quickly after lower, as opposed to upper, motor neurone lesions. It may also
be applied to other tissues, such as subcutaneous tissue (as in hemifacial atrophy).
Atrophy may sometimes be remote from the affected part of the neuraxis, hence a
false-localizing sign, for example, wasting of intrinsic hand muscles with foramen
magnum lesions.
What is ‘Attended Alone’ Sign?
Collateral history is crucial in assessing cognitive disorders, especially complaints
of memory impairment, for which reason individuals referred to memory clinics
are usually asked to bring with them a spouse, relative, or friend who knows them
well to provide such history. Failure to attend with an informant, the ‘attended
alone’ sign, is a robust (i.e. very sensitive, > 0.95) marker of the absence of
dementia.
What is Attention?
Attention is a distributed cognitive function, important for the operation of
many other cognitive domains; the terms concentration, vigilance, and persistence may be used synonymously with attention. Distinction may be made
between different types of attention, as follows:
• Sustained;
• Selective;
• Divided/executive function.
It is generally accepted that attention is effortful, selective, and closely linked
to intention.
Impairment of attentional mechanisms may lead to distractibility (with a resulting complaint of poor memory, perhaps better termed aprosexia), disorientation in time and place, perceptual problems, and behavioural problems (e.g. disinhibition), as in the cardinal disorder of attention, delirium.
The neuroanatomical substrates of attention encompass the ascending reticular activating system of the brainstem, the thalamus, and the prefrontal (multimodal association) cerebral cortex (especially on the right). Damage to any of these areas may cause impaired attention.
Attentional mechanisms may be tested in a variety of ways. Those adapted
to ‘bedside’ use all essentially look for a defect in selective attention, also known
as working memory or short-term memory (although this does not necessarily
equate with lay use of the term ‘short-term memory’):
• Orientation in time/place;
• Digit span forwards/backwards;
• Reciting months of the year backwards, counting back from 30 to 1;
• Serial sevens (serial subtraction of 7 from 100, = 93, 86, 79, 72, 65).
In the presence of severe attentional disorder (as in delirium) it is difficult to make any meaningful assessment of other cognitive domains (e.g. memory).
What is cause of inattention?
Besides delirium, attentional impairments may be seen following head injury,
and in ostensibly ‘alert’ patients, e.g. with Alzheimer’s disease (the dysexecutive
syndrome of impaired divided attention).
What is Auditory Agnosia?
Auditory agnosia refers to an inability to appreciate the meaning of sounds
despite normal perception of pure tones as assessed by audiological examination.
This agnosia may be for either verbal material (pure word deafness) or nonverbal material, either sounds (bells, whistles, animal noises) or music (amusia,
of receptive or sensory type).
What is Auditory–Visual Synaesthesia?
This name has been given to the phenomenon of sudden sound-evoked light flashes in patients with optic nerve disorders. This may be equivalent to noise induced visual phosphenes or sound-induced photisms. It is not certain that this phenomenon meets suggested criteria for synaesthesia.
What is the meaning of Phosphene?
A phosphene is a phenomenon characterized by the experience of seeing light without light actually entering the eye. The word phosphene comes from the Greek words phos (light) and phainein (to show). Phosphenes that are induced by movement or sound may be associated with optic neuritis.
What is an example of a pressure phosphene?
Pressure phosphenes can persist briefly after the rubbing stops and the eyes are opened, allowing the phosphenes to be seen on the visual scene. Hermann von Helmholtz and others have published drawings of their pressure phosphenes. One example of a pressure phosphene is demonstrated by gently pressing the side.
What does synesthesia look like?
Synesthetes — or people who have synesthesia — may see sounds, taste words or feel a sensation on their skin when they smell certain scents. They may also see abstract concepts like time projected in the space around them, like the image on the right. Many synesthetes experience more than one forms of the condition.
Is synesthesia a disorder or a variation of normal sensation?
Synesthesia is often refer to as being a condition, not a disease or disorder, because doesn’t interfere with normal daily life activities. I believe synesthesia is a variation of normal sensation and perceptions.
What is Augmentation?
The term augmentation may be used to describe a phenomenon seen in Lambert–
Eaton myasthenic syndrome (LEMS), namely, an increase in strength of affected
muscles detected in the first few seconds of maximal voluntary contraction, one
feature, along with facilitation, of post tetanic potentiation. This may also be
known as Lambert’s sign.
Augmentation also refers to the paradoxical worsening of the symptoms
of restless legs syndrome with dopaminergic treatment, manifesting with earlier
onset of symptoms in the evening or afternoon, shorter periods of rest to provoke
symptoms, greater intensity of symptoms when they occur, spread of symptoms
to other body parts such as the arms, and decreased duration of benefit from
medication.
What are facilitation techniques?
Facilitation Techniques. Facilitation and enhancement of muscle activity to achieve improved motor control are the key tenants to many of the techniques used in neurological rehabilitation, many of which also utilise neuroplasticity.
What is Aura?
An aura is a brief feeling or sensation, lasting seconds to minutes, occurring
immediately before the onset of a paroxysmal neurological event such as an
epileptic seizure or a migraine attack (migraine with aura, ‘classical migraine’),
‘warning’ of its imminent presentation, although auras may also occur in isolation. An aura indicates the focal onset of neurological dysfunction. Auras
are exclusively subjective, and may be entirely sensory, such as the fortification spectra (teichopsia) of migraine, or more complex, labelled psychosensory
or experiential, as in certain seizures.
What is Epileptic auras?
Epileptic auras may be classified into
subgroups:
• Somatosensory:
for example, paraesthesia;
• Visual:
hallucinations, illusions; occipital, or temporal origin; complex hallucinations and a ‘tunnel vision’ phenomenon are exclusive to seizures
of anteromedial temporal and occipitotemporal origin, whereas elementary hallucinations, illusions, and visual loss are common to both
occipital and temporal lobe seizures;
• Auditory:
may indicate an origin in the superior temporal gyrus;
• Olfactory:
parosmia may occur in seizures of medial temporal lobe origin (uncus;
uncinate fits);
• Gustatory;
• Autonomic;
• Abdominal:
rising epigastric sensation (visceral aura) of temporal lobe epilepsy;
• Psychic:
complex hallucinations or illusions that usually affect different senses,
e.g. distortions of familiarity such as deja vu or jamais vu auras of focal-onset epilepsy, indicative of temporal lobe and limbic onset, respectively.
What does Deja Vu mean?
déjà vu is a strange feeling that in some way you have already experienced what is happening now:
How do you explain the Deja Vu phenomenon?
Another possible explanation for the phenomenon of déjà vu is the occurrence of ” cryptomnesia “, which is where information learned is forgotten but nevertheless stored in the brain, and similar occurrences invoke the contained knowledge, leading to a feeling of familiarity because the event or experience being experienced has already been experienced in the past, known as ” déjà vu “.
What does tunnel vision look like?
Tunnel vision is the loss of peripheral vision with retention of central vision, resulting in a constricted circular tunnel-like field of vision.
Is there a treatment for tunnel vision?
If you have glaucoma, the best “cure” for tunnel vision is prevention. If eye drops are prescribed, you absolutely must take your glaucoma medication regularly to control high eye pressure, or you risk permanent optic nerve damage and development of blind spots in your visual field.
What is Parosmia?
It is a term used to describe health conditions that distort your sense of smell. If you have parosmia, you may experience a loss of scent intensity, meaning you can’t detect the full range of the scents around you.
What is jamais vu?
Jamais vu is sometimes associated with certain types of aphasia, amnesia, and epilepsy. Jamais vu is most commonly experienced when a person momentarily does not recognise a word or, less commonly, a person or place, that they know. This can be achieved by anyone by repeatedly writing or saying a specific word out loud.
What is fortification spectrum?
The best-known visual aura is called a fortification spectrum because its pattern resembles the walls of a medieval fort. It may start as a small hole of light, sometimes bright geometrical lines and shapes in your visual field. This visual aura may expand into a sickle- or C-shaped object, with zigzag lines on the leading edge.
What is Automatic Obedience?
Automatic obedience may be seen in startle syndromes such as the jumping Frenchmen of Maine, latah, and myriachit, when a sudden shout of, for example, ‘jump’ is followed by a jump. These are sometimes known as the startle-automatic obedience syndromes. Although initially classified (by Gilles de la Tourette) with tic syndromes, there are clear clinical and pathophysiological differences.
What is Automatic Writing Behaviour?
Automatic writing behaviour is a form of increased writing activity. It has been
suggested that it should refer specifically to a permanently present or elicitable,
compulsive, iterative and not necessarily complete, written reproduction of visually or orally perceived messages (cf. hypergraphia). This is characterized as
a particular, sometimes isolated, form of utilization behaviour in which the
inhibitory functions of the frontal lobes are suppressed.
What is Automatism?
Automatisms are complex motor movements occurring in complex motor
seizures, which resemble natural movements but occur in an inappropriate setting. These may occur during a state of impaired consciousness during or shortly
after an epileptic seizure. There is usually amnesia for the event.
Automatisms occur in about one-third of patients with complex partial
seizures, most commonly those of temporal or frontal lobe origin. Although
there are qualitative differences between the automatisms seen in seizures arising
from these sites, they are not of sufficient specificity to be of reliable diagnostic
value; bizarre automatisms are more likely to be frontal.
What are types of Automatisms?
Automatisms may take various forms:
• Oro-facial movements:
for example, lip smacking, chewing and swallowing movements, salivation (especially temporal lobe origin).
• Gestural:
hand fumbling, foot shuffling, tidying, or more complex actions such
as undressing; upper limb movements are said to be more suggestive of temporal lobe origin, lower limb movements (kicking, cycling)
of frontal lobe origin; pelvic thrusting (may also be seen in pseudo seizures).
• Ambulatory:
walking or running around (cursive seizures); prolonged wandering
may be termed fugue or poriomania.
• Emotional:
laughing and, more rarely, crying (gelastic and dacrystic seizures,
respectively, although crying may also be a feature of non-epileptic
seizures), fear, anger.
• Verbal:
humming, whistling, grunting, speaking incoherently; vocalization is
common in frontal lobe automatisms.
Automatic behaviour and fugue-like states may also occur in the context of
narcolepsy and must be differentiated from the automatisms of complex partial
seizures on the basis of history, examination, and EEG.
What is Autophony?
The perception of the reverberation of one’s own voice, which occurs with
external or middle, but not inner, ear disease.
What is Autoscopy?
Autoscopy (literally ‘seeing oneself’) is a visual hallucination of one’s own face,
sometimes with upper body or entire body, likened to seeing oneself in a mirror
(hence mirror hallucination). The hallucinated image is a mirror image, i.e. shows
left–right reversal as in a mirror image. Unlike heautoscopy, there is a coincidence
of egocentric and body-centred perspectives. Autoscopy may be associated with
parieto-occipital space-occupying lesions, epilepsy, and migraine.
What is Heautoscopy?
A hallucination in which one sees one’s own body from a distance. Heautoscopy may occur as a symptom in schizophrenia and epilepsy.
What is Autotopagnosia?
Autotopagnosia, or somatotopagnosia, is a rare disorder of body schema characterized by inability to identify parts of the body, either to verbal command or by
imitation; this is sometimes localized but at worst involves all parts of the body.
This may be a form of category-specific anomia with maximum difficulty for
naming body parts or one feature of anosognosia. Finger agnosia and right–left
disorientation are partial forms of autotopagnosia, all of which are most often
seen following cerebrovascular events involving the left parietal area.
What is Babinski’s Sign (1)?
Babinski’s sign is a polysynaptic cutaneous reflex consisting of an extensor
movement (dorsiflexion) of the big toe on eliciting the plantar response, due
to contraction of extensor hallucis longus. There may be in addition fanning
(abduction) of the other toes (fan sign; signe de l’éventail) but this is neither
necessary nor sufficient for Babinski’s sign to be judged present. There may be
simultaneous contraction of other limb flexor muscles, consistent with the notion
that Babinski’s sign forms part of a flexion synergy (withdrawal) of the leg. The
use of the term ‘negative Babinski sign’ to indicate the normal finding of a down going (flexor; plantar flexion) big toe is incorrect, ‘flexor plantar response’ being
the appropriate description. The plantar response is most commonly performed
by stroking the sole of the foot, although many other variants are described (e.g.
Chaddock’s sign, Gordon’s sign, Oppenheim’s sign).
Babinski’s sign is a normal finding in infants with immature (unmyelinated)
corticospinal tracts; persistence beyond 3 years of age, or re-emergence in adult
life, is pathological. In this context, Babinski’s sign is considered a reliable (‘hard’)
sign of corticospinal (pyramidal) tract dysfunction (upper motor neurone pathology) and may coexist with other signs of upper motor neurone dysfunction (e.g. weakness in a so-called pyramidal distribution, spasticity, hyperreflexia).
However, if weakness of extensor hallucis longus is one of the features of upper
motor neurone dysfunction, or from any other cause, Babinski’s sign may be
unexpectedly absent although anticipated on clinical grounds. Other causes of
Babinski’s sign includes hepatic coma, post epileptic seizure, deep sleep following
prolonged induced wakefulness, and cataplectic attack, hence it is not necessarily
a consequence of a permanent and irreversible lesion of the pyramidal tracts.
In the presence of extrapyramidal signs, it is important to distinguish
Babinski’s sign, a ‘pyramidal sign’, from a striatal toe (spontaneous up going
plantar).
What is Somatoparaphrenia?
Somatoparaphrenia is a type of monothematic delusion where one denies ownership of a limb or an entire side of one’s body. Even if provided with undeniable proof that the limb belongs to and is attached to their own body, the patient produces elaborate confabulations about whose limb it really is, or how the limb ended up on their body.
What is a striatal toe?
A “striatal toe” (dystonic toe) is tonic extension of the great toe that occurs in extrapyramidal disease, particularly conditions affecting the striatum. It resembles the great toe extension of Babinski’s plantar sign but is tonic and sustained, not accompanied by fanning of the toes and occurs without plantar stimulation.
What is striatal hand deformity?
The most typical deformity associated with striatal hand is characterised by flexion of the metacarpophalangeal joints, extension of the proximal interphalangeal joints, flexion of the distal interphalangeal joints, and ulnar deviation
What is striatal pathology?
Over a century ago, Charcot and Purves-Stewart recognised these deformities, which cause substantial functional disability and discomfort. The term striatal is used because pathology in the neostriatum (putamen and caudate) has been suggested to cause the deformities, but the pathogenesis is unknown.
What does Oppenheim’s sign mean?
Oppenheim’s sign is dorsiflexion of the great toe elicited by irritation downward of the medial side of the tibia. It is one of a number of Babinski-like responses. The sign’s presence indicates a damage to the pyramidal tract. It is named for Hermann Oppenheim.
What is Hyperreflexia (or hyper-reflexia)?
Hyperreflexia (or hyper-reflexia) is defined as overactive or overresponsive reflexes. Examples of this can include twitching or spastic tendencies, which are indicative of upper motor neuron disease as well as the lessening or loss of control ordinarily exerted by higher brain centers of lower neural pathways (disinhibition).
What is Chaddock’s sign?
The Chaddock reflex is a diagnostic reflex similar to the Babinski reflex. Chaddock’s sign is present when stroking of the lateral malleolus causes extension of the great toe, indicating damage to the corticospinal tract. It was identified by Charles Gilbert Chaddock in 1911.
What is Gordon’s sign?
Gordon’s sign is a clinical sign in which squeezing the calf muscle elicits an extensor plantar reflex. It is found in patients with pyramidal tract lesions, and is one of a number of Babinski-like responses. The sign is named after Alfred Gordon.
What is Babinski’s Sign (2)?
Babinski (1905) described the paradoxical elevation of the eyebrow in hemifacial spasm as orbicularis oris contracts and the eye closes, a synkinesis which is not reproducible by will. This observation indicated to Babinski the peripheral (facial nerve) origin of hemifacial spasm. It may assist in differentiating hemifacial spasm from other craniofacial movement disorders.
What is Hemifacial spasm?
Hemifacial spasm is most often caused by a blood vessel touching a facial nerve, but it may be caused by a facial nerve injury or a tumour, or it may not have a cause. Causes. Hemifacial spasm is most often caused by a blood vessel touching a facial nerve. It can also be caused by a facial nerve injury or a tumour.
What is Babinski’s Trunk–Thigh Test?
Babinski’s trunk–thigh test, also known as the ‘rising sign’, is suggested to be
of use in distinguishing organic from functional paraplegia and hemiplegia (the
abductor sign may also be of use in the former case, Hoover’s sign in the latter).
The recumbent patient is asked to sit up with the arms folded on the front of the
chest. In organic hemiplegia there is involuntary flexion of the paretic leg, which
may automatically rise higher than the normal leg; in paraplegia both legs are
involuntarily raised. In functional paraplegic weakness neither leg is raised, and
in functional hemiplegia only the normal leg is raised.
What is myokymia of the eye?
Myokymia is characterized by spontaneous, fine fascicular contractions of muscle without muscular atrophy or weakness. Eyelid myokymia results from fascicular contractions of the orbicularis oculi muscle. Eyelid myokymia is typically unilateral, with the most common involvement being one of the lower eyelids. Myokymia is a type of abnormal spontaneous electrical activity characterized by grouped discharges of motor unit action potentials. Myokymia originates from areas of axonal demyelination. The audio signal of myokymia is ‘marching.’ The principal clinical feature of myokymia is continuous involuntary rippling (worm-like) movements of muscle.
What is bag of worms?
Axial T2 MRI images show a nidus of compact vessel with the typical appearance of “bag of black worms” in the left frontoparietal region. The feeding artery appears to come from the pericallosal branch of left anterior cerebral artery, and the draining vein drains into internal cerebral vein.
What is Balaclava Helmet?
A pattern of facial sensory loss resembling in distribution a balaclava helmet,
involving the outer parts of the face but sparing the nose and mouth, may be seen
with central brainstem lesions such as syringobulbia which progress upwards
from the neck, such that the lowermost part of the spinal nucleus of the trigeminal nerve which serves the outer part of the face is involved whilst the upper part of the nucleus which serves the central part of the face is spared. This pattern of facial sensory impairment may also be known as onion peel or onion skin.
What is abductor sign?
To test the abductor sign, the examiner told the patient to abduct each leg, and opposed this movement with his hands placed on the lateral surfaces of the patient’s legs. The leg contralateral to the abducted one showed opposite actions for organic paresis and non-organic paresis: for example, when the paretic leg was abducted, the sound leg stayed fixed in organic paresis, but moved in the hyperadducting direction in non-organic paresis. Hoover’s sign was used for comparison in the same patients.
What is Balint’s Syndrome?
Balint’s syndrome, first described by a Hungarian neurologist in 1909, consists of:
• Simultanagnosia (q.v.; dorsal type):
A constriction of visual attention, such that the patient is aware of
only one object at a time; visual acuity is preserved, and patients can
recognize single objects placed directly in front of them; they are unable
to read or distinguish overlapping figures.
• Spatial disorientation:
Loss of spatial reference and memory, leaving the patient ‘lost in space’.
• Disorders of oculomotor function:
Specifically, visually guided eye movements (fixation, pursuit, saccades); Balint’s ‘psychic paralysis of gaze’, or ‘sticky fixation’, refers
to an inability to direct voluntary eye movements to visual targets,
despite a full range of eye movements; this has also been characterized as a form of oculomotor apraxia. Accurate eye movements may
be programmed by sound or touch. Loss of spontaneous blinking has
also been reported.
• Optic ataxia:
A failure to grasp or touch an object under visual guidance.
Not all elements may be present; there may also be coexisting visual field
defects, hemispatial neglect, visual agnosia, or prosopagnosia.
What is cause of Balint’s Syndrome?
Balint’s syndrome results from bilateral lesions of the parieto-occipital junction causing a functional disconnection between higher-order visual cortical regions and the frontal eye fields, with sparing of the primary visual cortex.
Brain imaging, either structural (CT, MRI) or functional (SPECT, PET), may demonstrate this bilateral damage, which is usually of vascular origin, for example, due to watershed or border zone ischaemia or top-of-the-basilar syndrome.
Balint syndrome has also been reported as a migrainous phenomenon, following traumatic brain injury and in association with Alzheimer’s disease, brain tumour (butterfly glioma), radiation necrosis, progressive multifocal leucoencephalopathy, Marchiafava–Bignami disease with pathology affecting the corpus callosum, and X-linked adrenoleucodystrophy.
What is Hemiballismus?
Hemiballismus or hemiballism in its unilateral form is a very rare movement disorder. It is a type of chorea caused in most cases by a decrease in activity of the subthalamic nucleus of the basal ganglia, resulting in the appearance of flailing, ballistic, undesired movements of the limbs. It can also appear rarely due to certain metabolic abnormalities. It is a rare movement disorder, being 500 times rarer than Parkinson’s disease. Hemiballismus can cause significant disability. Symptoms can decrease during sleep.
What is optic ataxia?
The term optic ataxia (optische Ataxie in the original German) was coined by Hungarian physician Rezso (Rudolf) Bálint in his 1909 report of a man with lesions of the posterior parietal lobe on both sides of the brain. Optic ataxia was one of several symptoms of a condition that later became known as Bálint syndrome. It is a failure to grasp or touch an object under visual guidance. Not all elements may be present; there may also be coexisting visual field defects, hemispatial neglect, visual agnosia, or prosopagnosia.
What is ballismus?
Ballism or ballismus is a hyperkinetic involuntary movement disorder characterized by wild, flinging, throwing movements of a limb. These movements
most usually involve one-half of the body (hemiballismus), although they may
sometimes involve a single extremity (monoballismus) or both halves of the
body (paraballismus). The movements are often continuous during wakefulness
but cease during sleep. Hemiballismus may be associated with limb hypotonia.
Clinical and pathophysiological studies suggest that ballism is a severe form
of chorea. It is most commonly associated with lesions of the contralateral
subthalamic nucleus.
What is Bathing Suit Sensory Loss?
Patients’ initial non-dermatomal sensory loss fits the textbook description of ‘bathing suit’ pattern associated with acute intermittent porphyria. 64-year old lady presented with sudden onset of flaccid tetraparesis and absent reflexes. Sensory deficit was non-dermatomal: affecting trunk, shoulders and buttocks.
What is Battle’s Sign?
Battle’s sign is a haematoma overlying the mastoid process, which indicates
an underlying basilar skull fracture extending into the mastoid portion of the
temporal bone. It appears 48–72 h after the trauma which causes the fracture.
What is Beevor’s Sign?
Beevor’s sign is an upward movement of the umbilicus in a supine patient
attempting either to flex the head onto the chest against resistance (e.g. the examiner’s hand) or performing a sit-up. It indicates a lesion causing rectus abdominis
muscle weakness below the umbilicus. This may occur with a spinal lesion (e.g.
tumour, syringomyelia) between T10 and T12 causing isolated weakness of the
lower part of the muscle, or myopathies affecting abdominal muscles, particularly
facioscapulohumeral muscular dystrophy. Lower cutaneous abdominal reflexes
are also absent, having the same localizing value.
Downward movement of the umbilicus (‘inverted Beevor’s sign’) due to
weakness of the upper part of rectus abdominis is less often seen.
What is Belle Indifférence?
La belle indifférence refers to a patient’s seeming lack of concern in the presence
of serious symptoms. This was first defined in the context of ‘hysteria’, along
with exaggerated emotional reactions, what might now be termed functional or
somatoform illness. However, the sign is a poor discriminator against ‘organic’
illness. Some patients’ coping style is to make light of serious symptoms; they
might be labelled stoical.
Patients with neuropathological lesions may also demonstrate a lack of concern for their disabilities, either due to a disorder of body schema (anosodiaphoria) or due to incongruence of mood (typically in frontal lobe syndromes, sometimes seen in multiple sclerosis).
What is Bell’s Palsy?
Bell’s palsy is an idiopathic peripheral (lower motor neurone) facial weakness
(prosopoplegia). It is thought to result from viral inflammation of the facial
(VII) nerve. Other causes of lower motor neurone facial paresis may need to be
excluded before a diagnosis of Bell’s palsy can be made.
In the majority of patients with Bell’s palsy (idiopathic facial paresis), spontaneous recovery occurs over 3 weeks to 2 months. Poorer prognosis is associated
with older age (over 40 years) and if no recovery is seen within 4 weeks of onset.
Meta-analyses suggest that steroids are associated with better outcome than no
treatment, but that acyclovir alone has no benefit.
What is Bell’s Phenomenon, Bell’s Sign?
Bell’s phenomenon or sign is reflex upward, and slightly outward, deviation of
the eyes in response to forced closure, or attempted closure, of the eyelids. This
is a synkinesis of central origin involving superior rectus and inferior oblique
muscles. It may be very evident in a patient with Bell’s palsy (idiopathic facial
nerve paralysis) attempting to close the paretic eyelid. The reflex indicates intact
nuclear and infranuclear mechanisms of upward gaze, and hence that any defect
of upgaze is supranuclear. However, in making this interpretation it should be
remembered that perhaps 10–15% of the normal population do not show a Bell’s
phenomenon.
Bell’s phenomenon is usually absent in progressive supranuclear palsy and is
only sometimes spared in Parinaud’s syndrome.
What is Benediction Hand?
Median nerve lesions in the axilla or upper arm cause weakness in all
median nerve innervated muscles, including flexor digitorum profundus. Thus
on attempting to make a fist, impaired flexion of the index and middle fingers,
complete and partial, respectively, but with normal ring and little finger flexion
(ulnar nerve mediated) results in a hand posture likened to that of a priest saying
benediction (also sometimes known as Benedictine hand or orator’s hand).
What is Bent spine syndrome (BSS)?
Bent spine syndrome (BSS) is defined as an unusual condition characterized by progressive forward flexion of the trunk
What is Claw hand?
The term clawing refers to the position of the fingers, the term simian hand refers to the position of the thumb.
What is a simian hand?
Paralysis of abduction and opposition leave the thumb resting in adduction, rotated parallel to the plane of the palm, with the thumbnail lying approximately in line with the fingernails. This degree of paralysis is usually accompanied by marked atrophy of the thenar muscles. The appearance of a paralyzed, atrophic thumb lying parallel instead of perpendicular to the fingers resembles an ape’s hand, and has been called the simian hand, ape hand or monkey paw deformity. The simian hand deformity can occur with severe median neuropathy, combined median and ulnar nerve lesions, lower brachial plexopathy, C8 radiculopathy, motor neuron disease or severe peripheral polyneuropathy, in this case due to long-standing CIDP.
What is Bielschowsky’s Sign, Bielschowsky’s Test?
Bielschowsky’s sign is head tilt towards the shoulder, typically towards the side
contralateral to a trochlear (IV) nerve palsy. The intorsion of the unaffected eye
brought about by the head tilt compensates for the double vision caused by the
unopposed extorsion of the affected eye. Very occasionally, head tilt is paradoxical, i.e. towards the involved side: presumably the greater separation of images thus produced allows one of them to be ignored.
Bielschowsky’s (head tilt) test consists of the examiner tipping the patient’s
head from shoulder to shoulder to see if this improves or exacerbates double
vision, as will be the case when the head is, respectively, tilted away from or
towards the affected side in a unilateral trochlear (IV) nerve lesion. The test
is usually negative in a skew deviation causing vertical divergence of the eyes.
This test may also be used as part of the assessment of vertical diplopia to see
whether hypertropia changes with head tilt to left or right; increased hypertropia
on left head tilt suggests a weak intortor of the left eye (superior rectus); increased
hypertropia on right head tilt suggests a weak intortor of the right eye (superior
oblique).
What is Camptocormia (bent spine syndrome or cyphose hystérique)?
It is a rare syndrome characterised by involuntary flexion of the thoracolumbar spine with weight-bearing which reduces when laying down, and is due to isolated atrophy of the paraspinal muscles.
What is Hypertropia?
It is a condition of misalignment of the eyes (strabismus), whereby the visual axis of one eye is higher than the fellow fixating eye. Hypotropia is the similar condition, focus being on the eye with the visual axis lower than the fellow fixating eye.
What is Strabismus?
It is a condition in which the eyes do not properly align with each other when looking at an object. The eye that is focused on an object can alternate. The condition may be present occasionally or constantly.
What is Skew deviation?
Skew deviation is an unusual ocular deviation (strabismus), wherein the eyes move upward (hypertropia), but in opposite directions. Skew deviation is caused by abnormal prenuclear vestibular input to the ocular motor nuclei, most commonly due to brainstem or cerebellar stroke. Other causes include multiple sclerosis and head trauma.
What is hemianopia?
Hemianopsia, or hemianopia, is a loss of vision or blindness (anopsia) in half the visual field, usually on one side of the vertical midline. The most common causes of this damage are stroke, brain tumour, and trauma.
What is Binasal Hemianopia?
Of the hemianopic defects, binasal hemianopia, suggesting lateral compression of the chiasm, is less common than bitemporal hemianopia. Various
causes are recorded including syphilis, glaucoma, drusen, and chronically raised
intracranial pressure.
What is Bitemporal Hemianopia?
Bitemporal hemianopia due to chiasmal compression, for example, by a pituitary
lesion or craniopharyngioma, is probably the most common cause of a heteronymous hemianopia. Conditions mimicking bitemporal hemianopia include
congenitally tilted discs, nasal sector retinitis pigmentosa, and papilloedema with
greatly enlarged blind spots.
What is Blepharoptosis?
Blepharoptosis is a disease commonly seen in the Asian population, defined as an abnormal lower upper eyelid margin that is <2.0 mm above the midpoint of the pupil when a person looks straightforward. In many patients, eyelid droop described as blepharoptosis is the first known symptom. What are the types of hemianopia? As an umbrella medical term, there are actually five types of hemianopia and two subcategories in total. In fact, the hemianopia type that a patient suffers from is typically correlated with the exact site of the visual field defect. Homonymous hemianopia Visual field is lost on the same side in both eyes, depending on which side of the brain is affected by a stroke or injury. The left optic nerve controls the right visual field and the right optic nerve controls the left visual field. The diminished vision is instrumental in helping doctors locate the exact area of the brain that’s been injured or where the stroke occurred. Heteronymous hemianopia Loss of vision occurs in different fields of the eyes. Heteronymous hemianopia is separated into two different categories: Binasal hemianopia: Blindness or vision loss occurs in the field of vision that’s within the closest proximity to the nose. This is caused by lateral damage to the retinal nerve fibers that don’t cross in the optic chiasm. They’re also responsible for registering information and sending it to the temporal retina. Bitemporal hemianopia: As the name suggests, bitemporal hemianopia is a loss of vision that happens on the side of the eyes that’s closest to the temple. Lesions and damage to the optic chiasm can cause bitemporal hemianopia. The optic chiasm is located near the pituitary gland where the nerves from the left and right eyeballs meet and cross over one another to reach the opposite side of the brain. Quadrantanopia Loss of vision occurs in one quadrant or portion of the visual field, and this usually depends on the part of the brain that’s damaged. The area that’s connected to the damaged portion of the brain will suffer either partial or complete hemianopia. Superior hemianopia: Superior hemianopia is when loss of vision occurs in the upper visual field of either the left or right eye or both. Inferior hemianopia: Inferior hemianopia is when loss of vision occurs in the lower visual field of either the left, right, or both eyes. What are the symptoms of ptosis? The primary symptom of ptosis is a visible drooping of the upper eyelid. Ptosis can affect children and adults at any stage of life. You may notice symptoms in one or both eyes. Why is one eyelid Droopy? In senile ptosis, the long-term effects of gravity and aging cause stretching of a wide, tendon-like tissue that helps the levator muscle lift the eyelid. Although both eyes usually are affected, drooping may be worse in one eye. What is Visual field defect? Visual field defect is one of the most important and disabling sequelae of PCA infarction. The impact of visual field defects on daily activities is significant, contributing to poor mobility, collisions, and impaired reading and driving. What is Blepharospasm? Blepharospasm is a focal dystonia of the orbicularis oculi resulting in repeated involuntary forced eyelid closure, with failure of voluntary eye opening. Usually bilateral in origin, it may be sufficiently severe to result in functional blindness. The condition typically begins in the sixth decade of life and is more common in women than in men. Blepharospasm may occur in isolation (‘benign essential blepharospasm’), or in combination with other involuntary movements which may be dystonic (orobuccolingual dystonia or Meige syndrome; limb dystonia) or dyspraxic (eyelid apraxia), or in association with another neurological disorder such as Parkinson’s disease. Other examples of ‘secondary blepharospasm’ include drug therapy (neuroleptics, levodopa) and lesions of the brainstem and more rarely cerebellum and striatum. Like other forms of dystonia, blepharospasm may be relieved by sensory tricks (geste antagoniste), such as talking, yawning, singing, humming, or touching the eyelid. This feature is helpful in diagnosis. Blepharospasm may be aggravated by reading, watching television, and exposure to wind or bright light. Blepharospasm is usually idiopathic but may be associated with lesions (usually infarction) of the rostral brainstem, diencephalon, and striatum; it has been occasionally reported with thalamic lesions. The pathophysiological mechanisms underlying blepharospasm are not understood, but may reflect dopaminergic pathway disruption causing disinhibition of brainstem reflexes. Local injections of botulinum toxin into orbicularis oculi are the treatment of choice, the majority of patients deriving benefit and requesting further injection. Failure to respond to botulinum toxin may be due to concurrent eyelid apraxia or dopaminergic therapy with levodopa. What is geste antagoniste? The geste antagoniste (moving an arm to the face or head) is a well-known clinical feature in cervical dystonia (CD) to alleviate the abnormal posture. What is Blindsight? Blindsight describes a rare phenomenon in which patients with bilateral occipital lobe damage affecting the primary visual cortex are nonetheless able to discriminate certain visual events within their ‘blind’ fields, but are not aware of their ability to do so. What is Blind Spot? The blind spot is defined anatomically as the point on the retina at which axons from the retinal ganglion cells enter the optic nerve; since this area is devoid of photoreceptors there is a physiological blind spot. This area may be mapped clinically by confrontation with the examiner’s blind spot or mechanically. Minor enlargement of the blind spot is difficult to identify clinically, formal perimetry is needed in this situation. Enlargement of the blind spot (peripapillary scotoma) is observed with raised intracranial pressure causing papilloedema: this may be helpful in differentiating papilloedema from other causes of disc swelling such as optic neuritis, in which a central scotoma is the most common field defect. Enlargement of the blind spot may also be a feature of peripapillary retinal disorders including big blind spot syndrome. What is Blinking? Involuntary blinking rate is decreased in idiopathic Parkinson’s disease (and may be improved by dopaminergic therapy) and in progressive supranuclear palsy (Steele–Richardson–Olszewski syndrome) where the rate may be <5/min. In contrast, blink rate is normal in multiple system atrophy and dopa-responsive dystonia, and increased in schizophrenia and postencephalitic parkinsonism. These disparate observations are not easily reconciled with the suggestion that blinking might be a marker of central dopaminergic activity. Loss of spontaneous blinking has been reported in Balint’s syndrome. In patients with impaired consciousness, the presence of involuntary blinking implies an intact pontine reticular formation; absence suggests structural or metabolic dysfunction of the reticular formation. Blinking decreases in coma. Functional disorders may be accompanied by an increase in blinking. What is bailint s syndrome? Bálint’s syndrome is an uncommon and incompletely understood triad of severe neuropsychological impairments: inability to perceive the visual field as a whole (simultanagnosia), difficulty in fixating the eyes (oculomotor apraxia), and inability to move the hand to a specific object by using vision (optic ataxia). Who gets Balint’s syndrome? Balint’s syndrome usually results from damage to both parietal lobes, the part of your brain which lets you know where you are as well as other objects. When symptoms come on suddenly, they’re likely due to stroke. However, other disorders such as tumors, trauma, near-drowning, eclampsia, HIV encephalitis, and even neurodegenerative diseases such as Alzheimer’s, can also lead to Balint’s syndrome. What is Blink Reflex? The blink reflex consists of bilateral reflex contraction of the orbicularis oculi muscles. This may be induced by: • Mechanical stimulus: Examples include percussion over the supraorbital ridge (glabellar tap reflex, Myerson’s sign, nasopalpebral reflex): this quickly habituates with repetitive stimulation in normal individuals; touching the cornea (corneal reflex); stroking the eyelashes in unconscious patients with closed eyes (‘eyelash reflex’). • Visual stimulus: Sudden visual stimulus approaching the eyes (menace reflex, threat reflex, visuopalpebral reflex): the stimulus should be unexpected since the reflex can be voluntarily suppressed; failure to respond to a stimulus moving into the temporal field of vision may indicate a hemianopic field defect in patients unable to comply with standard confrontation visual field testing. Care should be taken to avoid generating air currents with the hand movement as this may stimulate the corneal reflex which may simulate the visuopalpebral reflex. It is probable that this reflex requires cortical processing: it is lost in persistent vegetative states. Loss of this reflex may occur in Balint’s syndrome, ascribed to inability to recognize the nearness of the threatening object. • Acoustic stimulus: Sudden loud sounds (acousticopalpebral reflex). The final common (efferent) pathway for these responses is the facial nerve nucleus and facial (VII) nerve, the afferent limbs being the trigeminal (V), optic (II), and auditory (VIII) nerves, respectively. What is glabellar reflex? The glabellar reflex, also known as the “glabellar tap sign”, is a primitive reflex elicited by repetitive tapping on the forehead. Subjects blink in response to the first several taps. If the blinking persists, this is known as Myerson’s sign, and is abnormal and a sign of frontal release; it is often seen in people who have Parkinson’s disease. What is Body Part as Object? In this phenomenon, apraxic patients use a body part when asked to pantomime certain actions, such as using the palm when asked to demonstrate the use of a hair brush or comb, or fingers when asked to demonstrate use of scissors or a toothbrush. What does parapraxis mean? Parapraxis definition, a slip of the tongue or pen, forgetfulness, misplacement of objects, or other error thought to reveal unconscious wishes or attitudes. What is double parapraxis? Double parapraxes unlike single parapraxis seems to give way to utter incoherence, or perhaps it is just more volubly inventive. Where parapraxis is concerned, if the slip is unconscious or only a pretence of unconsciousness is not clear. Parapraxis and metalepsis meet at a threshold of distraction. What is Bon-Bon Sign? Involuntary pushing of the tongue against the inside of the cheek, the ‘bonbon sign’, is said to be typical of the stereotypic orolingual movements of tardive dyskinesia, along with chewing and smacking of the mouth and lips, and rolling of the tongue in the mouth. These signs may help to distinguish tardive dyskinesia from chorea, although periodic protrusion of the tongue (flycatcher, trombone tongue) is common to both. What is Trombone tongue? It is a new clinical sign for significant medullary compression at the craniovertebral junction. What is Buccolingual syndrome? a movement disorder present in patients with kinesthetic problems and those using antipsychotic drugs. It manifests as involuntary lingual movements like protruding the tongue and labial movements such as pursing the mouth or lips. Also called buccal- lingual masticatory syndrome. See oral-lingual dyskinesia – also tardive dyskinesia. What is buccolingual masticatory syndrome? The buccolingual masticatory syndrome is the most common tardive syndrome, and it usually affects elderly subjects. It consists of repetitive movements of tongue twisting and protruding, lip smacking and puckering, and chewing movements. When the respiratory muscles are involved, gasping and dyspnoea can occur. What is Bouche de Tapir? Patients with facioscapulohumeral (FSH) muscular dystrophy have a peculiar and characteristic facies, with puckering of the lips when attempting to whistle. The pouting quality of the mouth, unlike that seen with other types of bilateral (neurogenic) facial weakness, has been likened to the face of the tapir What is Bovine Cough? A bovine cough lacks the explosive character of a normal voluntary cough. It may result from injury to the distal part of the Vagus nerve, particularly the recurrent laryngeal branches which innervate all the muscles of the larynx (with the exception of cricothyroid) with resultant vocal cord paresis. Because of its longer intrathoracic course, the left recurrent laryngeal nerve is more often involved. A bovine cough may be heard in patients with tumours of the upper lobes of the lung (Pancoast tumour) due to recurrent laryngeal nerve palsy. Bovine cough may also result from any cause of bulbar weakness, such as motor neurone disease, Guillain–Barré syndrome, and bulbar myopathies. What is chorea? Chorea (or choreia, occasionally) is an abnormal involuntary movement disorder, one of a group of neurological disorders called dyskinesias. The term chorea is derived from the Ancient Greek: χορεία (“dance”; see choreia), as the quick movements of the feet or hands are comparable to dancing. The term hemichorea refers to chorea of one side of the body, such as chorea of one arm but not both What is causes of chorea? It is caused by many different diseases and agents. It is a symptom of several diseases, including Lesch-Nyhan syndrome, phenylketonuria, rheumatic, Sydenham’s, and Huntington disease. What is Vernet curtain sign? The curtain sign, also called the Vernet curtain sign, reflects a unilateral paralysis of the upper constrictor muscle of the pharynx, that is, the muscle that closes the pharynx. What is Diplophonia? Diplophonia, also known as diphthongia, is a phenomenon in which a voice is perceived as being produced with two concurrent pitches. Diplophonia is a result of vocal fold vibrations that are quasi-periodic in nature. What is Bradykinesia? Bradykinesia is a slowness in the initiation and performance of voluntary movements in the absence of weakness and is one of the typical signs of parkinsonian syndromes, in which situation it is often accompanied by difficulty in the initiation of movement (akinesia, hypokinesia) and reduced amplitude of movement (hypometria) which may increase with rapid repetitive movements (fatigue). It may be overcome by reflexive movements or in moments of intense emotion (kinesis paradoxica). Bradykinesia in parkinsonian syndromes reflects dopamine depletion in the basal ganglia. It may be improved by levodopa and dopaminergic agonists, less so, by anticholinergic agents. Slowness of voluntary movement may also be seen with psychomotor retardation, frontal lobe lesions producing abulia, and in the condition of obsessive slowness. What is Kinesia paradoxa? It is a phenomenon most often seen in people with Parkinson’s disease where individuals who typically experience severe difficulties with the simple movements may perform complex movements easily. What is Hypometria? Ataxia characterized by underreaching an object or goal; seen with cerebellar disease. Abnormality of eye movements in which the eyes overshoot (hypermetria) or undershoot (hypometria) when attempting to fixate an object. What does abulia mean? In general, abulia refers to a type of apathy that develops as a result of disease, specifically disease that affects the brain. Some people who have abulia are aware of the change in the level of motivation, but it is particularly noticeable and upsetting for friends and loved ones. What is the difference between akinesia and dyskinesia? As nouns the difference between akinesia and dyskinesia. is that akinesia is (medicine) the loss of the ability to control motor muscles while dyskinesia is impairment of voluntary movements resulting in fragmented or jerky motions. What is Bradykinesia in Parkinson’s disease? Bradykinesia is defined by slow movement and an impaired ability to move the body swiftly on command. It’s most commonly a symptom of Parkinson’s disease or a side effect of medications. It is one of the main symptoms doctors will look for when diagnosing Parkinson’s. Bradykinesia symptoms. What does hypokinetic mean? Hypokinesia refers to decreased bodily movement. One of the two categories of movement disorders, hypokinesia is characterized by a partial or complete loss of muscle movement due to a disruption in the basal ganglia. What are psychomotor disturbances-? They are psychomotor disturbances that may involve muscle rigidity, stupor or mutism, purposeless movements, negativism, echolalia, and inappropriate or unusual posturing and is associated with various medical conditions (such as schizophrenia and mood disorders) What is psychomotor retardation mean? Psychomotor retardation (also known as “psychomotor impairment” or “motormental retardation” or “psychomotor slowing”) involves a slowing-down of thought and a reduction of physical movements in an individual. Psychomotor retardation can cause a visible slowing of physical and emotional reactions, including speech and affect. What may cause parkinsonism? Parkinsonism is any condition that causes a combination of the movement abnormalities seen in Parkinson’s disease — such as tremor, slow movement, impaired speech or muscle stiffness — especially resulting from the loss of dopamine-containing nerve cells (neurons What is Bradylalia? Bradylalia is slowness of speech, typically seen in the frontal–subcortical types of cognitive impairment, with or without extrapyramidal features, or in depression. What is the difference between palilalia and echolalia? Echolalia is the repetition of words spoken by others, whereas palilalia is the automatic repetition of one’s own words. What is palilalia syndrome? Palilalia occurs most commonly in Tourette syndrome and may be present in neurodegenerative disorders like Alzheimer’s disease and progressive supranuclear palsy. Palilalia is defined as the repetition of the speaker’s words or phrases, often for a varying number of repeats. What is Bradyphrenia? Bradyphrenia is a slowness of thought, typically seen in the frontal–subcortical types of cognitive impairment, e.g. progressive supranuclear palsy, vascular dementia, and Huntington’s disease. Such patients typically answer questions correctly but with long response times. What is Lasegue’s sign? A clinical sign of pressure on nerve roots in the lumbar region in SCIATICA. With the patient lying on his or her back there is limitation of thigh bending (flexion) on the affected side, on attempts to raise the straight leg. What is Bragard’s Test? If the Lasegue Test elicits pain when the patient’s leg is passively elevated, then Bragard’s Test is included as an extra maneuver. In this test, the physician passively lowers the patient’s leg about an inch from the position in which pain was elicited, and while holding the patient’s leg in that position, the physician passively dorsiflexes the patient’s foot. The test is positive if pain is reported to be recreated in the sciatic trajectory. What is abulia? Abulia refers to a lack of will, drive, or initiative. The word is derived from the Greek “αβουλία,” meaning “non-will.” It should be distinguished from an inability to actually perform the activity due to cognitive or physical disability. Abulia is manifested by the lack of motivation, spontaneity, and initiation. What is Broca’s Aphasia? Broca’s aphasia is the classic ‘expressive aphasia’, in distinction to the ‘receptive aphasia’ of Wernicke; however, there are problems with this simple classification, since Broca’s aphasics may show comprehension problems with complex material, particularly in relation to syntax. Considering each of the features suggested for the clinical classification of aphasias Broca’s aphasia is characterized by: • Fluency: slow, laboured, effortful speech (non-fluent) with phonemic paraphasias, agrammatism, and aprosody; the patient knows what s/he wants to say and usually recognizes the paraphasic errors (i.e. patients can ‘self-monitor’); • Comprehension: comprehension for simple material is preserved, but there may be problems with more complex syntax; • Repetition: impaired; • Naming: impaired (anomia, dysnomia); may be aided by phonemic or contextual cueing (cf. Wernicke’s aphasia); • Reading: alexia with laboured oral reading, especially of function words and verb inflections. Silent reading may also be impaired (deep dyslexia) as reflected by poor text comprehension; • Writing: similarly affected. What are the causes of broca’s aphasia? More commonly there is infarction in the perisylvian region affecting the insula and operculum (Brodmann areas 44 and 45), which may include underlying white matter and the basal ganglia (territory of the superior branch of the middle cerebral artery). What is Brown-Séquard Syndrome? The Brown-Séquard syndrome is the consequence of anatomical or, more usually, functional hemisection of the spinal cord (spinal hemisection syndrome), producing the following pattern of clinical findings: • Motor: Ipsilateral spastic weakness, due to corticospinal tract involvement; Segmental lower motor neurone signs at the level of the lesion, due to root and/or anterior horn cell involvement. • Sensory: A dissociated sensory loss, i.e.: Ipsilateral loss of proprioception, due to dorsal column involvement; Contralateral loss of pain and temperature sensation, due to crossed spinothalamic tract involvement. Spinal cord lesions producing this syndrome may be either extramedullary (e.g. prolapsed cervical intervertebral disc, extrinsic spinal cord tumour) or intramedullary (e.g. multiple sclerosis, intrinsic spinal cord tumour, myelitis, radiation-induced myelopathy); the former group is said to be the more common cause. What is Brudzinski’s (Neck) Sign? Brudzinski described a number of signs, but the one most often used in clinical practice is the neck sign, which is sometimes evident in cases of meningeal irritation, for example, due to meningitis. Passive flexion of the neck to bring the head onto the chest is accompanied by flexion of the thighs and legs. As with nuchal rigidity and Kernig’s sign, Brudzinski’s sign may be absent in elderly or immunosuppressed patients with meningeal irritation. What is Kernig’s sign? Kernig’s sign is present if, with the patient supine and the hip and knee flexed, extension of the knee causes pain in the back and neck. What is Brueghel’s Syndrome? Brueghel’s syndrome [NB some texts give ‘Breughel’s’ syndrome] is the name given to a dystonia of the motor trigeminal nerve causing gaping or involuntary opening of the mouth, so named after Brueghel’s painting De Gaper of 1558, thought to illustrate a typical case. Additional features may include paroxysmal hyperpnoea and up beating nystagmus. Brueghel’s syndrome should be distinguished from other syndromes of cranial dystonia featuring blepharospasm and oromandibular dystonia, better termed Meige’s syndrome. What is blepharospasm? It is involuntary tight closure of the eyelids. What is Dystonia? Dystonia is a movement disorder in which your muscles contract involuntarily, causing repetitive or twisting movements. The condition can affect one part of your body (focal dystonia), two or more adjacent parts (segmental dystonia) or all parts of your body (general dystonia). The muscle spasms can range from mild to severe. They may be painful, and they can interfere with your performance of day-to-day tasks. There’s no cure for dystonia. But medications can improve symptoms. What is Bruit? Bruits arise from turbulent blood flow causing arterial wall vibrations which are audible at the body surface with the unassisted ear or with a stethoscope (diaphragm rather than bell, better for detecting higher frequency sounds). They are associated with stenotic vessels or with fistulae where there is arteriovenous shunting of blood. Dependent on the clinical indication, various sites may be auscultated: eye for orbital bruit in carotico-cavernous fistula; head for bruit of AV fistula; but probably the most frequently auscultated region is the carotid bifurcation, high up under the angle of the jaw, in individuals thought to have had a transient ischaemic attack or ischaemic stroke. Examination for carotid bruits in asymptomatic individuals is probably best avoided, other than in the clinical trial setting, since the optimal management of asymptomatic carotid artery stenosis has yet to be fully defined. What is Brushfield Spots? Brushfield spots are small grey-white specks of depigmentation that can be seen in the irides of some (90%) patients with Down’s syndrome; they may also occur in normal individuals. What is Bruxism? Bruxism is forcible grinding or gnashing of the teeth. This is common in children and is said to occur in 5–20% of the population during non-REM sleep (a parasomnia). Masseter hypertrophy may become apparent in persistent grinders. Bruxism may also occur in encephalopathic disorders (e.g. hepatic encephalopathy) and occasionally in disorders of the basal ganglia (multiple system atrophy, basal ganglia infarcts). Dysfunction of efferent and/or afferent thalamic and striatopallidal tracts has been suggested as the neural substrate. If necessary, a rubber gum shield or bite may be worn in the mouth to protect the teeth. Botulinum toxin injections have also been tried. What is Masseter muscle hypertrophy? Masseter muscle hypertrophy occurs as a soft enlargement of the jaw muscles near the angle of the lower jaw and seldom presents a major health problem. However, in some individuals the swelling can be associated with pain or may be so large that it causes facial disfigurement. What is Chronic traumatic encephalopathy (CTE)? It is a neurodegenerative disease which causes severe and irreparable brain damage, as a result of repeated head injuries. Symptoms do not typically begin until years after the injuries and can include behavioural problems, mood problems, and problems with thinking. The disease often gets worse over time and can result in dementia. It is unclear if the risk of suicide is altered. What is Buccofacial apraxia (BFA, or oral apraxia)? is a nonspeech skilled movement disorder that involves orofacial structures in the absence of paresis. BFA usually co-occurs with aphasia or apraxia of speech (AOS) and isolated BFA is an extremely rare phenomenon. What is Buccolingual Syndrome? This is a form of tardive dyskinesia that involves involuntary movements of the facial muscles and protrusion of the tongue. What is Developmental verbal dyspraxia (DVD)? It is also known as childhood apraxia of speech (CAS) and developmental apraxia of speech (DAS), is a condition in which children have problems saying sounds, syllables and words. This is not because of muscle weakness or paralysis. The brain has problems planning to move the body parts (e.g., lips, jaw, tongue) needed for speech. The child knows what they want to say, but their brain has difficulty coordinating the muscle movements necessary to say those words What is bon- bon sign? The most common and typical tardive stereotypies are the repetitive oral facial and lingual movements that resemble chewing, lip smacking, tongue protrusion (” fly-catching”) or lateral tongue movements in the floor of the mouth (Bon-Bon sign). What is the difference between dystonia and dyskinesia? Dystonia is a sustained muscle contraction with twisting. Dyskinesia is an involuntary movement. In pd, in a patient who is having fluctuations from levodopa, a patient can develop dyskinesias or dystonia. What is Bulbar Palsy? Bulbar palsy is weakness of bulbar musculature of lower motor neurone origin. This may be differentiated clinically from bulbar weakness of upper motor neurone origin (pseudobulbar palsy). Clinical features of bulbar palsy include • Dysarthria of flaccid/nasal type; • Dysphonia; • Dysphagia, often with nasal regurgitation; • Weak (‘bovine’) cough; risk of aspiration; • +/− wasted, fasciculating tongue; • +/− absent jaw jerk; • +/− absent gag reflex. What are the causes of Bulbar Palsy? Bulbar palsy is usually neurogenic. Recognized causes include • Brainstem disorders affecting cranial nerve motor nuclei (intrinsic): Motor neurone disease (which may also cause a pseudobulbar palsy); Poliomyelitis; Glioma; Syringobulbia. • Cranial nerve lesions outside the brainstem (there may be associated sensory signs): Infiltration by carcinoma, granuloma. • Neuromuscular junction transmission defect: Myasthenia gravis. A myogenic bulbar palsy may be seen in oculopharyngeal muscular dystrophy, inclusion body myositis, and polymyositis. What is Bulbocavernosus Reflex? A test of the integrity of the S2, S3, and S4 spinal roots, looking for contraction of the anal sphincter (may be felt with a gloved finger in the rectum) when squeezing the glans penis or clitoris. The reflex may be abolished in lesions of the cauda equina. What is Cauda equina syndrome (CES)? Cauda equina syndrome (CES) is a condition that occurs when the bundle of nerves below the end of the spinal cord known as the cauda equina is damaged. Signs and symptoms include low back pain, pain that radiates down the leg, numbness around the anus, and loss of bowel or bladder control. What is Buphthalmos? Buphthalmos, literally ox-eye, consists of a large and bulging eye caused by raised intraocular pressure due to congenital or secondary glaucoma. This is one of the ophthalmological features of Sturge–Weber syndrome. What are the characteristics of Sturge Weber syndrome? Sturge-Weber syndrome has three major features: a red or pink birthmark called a port-wine birthmark, a brain abnormality called a leptomeningeal angioma, and increased pressure in the eye (glaucoma). These features can vary in severity and not all individuals with Sturge-Weber syndrome have all three features. What is butt first” maneuver? The patient first turns to gets on all fours, then straightens the knees to thrust the derriere into the air in what is known as the “butt first” maneuver, forming an arch with the buttocks at the apex. Then he places one hand on a knee, creating support with both feet and one hand, the “tripod sign.” What is the Gowers sign or Gee sign? Gowers’ sign is a medical sign that indicates weakness of the proximal muscles, namely those of the lower limb. The sign describes a patient that has to use their hands and arms to walk up their own body from a squatting position due to lack of hip and thigh muscle strength. It is named after William Richard Gowers, identified principally with Duchenne muscular dystrophy. What is Cacogeusia? Sensation of a disagreeable taste, often associated with parosmia. What is the definition of Cacosmia? Cacosmia is a disorder of the sense of smell. It’s a type of parosmia. It occurs when there’s a problem somewhere along the pathway of smell. When this happens, a person is unable to recognize smells or interpret the odours of different substances. Around in the United States are believed to have a disorder related to the sense of smell. What is Calf Head Sign? A consistent pattern of muscle enlargement or wasting, described as ‘calf heads on a trophy’, has been observed in Miyoshi-type dysferlinopathy when the arms are raised with shoulder abducted and elbows flexed to 90◦. Diamond on quadriceps sign may also be seen in dysferlinopathies. Parosmia is a dysfunction with smell detection that is characterized by the inability of the brain to properly identify an odour’s “natural” smell. What happens instead, is that the natural odour is transcribed into what is most often described as an unpleasant aroma, typically a “‘burned,’ ‘rotting,’ ‘fecal,’ or ‘chemical’ smell”. The term is from the Greek παρά pará and ὀσμή osmḗ. There are rare instances, however, of pleasant odours; this is more specifically called euosmia (Greek). What is Diamond on quadriceps sign Diamond on quadriceps sign indicates selectivity of dystrophic process not only among different muscles but also within a muscle as suggested earlier. The sign was absent in other muscular dystrophies, suggesting specificity for dysferlinopathy. It would add to the calf-head sign described earlier in Miyoshi myopathy. What is Calf Hypertrophy? Calf enlargement has many causes; it may reflect true hypertrophy (enlargement of muscle fibres) or, more commonly, pseudohypertrophy, due to infiltration with tissue elements other than muscle. Hypertrophy may be due to neuromuscular disorders producing • chronic partial denervation, e.g.: radiculopathy; peripheral neuropathy; spinal muscular atrophy; following paralytic poliomyelitis. • continuous muscle activity, e.g.: myotonia congenital; Isaac’s syndrome (neuromyotonia); generalized myokymia. Calf (and other muscle) hypertrophy is also a feature of limb girdle muscular dystrophy type 2I. Calf pseudohypertrophy may be due to: • Dystrophinopathies (Duchenne muscular dystrophy, Becker dystrophy), due to excess connective tissue; • Infection/inflammation: myositis; • Infiltration: amyloidosis, tumour, cysticercosis. What is Myokymia? Myokymia may be defined as a condition which is characterized by an involuntary and spontaneous movement of the muscles caused due to its contraction. It also involves the quivering of the muscles involved without being able to cause the movement of the joints. Feb 9 2019 What is Myotonia? It is a symptom of a small handful of certain neuromuscular disorders characterized by delayed relaxation (prolonged contraction) of the skeletal muscles after voluntary contraction or electrical stimulation. Myotonia is the defining symptom of many chanelopathies such as myotonia congenita, paramyotonia congenita and myotonic dystrophy. What is neuromyotonia syndrome? Neuromyotonia (NMT), or Isaacs’ syndrome, is a syndrome of muscle hyperactivity with muscle stiffness and cramps most prominent in the limbs and trunk. Increased sweating is also very frequent. What is Muscle Hypertrophy? Muscle hypertrophy involves an increase in size of skeletal muscle through a growth in size of its component cells. Two factors contribute to hypertrophy: sarcoplasmic hypertrophy, which focuses more on increased muscle glycogen storage; and myofibrillar hypertrophy, which focuses more on increased myofibril size. What is Eyelid twitching? Alcohol intake Bright light Caffeine excess Fatigue Irritation of the eye surface or inner eyelids Smoking Stress Wind or air pollution Benign essential blepharospasm is a movement disorder (dystonia) of the muscles around the eye. No one knows exactly what causes it, but researchers believe it may be caused by a malfunction of certain cells in the nervous system called basal ganglia. Hemifacial spasm is typically caused by a small artery that irritates a facial nerve. Other conditions that sometimes include eyelid twitching as a sign include: Blepharitis Corneal abrasion Dry eyes Light sensitivity Uveitis Very rarely, eye twitching may be a sign of certain brain and nervous system disorders. When it is, it’s almost always accompanied by other signs and symptoms. Brain and nervous system disorders that can cause eye twitching include: Bell’s palsy Cervical dystonia Dystonia Multiple sclerosis Oromandibular dystonia and facial dystonia Parkinson’s disease Tourette syndrome Eye twitching may be a side effect of drugs, particularly medication used for Parkinson’s disease. And eye twitching is sometimes the earliest sign of a chronic movement disorder, especially if other facial spasms develop too. What is Caloric Testing? Caloric tests examine the vestibulo-ocular reflexes (VOR). They are mainly used in two circumstances: to identify vestibular pathology in the assessment of dizziness/vertigo when clinical tests of VOR are unhelpful and to assess brainstem integrity in coma. Each labyrinth may be separately assessed by irrigating each outer ear. Head flexion to 30◦ above the horizontal allows maximum stimulation of the horizontal semicircular canals, whereas 60◦ below horizontal maximally stimulates the lateral semicircular canals. Water 7◦C above and below body temperature (i.e. 30◦C and 44◦C) is used, applied for 30–40 s. Induced nystagmus is then timed both with and without visual fixation (in the dark, Frenzel glasses). This method is cheap but has poor patient acceptability. Normally, the eyes show conjugate deviation towards the ear irrigated with cold water, with corrective nystagmus in the opposite direction; with warm water the opposite pattern is seen. (The direction of nystagmus may thus be recalled by the mnemonic COWS: cold opposite, warm same.) Dysconjugate responses suggest brainstem damage or depression. A reduced duration of induced nystagmus is seen with canal paresis; enhancement of the nystagmus with removal of visual fixation suggests this is peripheral in origin (labyrinthine, vestibulocochlear nerve), whereas no enhancement suggests a central lesion. In coma the deviation may be present but without corrective saccades, even at a time when the oculocephalic responses elicited by the doll’s head manoeuvre are lost. As coma deepens even the caloric reflexes are lost as brainstem involvement progresses. How does someone become comatose? A person can become comatose immediately or gradually. If an infection or other illness causes the coma, for example, the person might run a high fever, feel dizzy or seem lethargic before falling into a coma. If the cause is a stroke or severe head trauma, they can become comatose almost immediately. What are causes of coma? The following medical conditions are some of the possible causes of Coma. Head injury Stroke Brain damage Heart attack Shock Persistent vegetative state Metabolic diseases Diabetic coma Diabetic ketoacidosis Kidney disease Liver disease Epilepsy Brain infection Meningitis Encephalitis Hypothermia Drug overdose Alcohol overdose Drug intoxication Alcohol intoxication Metabolic disturbance Infection Vascular disturbance Hypoxic injury Ischemic injury Bleeding in or around the brain Brain tumour Brain cancer Brain abscess Brain cyst What are the causes and triggers of vertigo? Vertigo is commonly caused by a problem with the way balance works in the inner ear, although it can also be caused by problems in certain parts of the brain. Causes of vertigo may include: benign paroxysmal positional vertigo (BPPV) – where certain head movements trigger vertigo. migraines – severe headaches. BPPV. These initials stand for benign paroxysmal positional vertigo. BPPV occurs when tiny calcium particles (canaliths) clump up in canals of the inner ear. The inner ear sends signals to the brain about head and body movements relative to gravity. It helps you keep your balance. Meniere’s disease. This is an inner ear disorder thought to be caused by a build-up of fluid and changing pressure in the ear. It can cause episodes of vertigo along with ringing in the ears (tinnitus) and hearing loss. Vestibular neuritis or labyrinthitis. This is an inner ear problem usually related to infection (usually viral). The infection causes inflammation in the inner ear around nerves that are important for helping the body sense balance. Less often vertigo may be associated with: Head or neck injury Brain problems such as stroke or tumour Certain medications that cause ear damage Migraine headaches What is Oculocephalic reflex? The patient’s eyes are held open, the head is briskly turned from side to side with the head held briefly at the end of each turn, a positive response occurs when the eyes rotate to the opposite side to the direction of head rotation, thus indicating that the brainstem (CN3,6,8) is intact. a similar result is seen when the head is flexed and extended — a positive result is downward deviation of the eyes during extension, and upward deviation during flexion (the eyelids, if closed, may also open as part of the ‘doll’s head phenomenon’). These vertical responses indicate that the brainstem (CN3,4,8) is intact. The eyes should gradually return to the mid-position in a smooth, conjugate movement if the brainstem is intact. Patients with metabolic coma (e.g. hepatic failure) may have exaggerated, brisk oculocephalic reflexes. What is Oculovestibular reflex (caloric stimulation)? The head is elevated to 30 degrees above horizontal so that the lateral semicircular canal is vertical, and so that stimulation with generate a maximal response. check that the tympanum is intact and that the external ear canal is clear — C-spine clearance is not necessary. introduce iced water into the external ear canal through a small catheter until one of the following occurs: nystagmus (in the intact brainstem the slow phase is towards the irrigated ear) ocular deviation 200mL of iced water has been instilled. allow 5 minutes between testing ears to allow re-equilibration of the oculovestibular system. as consciousness is lost, the fast component (towards the non-irrigated ear) is lost and the slow component deviates the eye in the direction of the irrigated ear. Vertical oculovestibular eye responses can be assessed by irrigating both ears simultaneously. If the brainstem is intact, cold water causes the eyes to deviate downwards and warm water causes the eyes to deviate upwards. The positive brainstem responses described above are those seen in a comatose patient with an intact brainstem. What is bilateral nystagmus? Nystagmus is an involuntary to-and-fro oscillation of the eyes. Nystagmus may be congenital or acquired, and the movements may affect both eyes (bilateral) or just one eye (unilateral). Bilateral nystagmus may be conjugate, which means that both eyes have identical movements, or dissociated, which implies separate movements. What is a jerk nystagmus? Jerk nystagmus can occur normally, such as when one is dizzy (e.g., from spinning around in circles) or is watching objects pass by quickly from the window of a moving vehicle. What are the symptoms of horizontal nystagmus? The symptoms include fast, uncontrollable eye movements. The direction of movement determines the type of nystagmus: Horizontal nystagmus involves side-to-side eye movements. Vertical nystagmus involves up-and-down eye movements. Rotary, or torsional, nystagmus involves circular movements. What is Camptocormia? Camptocormia, or ‘bent spine syndrome’, was first described as a psychiatric phenomenon in men facing armed conflict (a ‘war neurosis’). It has subsequently been realized that reducible lumbar kyphosis may also result from neurological disorders, including muscle disease (paravertebral myopathy, nemaline myopathy), Parkinson’s disease, dystonia, motor neurone disease, and, possibly, as a paraneoplastic phenomenon. Cases with associated lenticular (putaminal) lesions have also been described. Camptocormia may be related in some instances to dropped head syndrome. What is Camptodactyly? Camptodactyly, literally ‘bent finger’, is a flexion deformity at the proximal interphalangeal joint, especially affecting the little fingers; this may be unilateral or bilateral. A distinction is sometimes drawn between camptodactyly and streblodactyly: in the latter, several fingers are affected by flexion contractures (streblo twisted, crooked), but it is not clear whether the two conditions overlap or are separate. The term streblomicrodactyly has sometimes been used to designate isolated crooked little fingers. Camptodactyly is not accompanied by any sensory or motor signs. The condition may be familial and is more common in women. Camptodactyly may occur as part of a developmental disorder with other dysmorphic features or in isolation. It is important to differentiate camptodactyly, a non-neurogenic cause of clawing, from neurological diagnoses such as: • Ulnar neuropathy; • C8/T1 radiculopathy; • Cervical rib; • Syringomyelia. Awareness of the condition is important to avoid unnecessary neurological investigation. What is Capgras Syndrome? This is one of the classical delusional syndromes of psychiatry, in which patients recognize a close family relative, or other loved object, but believe them to be have been replaced by an exact alien or ‘double’ (illusion of doubles). Initially described in patients with psychiatric disorders, it may also occur in traumatic, metabolic, and neurodegenerative disorders (e.g. Alzheimer’s disease, dementia with Lewy bodies). Neurologists have encompassed this phenomenon under the term reduplicative paramnesia. Some believe this syndrome to be the ‘mirror image’ of prosopagnosia, in which faces are not recognized but emotional significance is. Capgras syndrome may be envisaged as a Geschwindian disconnection syndrome, in which the visual recognition system is disconnected from the limbic system, hence faces can be recognized but no emotional significance ascribed to them. What is a claw hand? Claw hand is a condition that causes curved or bent fingers. This makes the hand appear like the claw of an animal. Someone can be born with claw hand (congenital), or they can develop it because of certain disorders, such as nerve injury. What are the symptoms of Cotard’s syndrome? The list of signs and symptoms mentioned in various sources for Cotard syndrome includes the symptoms listed as -Depression. Suicidal thoughts. Negative thoughts. Belief that their body doesn’t exist. Belief they are already dead. Belief they are immortal. What is disconnect syndrome? Disconnection syndrome is a general term for a number of neurological symptoms caused by damage to the white matter axons of communication pathways—via lesions to association fibers or commissural fibers—in the cerebrum, independent of any lesions to the cortex. Callosal syndrome, or split-brain, is an example of a disconnection syndrome from damage to the corpus callosum between the two hemispheres of the brain. Disconnection syndrome can also lead to aphasia, left-sided apraxia, and tactile aphasia, among other symptoms. What is prosopagnosia? Prosopagnosia, or face blindness, is the inability to recognize or remember faces, including one’s own. Prosopagnosia may result from brain damage (acquired prosopagnosia), but the congenital or developmental form is more common. What is d’accoucheur sing? The sign is also known as main d’accoucheur (French for ” hand of the obstetrician “) because it supposedly resembles the position of an obstetrician’s hand in delivering a baby. The sign is named after French physician Armand Trousseau who described the phenomenon in 1861. It is distinct from the Trousseau sign of malignancy. What is Carphologia? Carphologia, or floccillation, is an aimless plucking at clothing, as if picking off pieces of thread. This may sometimes be seen in psychiatric illness, delirium, Alzheimer’s disease, or vascular dementia particularly affecting the frontal lobe. Some have characterized carphologia as a form of akathisia. What is Reduplicative paramnesia? Reduplicative paramnesia is the delusional belief that a place or location has been duplicated, existing in two or more places simultaneously, or that it has been ‘relocated’ to another site. What are carpopedal spasms? Carpopedal spasms are severely painful cramps of the muscles in your hands and feet. Carpopedal spasms may be caused by low blood calcium levels or by an infection called tetanus. Tetanus develops when a cut or deep puncture wound gets infected by bacteria. What is Catalepsy? This term has been used to describe increased muscle tone, leading to the assumption of fixed postures which may be held for long periods of time without apparent fatigue; it may be possible for the examiner to position an extremity into any posture, in which it then remains for some time. Clearly, this term is cognate with or overlaps with waxy flexibility which is a feature of catatonic syndromes. Catalepsy may be feigned (see Dr Arthur Conan Doyle’s story of The Resident Patient in The Memoirs of Sherlock Holmes, first published in 1894). Catalepsy should not be confused with the term cataplexy, a syndrome in which muscle tone is transiently lost. What is the Trousseau sign? The Trousseau sign of malignancy or Trousseau’s syndrome is a medical sign involving episodes of vessel inflammation due to blood clot (thrombophlebitis) which are recurrent or appearing in different locations over time (thrombophlebitis migrans or migratory thrombophlebitis). What is Cataplexy? Cataplexy is a sudden loss of limb tone which may lead to falls (drop attacks) without loss of consciousness, usually lasting less than 1 min. Attacks may be precipitated by strong emotion (laughter, anger, embarrassment, surprise). Sagging of the jaw and face may occur, as may twitching around the face or eyelids. During an attack there is electrical silence in antigravity muscles, which are consequently hypotonic, and transient areflexia. Rarely status cataplecticus may develop, particularly after withdrawal of tricyclic antidepressant medication. Cataplexy may occur as part of the narcoleptic syndrome of excessive and inappropriate daytime somnolence, hypnagogic hallucinations, and sleep paralysis (Gélineau’s original description of narcolepsy in 1877 included an account of ‘astasia’ which corresponds to cataplexy). Symptomatic cataplexy occurs in certain neurological diseases including brainstem lesions, von Economo’s disease (postencephalitic parkinsonism), Niemann–Pick disease type C, and Norrie’s disease. Therapeutic options for cataplexy include tricyclic antidepressants such as protriptyline, imipramine, and clomipramine; serotonin-reuptake inhibitors such as fluoxetine; and noradrenaline and serotonin-reuptake inhibitors such as venlafaxine. What is hypotonia? A condition in which there is a diminution or loss of muscular tonicity, in consequence of which the muscles may be stretched beyond their normal limits. What does hypersomnolence mean? Medically, hypersomnolence is expressed as a condition that involves feeling of excessive daytime sleepiness or EDS. This is also called by many as excessive daytime somnolence. What is Catathrenia? Catathrenia is expiratory groaning during sleep, especially its later stages. Although sufferers are unaware of the condition, it does alarm relatives and bed partners. There are no associated neurological abnormalities and no identified neurological or otorhinolaryngological cause. Catathrenia is categorized with the parasomnias in the International Classification of Sleep Disorders (ICSD2, 2005). What does areflexia mean? Areflexia is defined as acontractility due to an abnormality of neural control, implying the complete absence of centrally coordinated contraction. Can areflexia be transient? Therefore, damage to lower motor neurons will subsequently result in hyporeflexia and/or areflexia. Note that, in spinal shock, which is commonly seen in the transection of the spinal cord (Spinal cord injury), areflexia can transiently occur below the level of the lesion and can, after some time, become hyperreflexia. What is Catatonia? Catatonia is a clinical syndrome, first described by Kahlbaum (1874), characterized by a state of unresponsiveness but with maintained, immobile, body posture (sitting, standing; cf. stupor), mutism, and refusal to eat or drink, with or without staring, grimacing, limb rigidity, maintained abnormal postures (waxy flexibility or flexibilitas cerea), negativism, echophenomena (imitation behaviour), stereotypy, and urinary incontinence or retention. After recovery patients are often able to recall events which occurred during the catatonic state (cf. stupor). ‘Lethal catatonia’, in which accompanying fever and collapse lead to death, was described in the 1930s and seems to resemble neuroleptic malignant syndrome; the name ‘malignant catatonia’ has been proposed for this syndrome. Catatonia may be confused clinically with abulia. What are the causes of Catatonia? Kraepelin classified catatonia as a subtype of schizophrenia but most catatonic patients in fact suffer a mood or affective disorder. Furthermore, although initially thought to be exclusively a feature of psychiatric disease, catatonia is now recognized as a feature of structural or metabolic brain disease (the original account contains descriptions suggestive of extrapyramidal disease): • Psychiatric disorders: Manic-depressive illness; Schizophrenia. • Neurological disorders: Cerebrovascular disease (posterior circulation); Tumours (especially around third ventricle, corpus callosum); Head trauma; Encephalitis; Neurosyphilis; Extrapyramidal disorders; Epilepsy. • Systemic illnesses: Endocrine: hyperthyroidism, Addison’s disease, Cushing’s disease, diabetic ketoacidosis; Metabolic: uraemia, hypercalcaemia, hepatic encephalopathy; Others: systemic lupus erythematosus. Various subtypes of catatonia are enumerated by some authorities, including • Retarded catatonia (Kahlbaum’s syndrome); • Excited catatonia (manic delirium, Bell’s mania); • Malignant catatonia, lethal catatonia: also encompasses the neuroleptic malignant syndrome and the serotonin syndrome; • Periodic catatonia. What is Cauda Equina Syndrome? A cauda equina syndrome results from pathological processes affecting the spinal roots below the termination of the spinal cord around L1/L2, hence it is a syndrome of multiple radiculopathies. Depending on precisely which roots are affected, this may produce symmetrical or asymmetrical sensory impairment in the buttocks (saddle anaesthesia; sacral anaesthesia) and the backs of the thighs, radicular pain, and lower motor neurone type weakness of the foot and/or toes (even a flail foot). Weakness of hip flexion (L1) does not occur, and this may be useful in differentiating a cauda equina syndrome from a conus lesion which may otherwise produce similar features. Sphincters may also be involved, resulting in incontinence, or, in the case of large central disc herniation at L4/L5 or L5/S1, acute urinary retention. What are the Causes of a cauda equina syndrome? Causes of a cauda equina syndrome include • Central disc herniation; • Tumour: primary (ependymoma, meningioma, Schwannoma), metastasis; • Haematoma; • Abscess; • Lumbosacral fracture; • Inflammatory disease, e.g. sarcoidosis (rare); • Ankylosing spondylitis (rare). The syndrome needs to be considered in any patient with acute (or acute-on chronic) low back pain, radiation of pain to the legs, altered perineal sensation, and altered bladder function. Missed diagnosis of acute lumbar disc herniation may be costly, from the point of view of both clinical outcome and resultant litigation. What is Bulbocavernosus Reflex? Bulbocaverosus reflex (BCR) is a polysynaptic reflex which is used to test for the presence of spinal shock and is basically used to identify and record the presence of a spinal cord injury or neurogenic impotence (erectile dysfunction due to a neurological disease). This reflex response is also referred as Osinski reflex which involves the bulbocavernosus muscle (also known as bulbospongiosus muscle). This also refers to the contraction of the anal sphincter in response to stimulation. The trigone is a part of the stimulation which is the anatomical triangular region formed by the ureteral and urethral orifices of the urinary bladder. This is said to be performed in order to assess a person’s spinal cord integrity which basically reflects the functioning of our sacral sensory and motor fibers. Specifically, this will test the integrity of the sacral spinal roots; S2, S3 and S4. What is Foot drop? Foot drop is a gait abnormality in which the dropping of the forefoot happens due to weakness, irritation or damage to the common fibular nerve including the sciatic nerve, or paralysis of the muscles in the anterior portion of the lower leg. It is usually a symptom of a greater problem, not a disease in itself. What is Urinary incontinence? It is the loss of bladder control — is a common and often embarrassing problem. The severity ranges from occasionally leaking urine when you cough or sneeze to having an urge to urinate that’s so sudden and strong you don’t get to a toilet in time. What are the reasons for urine retention? Obstruction of the Urethra. Obstruction of the urethra causes urinary retention by blocking… Nerve Problems. Urinary retention can result from problems with the nerves… Medications. Various classes of medications can cause urinary retention by interfering… Weakened Bladder Muscles. Aging is a common cause of weakened bladder muscles. What is radiculopathy? In a radiculopathy, the problem occurs at or near the root of the nerve, shortly after its exit from the spinal cord. However, the pain or other symptoms often radiate to the part of the body served by that nerve. For example, a nerve root impingement in the neck can produce pain and weakness in the forearm. What is Central Scotoma, Centrocaecal Scotoma? These visual field defects are typical of retinal or optic nerve pathology. They may be mapped by confrontation testing or automatically. • Central scotoma: Field defect occupying the macula, due to involvement of the macula or the papillomacular bundle; this is the typical (but not exclusive) finding in optic neuritis, but may also be seen with disease of the macula, optic nerve compression, and Leber’s hereditary optic neuropathy. Examination for a concurrent contralateral superior temporal defect should be undertaken: such junctional scotomas may be seen with lesions at the anterior angle of the chiasm. • Centrocaecal or caecocentral scotoma: Field defect involving both the macula and the blind spot; seen in optic nerve disease, such as Leber’s hereditary optic neuropathy, toxic neuropathy, or nutritional optic neuropathy (said to be typical of vitamin B12 deficiency optic neuropathy), sometimes in optic neuritis. What are Cerebellar Syndromes? Differing clinical pictures may be seen with pathology in different parts of the cerebellum. Broadly speaking, a midline cerebellar syndrome (involving the vermis) may be distinguished from a hemispheric cerebellar syndrome (involving the hemispheres). Their clinical characteristics are as follows: • Midline cerebellar syndrome: Gait ataxia but with little or no limb ataxia, hypotonia, or nystagmus (because the vestibulocerebellum is spared), or dysarthria; causes include alcoholic cerebellar degeneration, tumour of the midline (e.g. medulloblastoma), paraneoplastic cerebellar degeneration. • Hemispheric cerebellar syndrome: Limb ataxia (e.g. ataxia on finger–nose and/or heel–shin testing), dysdiadochokinesia, dysmetria, dysarthria, nystagmus; usual causes are infarcts, haemorrhages, demyelination, and tumours. • Pancerebellar syndrome: Affecting all parts of the cerebellum and showing a combination of the above signs (e.g. cerebellar degenerations). What is Chaddock’s Sign? Chaddock’s sign, or the external malleolar sign, is a variant method for eliciting the plantar response, by application of a stimulus in a circular direction around the external malleolus, or the lateral aspect of the foot, moving from heel to little toe. Extension of the hallux (upgoing plantar response, Babinski’s sign) is pathological, indicating corticospinal tract (upper motor neurone) pathology. The development of Babinski’s sign always predates that of Chaddock’s sign. What is Cauda Equina Syndrome? A cauda equina syndrome results from pathological processes affecting the spinal roots below the termination of the spinal cord around L1/L2, hence it is a syndrome of multiple radiculopathies. Depending on precisely which roots are affected, this may produce symmetrical or asymmetrical sensory impairment in the buttocks (saddle anaesthesia; sacral anaesthesia) and the backs of the thighs, radicular pain, and lower motor neurone type weakness of the foot and/or toes (even a flail foot). Weakness of hip flexion (L1) does not occur, and this may be useful in differentiating a cauda equina syndrome from a conus lesion which may otherwise produce similar features. Sphincters may also be involved, resulting in incontinence, or, in the case of large central disc herniation at L4/L5 or L5/S1, acute urinary retention. What are the causes of Cauda Equina Syndrome? Causes of a cauda equina syndrome include • Central disc herniation; • Tumour: primary (ependymoma, meningioma, Schwannoma), metastasis; • Haematoma; • Abscess; • Lumbosacral fracture; • Inflammatory disease, e.g. sarcoidosis (rare); • Ankylosing spondylitis (rare). The syndrome needs to be considered in any patient with acute (or acute-on chronic) low back pain, radiation of pain to the legs, altered perineal sensation, and altered bladder function. Missed diagnosis of acute lumbar disc herniation may be costly, from the point of view of both clinical outcome and resultant litigation. What is Central Scotoma, Centrocaecal Scotoma? These visual field defects are typical of retinal or optic nerve pathology. They may be mapped by confrontation testing or automatically. • Central scotoma: Field defect occupying the macula, due to involvement of the macula or the papillomacular bundle; this is the typical (but not exclusive) finding in optic neuritis, but may also be seen with disease of the macula, optic nerve compression, and Leber’s hereditary optic neuropathy. Examination for a concurrent contralateral superior temporal defect should be undertaken: such junctional scotomas may be seen with lesions at the anterior angle of the chiasm. • Centrocaecal or caecocentral scotoma: Field defect involving both the macula and the blind spot; seen in optic nerve disease, such as Leber’s hereditary optic neuropathy, toxic neuropathy, or nutritional optic neuropathy (said to be typical of vitamin B12 deficiency optic neuropathy), sometimes in optic neuritis. What is Chaddock’s Sign? Chaddock’s sign, or the external malleolar sign, is a variant method for eliciting the plantar response, by application of a stimulus in a circular direction around the external malleolus, or the lateral aspect of the foot, moving from heel to little toe. Extension of the hallux (upgoing plantar response, Babinski’s sign) is pathological, indicating corticospinal tract (upper motor neurone) pathology. The development of Babinski’s sign always predates that of Chaddock’s sign. What is Charcot Joint? Charcot joint, or neuropathic joint, describes a destructive arthropathy seen following repeated injury to an anaesthetic joint in patients with impaired or absent pain sensation. There is trophic change, with progressive destruction of articular surfaces with disintegration and reorganization of joint structure. Although the destruction is painless, the Charcot joint itself may be painful. There may be concurrent skin ulceration. Charcot joints were originally described in the context of tabes dorsalis (knees, shoulders, elbows, hips, ankles) but they may also be seen in: • Syringomyelia (elbow); • Hereditary sensory (and autonomic) neuropathies (HSAN, ‘congenital insensitivity to pain’; ankles); • Leprosy; • Diabetes mellitus. What is Charles Bonnet Syndrome? Described by the Swiss naturalist and philosopher Charles Bonnet in 1760, this syndrome consists of well-formed (complex), elaborated, and often stereotyped visual hallucinations, of variable frequency and duration, in a partially sighted (usually elderly) individual who has insight into their unreality. Hallucinations may disappear on eye closure. Predisposing visual disorders include cataract, macular degeneration, and glaucoma. There are no other features of psychosis or neurological disease such as dementia. The pathogenesis of the visual hallucinations is uncertain. Reduced stimulation of the visual system leading to increased cortical hyperexcitability is one possible explanation (the deafferentation hypothesis), although the syndrome may occasionally occur in people with normal vision. Functional magnetic resonance imaging suggests ongoing cerebral activity in ventral extrastriate visual cortex. Treatment consists primarily of reassurance. Pharmacological treatment with atypical antipsychotics or anticonvulsants may be tried but there is no secure evidence base. What is the Pseudoradicular Syndrome? Lower Extremity Peripheral Nerve Entrapment Masquerading as Lumbar Radiculopathy Spine What is Cheiro-oral-pedal syndrome? Cheiro-oral-pedal syndrome is characterized by specific sensory disturbance around the corner of the mouth, in the hand and in the foot on the same side. Lesions responsible for causing this syndrome vary. We report two cases of cheiro-oral-pedal syndrome due to midbrain and pontine hemorrhage, respectively. What are the different types of hallucinations in schizophrenia? Auditory hallucinations. Visual Hallucinations. Tactile Hallucinations. Olfactory Hallucinations. What are pseudo hallucinations? The cause of pseudo-auditory hallucinations can be attributed to conditions in the ears such as tinnitus. It may also be attributed to hearing What is Cherry Red Spot at the Macula? The appearance of a ‘cherry red spot at the macula’, caused by the contrast of a red macula against retinal pallor, occurs in a number of metabolic storage disorders, including • Sialidosis (type I = cherry red spot–myoclonus syndrome); • Gangliosidoses (e.g. Tay–Sachs disease: Tay’s sign); • Metachromatic leucodystrophy; • Niemann–Pick disease (especially type A). Storage of sphingolipids or other substances in ganglion cells in the perimacular region gives rise to the appearance. What is maculopathy? A maculopathy is any pathological condition of the macula, an area at the centre of the retina that is associated with highly sensitive, accurate vision. What is toxic maculopathy? Toxic maculopathy is epitomized by chloroquine and hydroxychloroquine retinopathy. The most characteristic field defect caused by macular involvement is a ring-like central scotoma with a small island of slightly less visual loss in its center, commonly referred to as a “bull’s eye” What is Cheyne-Stokes breathing (CSB)? Cheyne-Stokes breathing (CSB) is an abnormal pattern of breathing characterized by oscillations of tidal volume between apnea or hypopnea at the nadir of ventilation and hyperpnea at the height of ventilation, with a spindle-like crescendo-decrescendo pattern in the depth of breathing. What causes Cheyne Stokes respirations? Cheyne Stokes is usually related to heart failure or stroke. It may also be caused by: brain tumors. traumatic brain injuries. high altitude sickness. encephalitis. increased intercranial pressure. What is periodic respiration? Periodic breathing is clusters of breaths separated by intervals of apnea or near-apnea. As opposed to normal breathing which is usually regular. Periodic breathing is defined as three or more episodes of central apnea lasting at least 4 seconds, separated by no more than 30 seconds of normal breathing. What is Chicken Wings dystrophy? In facioscapulohumeral (FSH) muscular dystrophy, the bulk of the deltoid and forearm muscles is normally well preserved, whilst biceps and triceps are wasted (and may be weak), thus giving rise to an appearance of the upper limbs sometimes labelled as ‘chicken wings’ or ‘Popeye arms’. What is Winging of scapula? Scapular winging, sometimes called a winged scapula, is a condition that affects the shoulder blades. Scapula is the anatomical term for the shoulder blade. The shoulder blades usually rest flat against the back of the chest wall. Scapular winging occurs when a shoulder blade sticks out. What is Chorea, Choreoathetosis? Chorea is an involuntary movement disorder characterized by jerky, restless, purposeless movements (literally dance-like) which tend to flit from one part of the body to another in a rather unpredictable way, giving rise to a fidgety appearance. There may also be athetoid movements (slow, sinuous, writhing), jointly referred to as choreoathetosis. Severe proximal choreiform movements of large amplitude (‘flinging’) are referred to as ballism or ballismus. When, as is often the case, such movements are confined to one side of the body they are referred to as hemichorea–hemiballismus. There may be concurrent abnormal muscle tone, either hypotonia or rigidity. Hyperpronation of the upper extremity may be seen when attempting to maintain an extended posture. What is pathophysiology of Chorea, Choreoathetosis? The pathophysiology of chorea (as for ballismus) is unknown; movements may be associated with lesions of the contralateral subthalamic nucleus, caudate nucleus, putamen, and thalamus What are the causes of chorea? Recognized causes of chorea and choreoathetosis are many, including • Inherited disorders: Autosomal dominant: Huntington’s disease; Spinocerebellar ataxias: including SCA, Machado–Joseph disease, DRPLA; Benign hereditary chorea (BHC). Autosomal recessive: Aminoacidopathies; Ataxia telangiectasia (AT); Basal ganglia calcification; Lesch–Nyhan syndrome; Lysosomal disorders; Neuroacanthocytosis; Neurodegeneration with brain iron accumulation (Hallervorden– Spatz disease); Porphyria; Tuberous sclerosis; Urea cycle disorders; Wilson’s disease. Others: Paroxysmal dyskinesias: paroxysmal kinesigenic choreoathetosis (PKC) and paroxysmal dystonic choreoathetosis (PDC); Leigh’s syndrome; Mitochondrial disease. • Drug-induced: Neuroleptics; Propofol; Antiepileptic drugs; Antiparkinsonian medication: levodopa therapy in later stages of idiopathic Parkinson’s disease; Oral contraceptives; Amphetamines and tricyclic antidepressants (rare). • Toxic/metabolic: Alcohol; Anoxia; Carbon monoxide poisoning; Cocaine; Heavy metal poisoning; Hyperthyroidism; Hypoparathyroidism; Pregnancy: chorea gravidarum. Hypernatraemia or hyponatraemia, hypomagnesaemia, hypocalcaemia; hyperosmolality; Hyperglycaemia or hypoglycaemia; Non-Wilsonian acquired hepatocerebral degeneration; Nutritional. • Infection: Sydenham’s chorea (postinfectious, rheumatic chorea, St Vitus dance, PANDAS); Brainstem encephalitis, encephalitis lethargica; Prion disease: Creutzfeldt–Jakob disease, variant CJD. • Immunological: Systemic lupus erythematosus; Henoch–Schonlein purpura; Neurosarcoidosis; Multiple sclerosis; Behçet’s disease (rare); Vasculitis; Hashimoto’s encephalopathy. • Vascular: Infarction (including Binswanger’s encephalopathy); Haemorrhage; Arteriovenous malformation; Polycythaemia rubra vera (hyperviscosity); Migraine; Cerebral palsy. • Tumours: Primary and secondary (rare). • Others: Trauma; Physiological chorea of infancy; ‘Senile chorea’; Postpump (cardiac bypass) chorea; Psychogenic. What are the treatment of chorea? Where treatment is necessary, antidopaminergic agents such as dopaminereceptor antagonists (e.g. neuroleptics, sulpiride, risperidone) and dopaminedepleting agents (e.g. tetrabenazine, reserpine) may help, although they may cause parkinsonism, akathisia, neuroleptic malignant syndrome, and sedation. Chronic neuroleptic use may also cause chorea, but these movements are repetitive and predictable, unlike ‘classic’ chorea. What is a milkmaid grip? Milkmaid’s Grip. Milk maids grip is appreciated as an alternating squeezing and releasing of the finger like a milking motion, when asked to maintain a constant, firm grip of examiner’s fingers. As a result of poor grip, patients often involuntarily drop objects. What is Chromesthesia or sound-to-colour synesthesia? Chromesthesia or sound-to-colour synesthesia is a type of synesthesia in which heard sounds automatically and involuntarily evoke an experience of colour. For the purpose of disambiguation, this article will refer to this chromesthesia in inducer-concurrent terms used to describe other forms of synesthesia. What is hemiballism? Hemiballismus or hemiballism in its unilateral form is a very rare movement disorder. It is a type of chorea caused in most cases by a decrease in activity of the subthalamic nucleus of the basal ganglia, resulting in the appearance of flailing, ballistic, undesired movements of the limbs. It can also appear rarely due to certain metabolic abnormalities. What is Chronognosia? This name has been sometimes given to a primary disturbance of the sense of time. Luria claimed it was associated with deep-seated temporal and temporodiencephalic lesions, possibly right-sided lesions in particular. It occurs in some patients with Alzheimer’s disease who get up and dress, make tea, or phone relatives in the small hours, oblivious to the actual time, much to the exasperation of their loved ones. Whether this is a true agnosia remains open to investigation. What causes muscle spasms? Spasms may occur when a muscle is overused, tired, previously injured, or strained. The spasm may occur if the muscle has been overstretched or if it has been held in the same position for a prolonged period of time. In effect, the muscle cell runs out of energy and fluid and becomes hyperexcitable. What is Chvostek’s Sign? Chvostek’s sign is contraction of facial muscles provoked by lightly tapping over the facial nerve as it crosses the zygomatic arch. Chvostek’s sign is observed in hypocalcaemic states, such as hypoparathyroidism and the respiratory alkalosis associated with hyperventilation. There may be concurrent posturing of the hand, known as main d’accoucheur for its resemblance to the posture adopted for manual delivery of a baby. The pathophysiology of this mechanosensitivity of nerve fibres is uncertain, but is probably related to increased discharges in central pathways. Although hypocalcaemia might be expected to impair neuromuscular junction transmission and excitation–contraction coupling (since Ca2+ ions are required for these processes) this does not in fact occur. What is Ciliospinal Response? The ciliospinal response consists of rapid bilateral pupillary dilatation and palpebral elevation in response to a painful stimulus in the mantle area, for example, pinching the skin of the neck. What is Cinematic Vision? Cinematic vision is a form of metamorphopsia, characterized by distortion of movement with action appearing as a series of still frames as if from a movie. Causes include migraine aura, partial seizures, and schizophrenic psychosis. What is Circumlocution? Circumlocution may be used to refer to: • A discourse that wanders from the point, only eventually to return to the original subject matter, as seen in fluent aphasias. • A response to word-finding difficulties, as in early Alzheimer’s disease or non-fluent aphasias: in response to familiar pictures, patients may comment that the name is on the tip-of-the-tongue but they cannot access it, and therefore, give alternatives, e.g. ‘gardener’s friend’ or ‘beetle’ for ladybird. What is Metamorphopsia? Metamorphopsia is a type of distorted vision in which a grid of straight lines appears wavy and parts of the grid may appear blank. People can first notice they suffer with the condition when looking at mini-blinds in their home. It is mainly associated with macular degeneration, particularly age-related macular degeneration with choroidal neovascularization. What is Clapping test? It is ‘clapping’ as a bedside test to determine the competency of the corpus callosum in multiple sclerosis. What is Clasp-Knife Phenomenon? Clasp-knife phenomenon is the name sometimes applied to the sudden ‘give’ encountered when passively moving a markedly spastic limb. Since the clasp knife phenomenon is a feature of spasticity, the term ‘clasp-knife rigidity’ is probably best eschewed to avoid possible confusion. What is the meaning of APPLAUSE sign? The applause sign, originally reported as a specific sign of progressive supranuclear palsy (PSP), has recently been found in several parkinsonian disorders. Its nature is still uncertain. It has been interpreted as a motor perseveration or a form of apraxia. What is Claudication? Claudication (literally limping, Latin claudication) refers to intermittent symptoms of pain secondary to ischaemia. Claudication of the legs on walking is a symptom of peripheral vascular disease. Claudication of the jaw, tongue, and limbs (especially upper) may be a feature of giant cell (temporal) arteritis. Jaw claudication is said to occur in 40% of patients with giant cell arteritis and is the presenting complaint in 4%; tongue claudication occurs in 4% and is rarely the presenting feature. Presence of jaw claudication is one of the clinical features which increases the likelihood of a positive temporal artery biopsy. What is Claw Foot? Claw foot, or pied en griffe, is an abnormal posture of the foot, occurring when weakness and atrophy of the intrinsic foot muscles allows the long flexors and extensors to act unopposed, producing shortening of the foot, heightening of the arch, flexion of the distal phalanges and dorsiflexion of the proximal phalanges (cf. pes cavus). This may occur in chronic neuropathies of early onset which involve motor fibres, such as hereditary motor and sensory neuropathies (types I and II). What is Claw Hand? Claw hand, or main en griffe, is an abnormal posture of the hand with hyperextension at the metacarpophalangeal joints (fifth, fourth, and, to a lesser extent, third finger) and flexion at the interphalangeal joints. This results from ulnar nerve lesions above the elbow, or injury to the lower part of the brachial plexus (Dejerine–Klumpke type), producing wasting and weakness of hypothenar muscles, interossei, and ulnar (medial) lumbricals, allowing the long finger extensors and flexors to act unopposed. What is hand of benediction? The hand of benediction, also known as benediction sign or preacher’s hand, occurs as a result of prolonged compression or injury of the median nerve at the forearm or elbow. What does camptodactyly mean? Camptodactyly is a medical condition that causes one or more fingers to be permanently bent. What is pes cavus? Pes cavus, also known as high arch, is a human foot type in which the sole of the foot is distinctly hollow when bearing weight. That is, there is a fixed plantar flexion of the foot. A high arch is the opposite of a flat foot and is somewhat less common. What is Clonus? Clonus is rhythmic, involuntary, repetitive, muscular contraction and relaxation. It may be induced by sudden passive stretching of a muscle or tendon, most usually the Achilles tendon (ankle clonus) or patella (patellar clonus). Ankle clonus is best elicited by holding the relaxed leg underneath the moderately flexed knee, then quickly dorsiflexing the ankle and holding it dorsiflexed. A few beats of clonus are within normal limits but sustained clonus is pathological. Clonus reflects hyperactivity of muscle stretch reflexes and may result from self-re-excitation. It is a feature of upper motor neurone disorders affecting the corticospinal (pyramidal) system. Patients with disease of the corticospinal tracts may describe clonus as a rhythmic jerking of the foot, for example, when using the foot pedals of a car. Clonus may also be observed as part of a generalized (primary or secondary) epileptic seizure, either in isolation (clonic seizure) or much more commonly following a tonic phase (tonic–clonic seizure). The clonic movements usually involve all four limbs and decrease in frequency and increase in amplitude over about 30–60 s as the attack progresses. Rather different ‘clonic’ movements may occur in non-epileptic seizures. A few clonic jerks may also be observed in syncopal attacks, leading the uninitiated to diagnose ‘seizure’ or ‘convulsion’. What are causes of clonus? Other neurological and muscular issues that may occur alongside clonus can include: A common condition associated with clonus is multiple sclerosis (MS). What is Closed Fist Sign? This is one of the provocative tests for carpal tunnel syndrome: it is positive if paraesthesia in the distribution of the median nerve develops after maintaining fist closure for 60 s. What is Flick sign? Rapid back and forth movement of the hand and fingers when patients experience painful symptoms in them. The finding is an imprecise and unreliable physical diagnostic sign in patients with carpal tunnel syndrome. What is Phalen’s sign? The patient is asked to hold their wrists in complete and forced flexion (pushing the dorsal surfaces of both hands together) for 30–60 seconds. The lumbricals attach in part to the flexor digitorum profundus tendons. As the wrists flex, the flexor digitorum profundus contracts in a proximal direction, drawing the lumbricals along with it. In some individuals, the lumbricals can be “dragged” into the carpal tunnel with flexor digitorum profundus contraction. As such, Phalen’s maneuver can moderately increase the pressure in the carpal tunnel via this mass effect, pinching the median nerve between the proximal edge of the transverse carpal ligament and the anterior border of the distal end of the radius. By compressing the median nerve within the carpal tunnel, characteristic symptoms (such as burning, tingling or numb sensation over the thumb, index, middle and ring fingers) conveys a positive test result and suggests carpal tunnel syndrome. Because not all individuals will draw the lumbricals into the carpal tunnel with this maneuver, this test cannot be perfectly sensitive or specific for carpal tunnel syndrome What is Tinel’s sign? Tinel’s sign is a way to detect irritated nerves. It is performed by lightly tapping (percussing) over the nerve to elicit a sensation of tingling or “pins and needles” in the distribution of the nerve. … Tinel’s sign is sometimes referred to as “distal tingling on percussion” or DTP. What is Closing-In Sign? Copying of drawings which are close to or superimposed on the original has been referred to as the ‘closing-in’ sign. It may be seen in patients with Alzheimer’s disease with deficits in visuospatial function. This has sometimes been characterized as one aspect of the ‘constructional apraxia’ of Alzheimer’s disease; it may be useful in differentiating AD from subcortical vascular dementia. What is Cluster Breathing? Damage at the pontomedullary junction may result in a breathing pattern characterized by a cluster of breaths following one another in an irregular sequence. This sign may be of localizing value in comatose patients. What is Coactivation Sign? This sign is said to be characteristic of psychogenic tremors, namely, increased tremor amplitude with loading (cf. reduced amplitude of organic tremor with loading), perhaps due to muscle coactivation to maintain oscillation. What does walk on your toes mean? Typically, toe walking is a habit that develops when a child learns to walk. In a few cases, toe walking is caused by an underlying condition, such as: A short Achilles tendon. This tendon links the lower leg muscles to the back of the heel bone. If it’s too short, it can prevent the heel from touching the ground. What is Cogan’s (Lid Twitch) Sign? Cogan’s sign is a twitching of the upper eyelid seen a moment after the eyes are moved from downgaze to the primary position. Twitches may also be seen with eye closure after sustained upgaze. These phenomena are said to be characteristic signs of ocular myasthenia gravis and were found in 60% of myasthenics in one study. They may also occur occasionally in other oculomotor brainstem disorders such as Miller Fisher syndrome, but are not seen in normal. Hence, the sign is neither sensitive nor specific. Cogan’s lid twitch sign should not be confused with either Cogan’s syndrome, an autoimmune disorder of episodic vertigo, tinnitus, hearing loss, and interstitial keratitis; or the oculomotor apraxia of Cogan, a congenital lack of lateral gaze. What is cogwheeling in Parkinson’s? Cogwheel phenomenon, also known as cogwheel rigidity or cogwheeling, is a type of rigidity seen in people with Parkinson’s disease. It’s often an early symptom of Parkinson’s, and it can be used to make a diagnosis. What is ice pack tests? To help confirm this, they performed the ice pack test, which consists of placing a bag filled with ice over the patients’ eyelids for two to five minutes, then checking for signs of droopy eyelid improvement. This test is conducted on the basis that cold improves MG symptoms, while heat worsens them. What is Cold Hands Sign? In multiple system atrophy (MSA), the hands may be cold, dusky, and violaceous with poor circulatory return after blanching by pressure, suggesting defective neurovascular control of the distal extremities as one feature of the autonomic dysfunction in MSA. The findings are not present in idiopathic Parkinson’s disease. What is Collapsing Weakness? Collapsing weakness, or ‘give-way’ weakness, suggesting intermittent voluntary effort, is often taken as a sign of functional weakness. Although sometimes labelled as ‘volitional weakness’, it is not clear that such weakness is in any conscious sense willed, and it is therefore probably better to use a non-committal term such as ‘apparent weakness’. Such collapsing weakness has also been recorded following acute brain lesions such as stroke. What is Collier’s Sign? Collier’s sign (‘posterior fossa stare’, ‘tucked lid’ sign), first described in 1927, is elevation and retraction of the upper eyelids, baring the sclera above the cornea, with the eyes in the primary position or looking upward. This may be seen with upper dorsal midbrain supranuclear lesions, e.g. ‘top of the basilar syndrome’, Parinaud’s syndrome. There may be accompanying paralysis of vertical gaze (especially upgaze) and light-near pupillary dissociation. The sign is thought to reflect damage to the posterior commissure levator inhibitory fibres. What are the cause of Parinaud’s syndrome? Parinaud’s syndrome, also known as dorsal midbrain syndrome, vertical gaze palsy, and Sunset Sign, is an inability to move the eyes up and down. It is caused by compression of the vertical gaze center at the rostral interstitial nucleus of medial longitudinal fasciculus (riMLF). What is Graves ophthalmopathy? Graves ophthalmopathy, also known as thyroid eye disease (TED), is an autoimmune inflammatory disorder of the orbit and periorbital tissues, characterized by upper eyelid retraction, lid lag, swelling, redness (erythema), conjunctivitis, and bulging eyes (exophthalmos). It occurs most commonly in individuals with Graves’ disease, and less commonly in individuals with Hashimoto’s thyroiditis, or in those who are euthyroid. What is Coma? Coma is a state of unresponsiveness, with eyes closed, from which a patient cannot be roused by verbal or mechanical stimuli. It represents a greater degree of impairment of consciousness than stupor or obtundation, all three forming part of a continuum, rather than discrete stages, ranging from alert to comatose. This lack of precision prompts some authorities to prefer the description of the individual aspects of neurological function in unconscious patients, such as eye movements, limb movements, vocalization, and response to stimuli, since this conveys more information than the use of terms such as coma, stupor, or obtundation, or the use of a lumped ‘score’, such as the Glasgow Coma Scale. These signs should be documented serially to assess any progression of coma. Assessment of the depth of coma may be made by observing changes in eye movements and response to central noxious stimuli: roving eye movements are lost before oculocephalic responses; caloric responses are last to go. The switch from flexor to extensor posturing (decorticate vs. decerebrate rigidity) also indicates increasing depth of coma. What are the causes of Coma? There are many causes of coma, which may be broadly categorized as structural or toxic-metabolic; the latter are generally more slowly progressive and produce symmetrical signs, whereas structural lesions more often have an abrupt onset and some focal asymmetric findings on examination, but these distinctions are not absolute. Recognized causes of coma include • Structural: Vascular insults (subarachnoid haemorrhage, cerebral infarction or haemorrhage, CADASIL); Trauma; Tumour; Hydrocephalus; Vasculitides, leucodystrophies, leucoencephalopathies. • Toxic-metabolic: Metabolic causes: e.g. hypoxia, hypercapnia, hypoglycaemia; Infections: e.g. meningitis, encephalitis, sepsis; Epilepsy. Un-rousability which results from psychiatric disease, or which is being feigned (‘pseudocoma’), also needs to be differentiated. A number of neurobehavioral states may be mistaken for coma, including abulia, akinetic mutism, catatonia, and the locked-in syndrome. EEG features may assist in differential diagnosis: prominent rhythmic beta activity raises the possibility of drug intoxication. What is Decerebrate rigidity? It is characterized by extension of all four limbs and the trunk. It is caused by a lesion in the rostral brainstem (midbrain or pons). Opisthotonos may be associated with decerebrate rigidity if the rostral lobes of the cerebellum are damaged. Opisthotonos is extension of the head and the neck. Mentation is often altered. What is Decorticate posturing? It is a sign of severe damage to the brain — is a specific type of involuntary abnormal posturing of a person. Decorticate posture is stiff with legs held out straight, fists clenched, and arms bent to hold the hands on the chest. Is decerebrate or decorticate worse? The presence of abnormal posturing indicates a severe medical emergency requiring immediate medical attention. Decerebrate and decorticate posturing are strongly associated with poor outcome in a variety of conditions. For example, near-drowning victims that display decerebrate or decorticate posturing have worse outcomes than those that do not. What is a locked in syndrome? Locked-in syndrome. Locked-in syndrome (LIS), also known as pseudo coma, is a condition in which a patient is aware but cannot move or communicate verbally due to complete paralysis of nearly all voluntary muscles in the body except for vertical eye movements and blinking. What is Compulsive Grasping Hand? This name has been given to involuntary left-hand grasping related to all right-hand movements in a patient with a callosal haemorrhage. This has been interpreted as a motor grasp response to contralateral hand movements and a variant of anarchic or alien hand. The description does seem to differ from that of behaviours labelled as forced groping and the alien grasp reflex. What is Intermanual conflicts? Intermanual conflicts due to unintended actions of the apraxic hand have been interpreted as manifestation of conflicting intentions of disconnected hemispheres. On scrutiny, however, the majority of them seem to be due to the propensity of the disobedient hand to perform actions that are intended to be performed by the other hand. What is Conduction Aphasia? Conduction aphasia is defined as a fluent aphasia with paraphasic errors (especially phonemic/literal) during speech, repetition, and naming. Conduction aphasia is most often seen during recovery from Wernicke’s aphasia, and clinically there is often evidence of some impairment of comprehension. If isolated, the prognosis for conduction aphasia is good. What is Conduit d’approche? Conduit d’approche, or ‘homing-in’ behaviour, is a verbal output phenomenon applied to patients with conduction aphasia attempting to repeat a target word, in which multiple phonemic approximations of the word are presented, with gradual improvement until the target word is achieved. This phenomenon suggests that an acoustic image of the target word is preserved in this condition. A similar phenomenon may be observed in patients with optic aphasia attempting to name a visual stimulus. A similar behaviour is seen in so-called speech apraxia, in which patients repeatedly approximate to the desired output before reaching it. The term may also be used to refer to a parapraxis in which patients attempt to perform a movement several times before achieving the correct movement. What is Confabulation? The old definition of confabulation as the falsification of episodic memory occurring in clear consciousness, often in association with amnesia (in other words, paramnesias related as true events), has proven increasingly deficient, not least because most amnesic patients, suffering from medial temporal lobe/hippocampal lesions, do not confabulate, and poor memory alone cannot explain confabulation. Schnyder has developed a fourfold schema of intrusions, momentary confabulations, fantastic confabulations, and behaviourally spontaneous confabulations, of which the latter are clinically the most challenging. Anterior limbic structures are thought culpable, and the pathogenesis includes a wide variety of diseases, which may include associated phenomena such as amnesia, disorientation, false recognition syndromes including the Capgras delusion, and anosognosia. Psychophysical and neuroimaging studies suggest that confabulators have reality confusion and a failure to integrate contradictory information due to the failure of a filtering process, 200–300 ms after stimulus presentation and before recognition and re-encoding, which normally permits suppression of currently irrelevant memories. What are the types of visual impairments? The most common types of visual impairments are simple refractive errors. These include near-sightedness, farsightedness, and astigmatism. In near-sightedness images are focused in front of the retina, making far away images appear blurry. What is a cortical visual impairment? Cortical Visual Impairment. Overview. Cortical Visual Impairment (CVI) is diagnosed when children show abnormal visual responses that aren’t caused by the eyes themselves. When CVI is suspected, fixation and following—even to intense stimulation—may be poor, and the child will not respond normally to people’s faces. What is Confusion? Confusion, understood as the inability to think with one’s customary clarity and coherence, is a feature of not only delirium, but also of other situations (encephalopathies, attentional disorders). Moreover, as there is a lack of correlation of meaning when this term is used by different health professionals, it is regarded by some as an unhelpful term. What is Congenital Nystagmus? Congenital nystagmus is a pendular nystagmus with the following characteristics: • Usually noted at birth or in early infancy; sometimes may only become apparent in adult life; • Irregular waveforms; • Conjugate; • Almost always horizontal; • Accentuated by fixation, attention, anxiety; • Decreased by convergence, active eyelid closure; • Often a null point or region; • No complaint of oscillopsia; • It may appear with blindness of childhood onset. Acquired pendular nystagmus may be a result of neurological disease which may present in childhood, such as Pelizaeus–Merzbacher disease, mitochondrial disease, multiple sclerosis, and Whipple’s disease. What is Contracture? The term contracture may be used in various contexts: • Clinically, to describe an acquired restriction of joint mobility (prenatally acquired restriction of joint mobility is called arthrogryposis). This may be due to a variety of factors, including prolonged muscle spasticity with or without muscle fibrosis (i.e. without pathological muscle shortening) and ligamentous restrictions. This often occurs in the context of limb immobilization or inactivity, for example, in a flexed posture. Injections of botulinum toxin to abolish muscle spasticity may be required to assess whether there is concurrent ligamentous restriction, and thus to plan optimum treatment, which may involve surgery. Contractures of muscular origin may be seen in conditions such as Emery–Dreifuss disease (especially elbow, Achilles tendon, posterior part of neck), Bethlem myopathy, and Ullrich congenital muscular dystrophy associated with mutations in genes encoding the peptide chains of collagen VI, limb girdle muscular dystrophy type 2A associated with mutations in the calpain 3 gene, and Duchenne muscular dystrophy. • Clinically, to describe a hard, contracted muscle which is painful to straighten and lasting for several hours following exercise in a metabolic myopathy such as McArdle’s disease (myophosphorylase deficiency, glycogen storage disease type V); this may be associated with EMG silence. • Physiologically, to describe a prolonged painful muscle spasm with EMG silence, as observed in myotonia and paramyotonia. What is Coprolalia? Coprolalia is the use of expletives or other obscene language. This may be • Vocal: involuntary utterance of obscenities; • Mental: compulsion to think obscenities. The former is a complex vocal tic most characteristically seen in Tourette syndrome although it actually occurs in less than half of affected individuals. Other recognized disease associations are as follows: • Lesch–Nyhan syndrome; • Postencephalitic parkinsonism; • Neuroacanthocytosis; • Cingulate cortical seizures. The pathophysiology of coprolalia is unknown but may be related to frontal (cingulate and orbitofrontal) dysfunction, for which there is some evidence in Tourette syndrome. What is the cause of Parinaud’s syndrome? Parinaud’s syndrome, also known as dorsal midbrain syndrome, vertical gaze palsy, and Sunset Sign, is an inability to move the eyes up and down. It is caused by compression of the vertical gaze center at the rostral interstitial nucleus of medial longitudinal fasciculus (riMLF). The eyes lose the ability to move upward and down. What is Copropraxia? Copropraxia is a complex motor tic comprising obscene gesturing, sometimes seen in Tourette syndrome. What is coprolalia in Tourettes? Coprolalia is a typical symptom of Tourette syndrome, a condition that has its onset in childhood and is characterized by compulsive arm movements, facial tics, grunting, groaning and shouting. Aside from coprolalia, there is often echolalia, the involuntary parrot-like repetition (echoing) of a word or sentence just spoken by another person. What is Corectopia? Corectopia is pupillary displacement, which may be seen with midbrain lesions, including transtentorial herniation and top-of-the-basilar syndrome, peripheral oculomotor nerve palsies, and focal pathology in the iris. What is Corneal Reflex? The corneal reflex consists of a bilateral blink response elicited by touching the cornea lightly, for example, with a piece of cotton wool. As well as observing whether the patient blinks, the examiner should also ask whether the stimulus was felt: a difference in corneal sensitivity may be the earliest abnormality in this reflex. Synkinetic jaw movement may also be observed: the corneomandibular reflex. Cerebral hemisphere (but not thalamic) lesions causing hemiparesis and hemisensory loss may also be associated with a decreased corneal reflex. The corneal reflex has a high threshold in comatose patients and is usually preserved until late (unless coma is due to drug overdose), in which case its loss is a poor prognostic sign. What is Corneomandibular Reflex? The corneomandibular reflex, also known as the corneopterygoid reflex or Wartenberg’s reflex or sign, consists of anterolateral jaw movement following corneal stimulation. In one study, the corneomandibular reflex was observed in about three-quarters of patients with motor neurone disease (MND) who displayed no other pathological reflexes, a frequency much higher than that seen in patients with stroke causing hemiparesis or pseudobulbar palsy. It was therefore suggested to be a sensitive indicator of upper motor neurone involvement in MND. What is Cortical Blindness? Cortical blindness (Rindblindheit) is loss of vision due to bilateral visual cortical damage, usually hypoxic–ischaemic in origin, or bilateral subcortical lesions affecting the optic radiations. A small central field around the fixation point may be spared (macula sparing). Pupillary reflexes are preserved but optokinetic nystagmus cannot be elicited. Cortical blindness may result from: • Bilateral (sequential or simultaneous) posterior cerebral artery occlusion; • ‘Top of the basilar syndrome’; • Migraine; • Cerebral anoxia; • Bacterial endocarditis; • Wegener’s granulomatosis; • Following coronary or cerebral angiography (may be transient); • Epilepsy (transient); • Ciclosporin therapy, e.g. following organ transplantation. If acute in onset (i.e. vascular), cortical blindness may ultimately evolve to prosopagnosia via visual object agnosia. Patients with cortical blindness may deny their visual defect (Anton’s syndrome, visual anosognosia) and may confabulate about what they ‘see’. What is Cotard’s Syndrome? A delusional syndrome, first described in the 1890s, characterized by the patient’s denial of their own existence, or of part of their body. The patient may assert that they are dead and able to smell rotten flesh or feel worms crawling over their skin. Although this may occur in the context of psychiatric disease, especially depression and schizophrenia, it may also occur in association with organic brain abnormalities, specifically lesions of the non-dominant temporoparietal cortex, or migraine. Some envisage Cotard’s syndrome as a more pervasive form of the Capgras syndrome, originating similarly as a consequence of Geschwindian disconnection between the limbic system and all sensory areas, leading to a loss of emotional contact with the world. Antidepressant treatment and/or ECT may sometimes be helpful in Cotard syndrome of psychiatric origin. What is Coup de Poignard? Coup de poignard, or dagger thrust, refers to a sudden precordial pain, as may occur in myocardial infarction or aortic dissection, also described with spinal subarachnoid haemorrhage. What is Coup de Sabre? Coup de sabre is a localized form of scleroderma manifest as a linear, atrophic lesion on the forehead which may be mistaken for a scar. This lesion may be associated with hemifacial atrophy and epilepsy, and neuroimaging may show hemi atrophy and intracranial calcification. Whether these changes reflect inflammation or a neurocutaneous syndrome is not known. What is progressive hemifacial atrophy? Progressive hemifacial atrophy (PHA), also known as Parry-Romberg syndrome, is characterized by slowly progressive deterioration of the skin and soft tissues on one side of the face. It sometimes occurs on both sides of the face and occasionally involves the arm, trunk, and/or leg. What is Cover Tests? The simple cover and cover–uncover tests may be used to demonstrate manifest and latent strabismus (heterotropia and heterophoria), respectively. The cover test demonstrates tropias: the uncovered eye is forced to adopt fixation; any movement therefore represents a manifest strabismus (heterotropia). The cover–uncover test demonstrates phorias: any movement of the covered eye to re-establish fixation as it is uncovered represents a latent strabismus (heterophoria). The alternate cover or cross-cover test, in which the hand or occluder moves back and forth between the eyes, repeatedly breaking and re-establishing fixation, is more dissociating, preventing binocular viewing, and therefore helpful in demonstrating whether or not there is strabismus. It should be performed in the nine cardinal positions of gaze to determine the direction that elicits maximal deviation. However, it does not distinguish between tropias and phorias, for which the cover and cover–uncover tests are required. What does heterophoria mean? Heterophoria is an eye condition in which the directions that the eyes are pointing at rest position, when not performing binocular fusion, are not the same as each other, or, “not straight”. The tendency for images to slip out of register is termed heterophoria. The normally single monocular vision does not overlap perfectly. Heterotropia presents as a diplopia and the image is seen in double. What is Cramp? Cramps are defined as involuntary contractions of a number of muscle units which results in a hardening of the muscle with pain due to a local lactic acidosis. Cramps are not uncommon in normal individuals but in a minority of cases they are associated with an underlying neurological or metabolic disorder. Cramps need to be distinguished from spasticity, neuromyotonia, and myokymia. Recognized associations of cramp include • Normal individuals: Especially during periods of dehydration with salt loss; pregnancy. Benign cramp syndrome, there is a family history of cramps. • Metabolic causes: Hypothyroidism; Haemodialysis; Hypocalcaemia; hyperventilation (with secondary hypocalcaemia). • Neurological causes: Chronic peripheral neuropathy; Metabolic myopathies (e.g. myophosphorylase deficiency, lactate dehydrogenase (LDH) deficiency, with exercise intolerance and myoglobinuria); Muscular dystrophies (especially Becker, Duchenne); Motor neurone disease; Stiff man syndrome. What is treatment of Cramp? Treatment involves addressing any underlying metabolic abnormality. Symptomatic treatment of cramps may include use of quinine sulphate, vitamin B, naftidrofuryl, and calcium channel antagonists such as diltiazem; carbamazepine, phenytoin, and procainamide have also been tried. What is Cremasteric Reflex? The cremasteric reflex is a superficial or cutaneous reflex consisting of contraction of the cremaster muscle causing elevation of the testicle, following stimulation of the skin of the upper inner aspect of the thigh from above downwards (i.e. the L1, L2 dermatomes, via the ilioinguinal and genitofemoral nerves). The cremasteric reflex is lost when the corticospinal pathways are damaged above T12 or following lesions of the genitofemoral nerve. It may also be absent in elderly men or with local pathology such as hydrocele, varicocele, orchitis, or epididymitis. What are Crocodile Tears? Crocodile tears, gustatory epiphora, or Bogorad’s syndrome reflect inappropriate unilateral lacrimation during eating, such that tears may spill down the face (epiphora). This autonomic synkinesis is a striking but rare consequence of aberrant reinnervation of the facial (VII) nerve, usually after a Bell’s palsy, when fibres originally supplying the salivary glands are re-routed to the lacrimal gland via the greater superficial petrosal nerve. What is epiphora? Epiphora is an overflow of tears onto the face, other than caused by normal crying. It is a clinical sign or condition that constitutes insufficient tear film drainage from the eyes, in that tears will drain down the face rather than through the nasolacrimal system. What is synkinesis? Synkinesis refers to involuntary movements of the face – usually as a result of incomplete recovery from facial nerve damage (facial paralysis). Symptoms include: abnormal muscle contractions of the eye, mouth, mid-face and neck, tightness, rigidity and hyperlacrimation (watery eyes). What is Crossed Adductor Reflex? Contralateral adductor muscle contraction in response to a tap on the adductor tendon may be found with a pyramidal lesion above L2, although it is a normal finding in infants. What is Crossed Aphasia? Aphasia from a right-sided lesion in a right-handed patient, crossed aphasia, is rare, presumably a reflection of crossed or mixed cerebral dominance. It may occur transiently during a focal epileptic seizure or migraine aura. What is Crossed Apraxia? A name given to apraxia in right-handed patients with right-sided lesions; apraxia is more commonly associated with left-sided brain injury. What is a Lasegue test? If patient has pain at the posterior leg and knee while the affected leg is raised, the test is positive. It means that one or more of the nerve roots leading to the sciatic nerve may be compressed or irritated. If doing this test on the unaffected leg causes pain in the affected leg, it helps What is crossed straight leg raising test? It is a diagnostic sign of herniated disc. Increased sciatica on raising the opposite or “well” leg, the crossed straight leg raising (XSLR) sign, is associated with a herniated lumbar disc in 97% of patients. What is Cross over? In the line bisection task for the detection of unilateral spatial neglect, in which the subjective midline is placed more towards the ipsilesional extreme of the line compared to the objective midline, especially with longer lines (length effect), with shorter lines there is a paradoxical deviation towards the contralesional side, a sign called cross-over. What is focal sensory loss? Dissociated sensory loss always suggests a focal lesion within the spinal cord or brainstem. The location of cord lesions affects presentation—for instance, a central lesion (such as that of syringomyelia) will knock out second order neurons of the spinothalamic tract as they cross the centre of the cord, and will cause loss of pain and temperature without loss of fine touch or proprioception. What is the main sensory loss? The separate location of the main sensory nucleus and nucleus of the descending trigeminal tract account for dissociated sensory loss, i.e. a low pontine or medullary lesion will result in loss of pain and temperature sensation with preservation of light touch. What is dissociated sensory loss? Dissociated sensory loss is a pattern of neurological damage caused by a lesion to a single tract in the spinal cord which involves preservation of fine touch and proprioception with selective loss of pain and temperature. This means that a lesion of the dorsal columns will cause loss of touch and proprioception below the lesion and on the same side as it, while a lesion of the spinothalamic tracts will cause loss of pain and temperature below the lesion and on the opposite side to it. What is a pathological Cry? Pathological laughter and crying (PLC) is a condition defined by relatively uncontrollable episodes of laughter, crying or both. The episodes either do not have an apparent motivating stimulus or are triggered by a stimulus that would not have led the subject to laugh or cry prior to the onset of the condition. What is pathological laughing? Pseudobulbar affect (PBA), or emotional incontinence, is a type of emotional disturbance characterized by uncontrollable episodes of crying and/or laughing, or other emotional displays. What is Cushing Reflex, Cushing Response? This is the triad of increasing systolic and pulse pressure with bradycardia and slow irregular respiration associated with increased intracranial pressure which may lead to cerebral herniation and fatal brainstem compression, for example, with posterior fossa masses or subarachnoid haemorrhage. What is Czarnecki’s Sign? Aberrant regeneration of the oculomotor (III) nerve to the iris sphincter may lead to gaze-evoked segmental constriction of the pupil, which may be visible only with slit-lamp examination. What is Dalrymple’s Sign? Dalrymple’s sign is increased width of the palpebral fissure, often seen in hyperthyroidism. What is Dazzle? Dazzle is a painless intolerance of the eyes to bright light (cf. photophobia). It may be peripheral in origin (retinal disease; opacities within cornea, lens, vitreous); or central (lesions anywhere from optic nerve to occipitotemporal region). What is Decerebrate Rigidity? Decerebrate rigidity is a posture observed in comatose patients in which there is extension and pronation of the upper extremities, extension of the legs, and plantar flexion of the feet (= extensor posturing), which is taken to be an exaggeration of the normal standing position. Painful stimuli may induce opisthotonos, hyperextension, and hyperpronation of the upper limbs. Decerebrate rigidity occurs in severe metabolic disorders of the upper brainstem (anoxia/ischaemia, trauma, structural lesions, drug intoxication). A similar picture was first observed by Sherrington (1898) following section of the brainstem of cats at the collicular level, below the red nuclei, such that the vestibular nuclei were intact. The action of the vestibular nuclei, unchecked by higher centres, may be responsible for the profound extensor tone. Decerebrate rigidity indicates a deeper level of coma than decorticate rigidity; the transition from the latter to the former is associated with a worsening of prognosis. What is De Clerambault syndrome? A syndrome which was first described by G.G. De Clerambault in 1885 is reviewed and a case is presented. Popularly called erotomania, the syndrome is characterized by the delusional idea, usually in a young woman, that a man whom she considers to be of higher social and/or professional standing is in love with her. What is Kandinsky clerambo syndrome? The presence of Kandinsky Clerambo syndrome in combination with schizoid conditions is an unfavourable sign for the course and prognosis of a mental illness. The patient experiences the influence of external forces and makes fantastic complaints. What is Decorticate Rigidity? Decorticate rigidity is a posture observed in comatose patients in which there is adduction of the shoulders and arms and flexion of the elbows and wrists (= flexor posturing). The lesion responsible for decorticate rigidity is higher in the neuraxis than that causing decerebrate rigidity, often being diffuse cerebral hemisphere or diencephalic disease, although, despite the name, it may occur with upper brainstem lesions. Common causes are anoxia/ischaemia, trauma, and drugs. What is Déjà Entendu? A sensation of familiarity akin to déjà vu but referring to auditory rather than visual experiences. What is Déjà Vu? Déjà vu (literally ‘already seen’) is a subjective, inappropriate impression of familiarity for a present experience in relation to an undefined past. What are the causes of Déjà Vu? Epileptic déjà vu may last longer and be more frequent and may be associated with other features such as depersonalization and derealization, strong emotion such as fear, epigastric aura, or olfactory hallucinations. Epileptic déjà vu is a complex aura of focal onset epilepsy; specifically, it is indicative of temporal lobe onset of seizures and is said by some authors to be the only epileptic aura of reliable lateralizing significance (right). Déjà vécu (‘already lived’) has been used to denote a broader experience than déjà vu but the clinical implications are similar. Déjà vu has also been reported to occur in several psychiatric disorders, such as anxiety, depression, and schizophrenia. What is Delirium? Delirium, also sometimes known as acute confusional state, acute organic reaction, acute brain syndrome, or toxic-metabolic encephalopathy, is a neurobehavioral syndrome of which the cardinal feature is a deficit of attention, the ability to focus on specific stimuli. Diagnostic criteria also require a concurrent alteration in level of awareness, which may range from lethargy to hypervigilance, although delirium is not primarily a disorder of arousal or alertness (cf. coma, stupor, obtundation). Other features commonly observed in delirium include • impaired cognitive function: disorientation in time and place; • perceptual disorders: illusions, hallucinations; • behavioural disturbances: agitation, restlessness, aggression, wandering, which may occur as a consequence of perceptual problems (hyperalert type); or unresponsiveness, withdrawal (hypoalert or quiet type); • language: rambling incoherent speech, logorrhoea; • altered sleep–wake cycle: ‘sundowning’ (restlessness and confusion at night); • tendency to marked fluctuations in alertness/activity, with occasional lucid intervals; • delusions: often persecutory. Hence this abnormal mental state shows considerable clinical heterogeneity. Subtypes or variants are described, one characterized by hyperactivity (‘agitated’), the other by withdrawal and apathy (‘quiet’). The course of delirium is usually brief (seldom more than a few days, often only hours). On recovery the patient may have no recollection of events, although islands of recall may be preserved, corresponding with lucid intervals (a useful, if retrospective, diagnostic feature). Delirium is often contrasted with dementia, a ‘chronic brain syndrome’, in which attention is relatively preserved, the onset is insidious rather than acute, the course is stable over the day rather than fluctuating, and which generally lasts months to years. However, it should be noted that in the elderly delirium is often superimposed on dementia, which is a predisposing factor for the development of delirium, perhaps reflecting impaired cerebral reserve. The pathophysiology of delirium is not well understood. Risk factors for the development of delirium may be categorized as either predisposing or precipitating. • Predisposing factors include Age: frailty, physiological age rather than chronological Sex: men > women
Neurological illness: dementia
Burden of comorbidity; dehydration
Drugs: especially anticholinergic medication
Primary sensory impairment (hearing, vision)
• Precipitating factors include
Drugs/toxins: benzodiazepines, opiates
Alcohol, especially withdrawal from, as in delirium tremens
Intercurrent illness:
Infection: primary CNS (encephalitis, meningitis), or systemic (urinary tract, chest, septicaemia)
Metabolic: hypoxia, hypo-/hyperglycaemia, hepatic failure, uraemia,
porphyria
CNS disorders: head injury, cerebrovascular disease, epilepsy (e.g.
some forms of status), inflammatory disorders (e.g. collagen vascular
disease)
What is Delusion?
A delusion is a fixed false belief, not amenable to reason (i.e. held despite evidence
to the contrary), and not culturally sanctioned. There are a number of common
forms of delusion, including
• persecutory (paranoia);
• reference: important events or people being influenced by patient’s thoughts,
ideas;
• grandiose/expansive: occur particularly in mania;
• guilt/worthlessness: occur particularly in depression;
• hypochondria;
• thought broadcast and thought insertion;
• control by an external agency.
Specific, named, delusional syndromes are those of:
• Capgras: the ‘delusion of doubles’, a familiar person or place is thought
to be an impostor, or double; this resembles the reduplicative paramnesia
described in neurological disorders such as Alzheimer’s disease.
• Fregoli: a familiar person is identified in other people, even though they bear
no resemblance; this may occur in schizophrenia.
• De Clérambault (erotomania): the belief (usually of a single woman) that a
famous person is secretly in love with her (‘hope’), followed by the belief that
the person is persecuting her (‘resentment’); may occur in schizophrenia.
Delusions are not only a feature of primary psychiatric disease (psychoses
such as schizophrenia; neuroses such as depression), but may also be encountered
in neurological disease with secondary psychiatric features (‘organic psychiatry’),
e.g. delirium, and dementing syndromes such as Alzheimer’s disease, dementia
with Lewy bodies.
What is Intermetamorphosis?
It is a delusional misidentification syndrome, related to agnosia. The main symptoms consist of patients believing that they can see others change into someone else in both external appearance and internal personality. The disorder is usually comorbid with neurological disorders or mental disorders. The disorder was first described in 1932 by Paul Courbon (1879-1958), a French Psychiatrist. Intermetamorphosis is rare, although issues with diagnostics and comorbidity may lead to under-reporting.
What are Misidentification syndromes?
They all involve a belief that the identity of a person, object, or place has somehow changed or has been altered. As these delusions typically only concern one particular topic, they also fall under the category called monothematic delusions.
What is Reduplicative paramnesia?
It is the delusional belief that a place or location has been duplicated, existing in two or more places simultaneously, or that it has been ‘relocated’ to another site.
What is Dementia?
Dementia is a syndrome characterized by loss of intellectual (cognitive) functions sufficient to interfere with social and occupational functioning. Cognition
encompasses multiple functions including language, memory, perception, praxis,
attentional mechanisms, and executive function (planning, reasoning). These
elements may be affected selectively or globally: older definitions of dementia
requiring global cognitive decline have now been superseded
What are the causes of a dementia?
Recognized causes of a dementia syndrome include
• Neurodegenerative diseases:
Alzheimer’s disease, frontotemporal lobar degenerations (frontotemporal dementia, encompassing Pick’s disease; semantic dementia; primary non-fluent aphasia), dementia with Lewy bodies, Huntington’s
disease, progressive supranuclear palsy, corticobasal degeneration,
prion disease, Down’s syndrome, dementia pugilistica.
• Cerebrovascular disease:
Focal strategic infarcts (e.g. paramedian thalamic infarction), multiple
infarcts, subcortical vascular disease, Binswanger’s disease.
• Inflammatory disorders: multiple sclerosis, systemic lupus erythematosus.
• Structural disease: normal pressure hydrocephalus, subdural haematoma,
tumours, dural arteriovenous fistula.
• Infection: HIV dementia, neurosyphilis, Whipple’s disease.
• Metabolic causes: Wernicke–Korsakoff syndrome, vitamin B12 deficiency, hypothyroidism, hyperparathyroidism/hypercalcaemia, leucodystrophies, Wilson’s disease.
Cognitive dysfunction may be identified in many other neurological illnesses.
Investigation of patients with dementia aims to identify its particular cause.
Because of the possibility of progression, reversible causes are regularly sought
though very rare. Specific treatments for dementia are few: cholinesterase
inhibitors have been licensed for the treatment of mild-to-moderate Alzheimer’s
disease and may find a role in other conditions, such as dementia with Lewy
bodies and vascular dementia, for behavioural as well as amnestic features.
What is de Musset’s sign?
It is a condition in which there is rhythmic nodding or bobbing of the head in synchrony with the beating of the heart, in general as a result of aortic insufficiency whereby blood from the aorta regurgitates into the left ventricle due to a defect in the aortic valve.
What are the symptoms of tremors in the head?
The following are symptoms of essential tremor in different parts of the body: You may experience noticeable shakiness in the hands or arms when trying to do activities with your hands. Tremors in the head and neck can make your head shake in an up-and-down or side-to-side motion. Parts of your face may appear to twitch, such as your eyelids.
What is the treatment for severe head tremors?
This treatment has been effective for vocal and head tremors. Surgery: Deep brain stimulation (DBS) is a surgical treatment option for people with severe tremor despite medical therapy. DBS involves surgical implantation of electrical leads into the thalamus.
What is Depersonalization?
Depersonalization, a form of dissociation, is the experience of feeling detached
or alienated from oneself, such that the body feels strange, lacking control,
or being viewed from the outside. There may be concurrent derealization.
Depersonalization is a very common symptom in the general population and
may contribute to neurological presentations described as dizziness, numbness,
and forgetfulness, with the broad differential diagnoses that such symptoms
encompass. Such self-induced symptoms may occur in the context of meditation
and self-suggestion.
What is Derealization?
Derealization, a form of dissociation, is the experience of feeling that the world
around is unreal. There may be concurrent depersonalization.
What is Diagonistic Dyspraxia?
A dissociative phenomenon observed after callosotomy, probably identical to
intermanual conflict.
What is Diamond on Quadriceps Sign?
Diamond on quadriceps sign may be seen in patients with dysferlinopathies (limb
girdle muscular dystrophy type 2B, Miyoshi myopathy): with the knees slightly
bent so that the quadriceps are in moderate action, an asymmetric diamond shaped bulge may be seen, with wasting above and below, indicative of the selectivity of the dystrophic process in these conditions.
What is Diaphoresis?
Diaphoresis is sweating, either physiological as in sympathetic activation
(e.g. during hypotension, hypoglycaemia), or pathological (hyperhidrosis, q.v.).
Diaphoresis may be seen in syncope, delirium tremens, or may be induced by
certain drugs (e.g. cholinesterase inhibitors) or drug withdrawal (e.g. opiates in
dependent individuals). Anticholinergics decrease diaphoresis but increase core
temperature, resulting in a warm dry patient.
What is Calf head sign?
There is a slowly progressive weakness and the proximal muscles may be involved late “Calf heads on a trophy sign” is a specific clinical sign that is almost specific for Miyoshy myopathy: First is a prominent deltoid muscle looking like a calf’s heads with the mouth at the muscle’s insertion and one of the several linear depressions appearing like a half-closed eye.
What is Diaphragm Weakness?
Diaphragm weakness is a feature of certain myopathies, such as acid maltase
deficiency, and of cervical cord lesions (C3–C5) affecting phrenic nerve function. Forced vital capacity measured in the supine and sitting positions is often
used to assess diaphragmatic function, a drop of 25% being taken as indicating
diaphragmatic weakness.
What is the Hoffman and Tromner signs?
They are most commonly clinically used corticospinal tract signs of upper extremities similar to the Babinski reflex in the lower extremity. Although, these reflexes can be elicited in normal subjects but importantly indicate a pyramidal tract lesion, especially if asymmetric and accompanied by other pathological reflexes.
What is Diplophonia?
Diplophonia, the simultaneous production of two pitch levels when phonating,
occurs in unilateral vocal cord paralysis because each vocal fold has a different
vibration frequency.
What does Hoffman sign mean?
Hoffmann sign or Hoff·mann sign. 1. in latent tetany mild mechanical stimulation of the trigeminal nerve causes severe pain; 2. flexion of the terminal phalanx of the thumb and of the second and third phalanges of one or more of the fingers when the volar surface of the terminal phalanx of the fingers is flicked.
What is a positive Hoffman test?
Hoffman’s sign is a neurological sign in the hand which is an indicator of problems in the spinal cord. It is associated with a loss of grip. The test for Hoffman’s sign involves tapping the nail on the third or fourth finger. A positive Hoffman’s is the involuntary flexing of the end of the thumb and index finger.
What is Diplopia?
Diplopia is double vision, viz., seeing two images of a single object.
Examination of the eye movements should include asking the patient to look
at a target, such as a pen, in the various directions of gaze (versions) to ascertain
where diplopia is maximum. Ductions are tested monocularly with the opposite
eye covered. Then, each eye may be alternately covered to try to demonstrate
which of the two images is the false one, namely that from the non-fixing eye?
The false image is also the most peripheral image. Thus, in a left abducens (VI)
nerve palsy, diplopia is maximum on left lateral gaze; when the normal right eye
is covered the inner image disappears; the non-fixing left eye is responsible for the
remaining false image, which is the more peripheral and which disappears when
the left eye is covered.
What is the Parks–Bielschowsky three-step test?
It is also known as Park’s three-step test or Bielschowsky head tilt test, is a method used to isolate the paretic extraocular muscle, particularly superior oblique muscle and trochlear nerve (IVth cranial nerve), in acquired vertical double vision. It was originally described by Marshall M. Parks.
What is Amblyopia?
It is also called lazy eye, is a disorder of sight in which the brain fails to process inputs from one eye and over time favours the other eye. It results in decreased vision in an eye that otherwise typically appears normal.
What is Directional Hypokinesia?
Directional hypokinesia is a reluctance to move towards contralesional space
seen in the neglect syndrome.
What is Disc Swelling?
Swelling or oedema of the optic nerve head may be visualized by ophthalmoscopy. It produces haziness of the nerve fibre layer obscuring the underlying vessels; there may also be haemorrhages and loss of spontaneous retinal venous pulsation. Disc swelling due to oedema must be distinguished from Pseudopapilloedema, elevation of the optic disc not due to oedema, in which the nerve fibre layer is clearly seen.
Disc swelling may be due to raised intracranial pressure (papilloedema, q.v.),
or local inflammation of the optic nerve (papillitis), and may be associated with
marked impairment of vision, for example, in optic neuritis, or be without specific visual complaint (as may be the case in papilloedema). The clinical history,
visual acuity, and visual fields may help determine the cause of disc swelling.
What are the causes of disc swelling?
Recognized causes of disc swelling include
• Unilateral:
Optic neuritis
Acute ischaemic optic neuropathy (arteritic, non-arteritic)
Orbital compressive lesions, e.g. optic nerve sheath meningioma
(Foster Kennedy syndrome)
Grave’s ophthalmopathy (through compression of retinal veins by
myositis)
Central retinal vein occlusion
Infiltration: carcinoma, lymphoma, granuloma
Raised intracranial pressure (papilloedema; more usually bilateral)
• Bilateral:
Raised intracranial pressure (papilloedema)
Malignant hypertension
Hypercapnia
High CSF protein, as in Guillain–Barré syndrome
Any of the unilateral causes
What is Disinhibition?
Disinhibited behaviour is impulsive, showing poor judgment and insight, and
may transgress normal cultural or social bounds. There is a loss of normal
emotional and/or behavioural control. The disinhibited patient may be inappropriately jocular (witzelsucht), short-tempered (verbally abusive, physically
aggressive), distractible (impaired attentional mechanisms), and show emotional lability. A Disinhibition Scale encompassing various domains (motor,
intellectual, instinctive, affective, sensitive) has been described.
Disinhibition is a feature of frontal lobe, particularly orbitofrontal, dysfunction. This may be due to neurodegenerative disorders (frontotemporal dementia, Alzheimer’s disease), mass lesions, or be a feature of epileptic seizures.
What is Witzelsucht?
It is a set of pure and rare neurological symptoms characterized by a tendency to make puns, or tell inappropriate jokes or pointless stories in socially inappropriate situations. It makes one unable to read sarcasm. A less common symptom is hypersexuality, the tendency to make sexual comments at inappropriate times or situations.
What is Dissociated Sensory Loss?
Dissociated sensory loss refers to impairment of selected sensory modalities
with preservation, or sparing, of others. It is usually an indication of an
intramedullary spinal cord lesion. For example, a focal central cord pathology
such as syringomyelia will, in the early stages, selectively involve decussating
fibres of the spinothalamic pathway within the ventral commissure, thus impairing pain and temperature sensation (often in a suspended, ‘cape-like’, ‘bathing
suit’, ‘vest-like’, or cuirasse distribution), whilst the dorsal columns are spared,
leaving proprioception intact. The anterior spinal artery syndrome also leaves the
dorsal columns intact. Conversely, pathologies confined, largely or exclusively, to
the dorsal columns (classically tabes dorsalis and subacute combined degeneration of the cord from vitamin B12 deficiency, but probably most commonly seen
with compressive cervical myelopathy) impair proprioception, sometimes sufficient to produce pseudoathetosis or sensory ataxia, whilst pain and temperature
sensation is preserved. A double dissociation of sensory modalities on opposite
sides of the trunk is seen in the Brown–Séquard syndrome.
Small fibre peripheral neuropathies may selectively affect the fibres which
transmit pain and temperature sensation, leading to a glove-and-stocking impairment to these modalities. Neuropathic (Charcot) joints and skin ulceration may
occur in this situation; tendon reflexes may be preserved.
What causes Charcot deformity?
The neurotraumatic theory states that Charcot arthropathy is caused by an unperceived trauma or injury to an insensate foot. The sensory neuropathy renders the patient unaware of the osseous destruction that occurs with ambulation
What is succulent hand?
Marinesco succulent hand is oedema of the hand with coldness and lividity of the skin, observed in syringomyelia.
What is Brown Sequard syndrome?
Brown -Séquard syndrome is an incomplete spinal cord lesion characterized by findings on clinical examination which reflect hemisection of the spinal cord (cutting the spinal cord in half on one or the other side). Brown-Sequard syndrome (BSS) is a rare neurological condition characterized by a lesion in the spinal cord which results in weakness or paralysis (hemiparaplegia) on one side of the body and a loss of sensation (hemianesthesia) on the opposite side. Magnetic resonance imaging (MRI) is the imaging of choice in spinal cord lesions.
What is Dissociation?
Dissociation is an umbrella term for a wide range of symptoms involving feelings
of disconnection from the body (depersonalization) or the surroundings (derealization). Common in psychiatric disorders (depression, anxiety, schizophrenia), these symptoms are also encountered in neurological conditions (epilepsy,
migraine, presyncope), conditions such as functional weakness and non-epileptic
attacks, and in isolation by a significant proportion of the general population.
Symptoms of dizziness and blankness may well be the result of dissociative states
rather than neurological disease.
What is Derealization?
It involves feeling detached from your surroundings. You may feel disconnected from external objects in your immediate environment, including other people. Even your closest family members or friends may seem like strangers.
What does depersonalization feel like?
Symptoms of depersonalization include: Feelings that you’re an outside observer of your thoughts, feelings, your body or parts of your body — for example, as if you were floating in air above yourself. Feeling like a robot or that you’re not in control of your speech or movements.
What is Divisional Palsy?
The oculomotor (III) nerve divides into superior and inferior divisions, usually at
the superior orbital fissure. The superior division or ramus supplies the superior
rectus and levator palpebrae superioris muscles; the inferior division or ramus
supplies medial rectus, inferior rectus and inferior oblique muscles. Isolated dysfunction of these muscular groups allows diagnosis of a divisional palsy and
suggests pathology at the superior orbital fissure or anterior cavernous sinus.
What is the Dix test for paroxysmal positional vertigo?
There are two main techniques used in the assessment and management of benign paroxysmal positional vertigo (BPPV) – the Dix-Hallpike test and the Epley Manoeuvre. The Dix-Hallpike Test is used for the diagnosis of BPPV, whilst the Epley Manoeuvre can be used for its treatment once diagnosed.
How to administer Dix Hallpike?
Continuing from the Dix-Hallpike Test, keep the patient supine and turn the head to the neutral position, still hanging over the end of the bed. Next, turn the head to the contralateral side, approximately 30 degree past the midline. Maintaining the position of the head, ask the patient to roll onto their shoulder.
What is Doll’s Eye Manoeuvre, Doll’s Head Manoeuvre?
This test of the vestibulo-ocular reflex (VOR) is demonstrated by rotating
the patient’s head and looking for a conjugate eye movement in the opposite direction. Although this can be done in a conscious patient focusing on a
visual target, smooth pursuit eye movements may compensate for head turning; hence the head impulse test (q.v.) may be required. The manoeuvre is easier to do in the unconscious patient, when testing for the integrity of brainstem reflexes.
A slow (0.5–1.0 Hz) doll’s head manoeuvre may be used in conscious patients
to assess vestibulo-ocular reflexes. Whilst directly observing the eyes, ‘catch up’
saccades may be seen in the absence of VOR. Measuring visual acuity with head
movement compared to visual acuity with the head still (dynamic visual acuity,
or illegible E test), two to three lines may be dropped if VOR is impaired. On
ophthalmoscopy, the disc moves with the head if VOR is lost.
What is head impulse test?
The head impulse test can be done at the bed side and used as a screening tool for problems with a person’s vestibular system. It can also be diagnostically tested by doing a video-head impose test (VHIT). In this diagnostic test, a person wears highly sensitive goggles that detect rapid changed in eye movement
What is a head thrust test?
The head impulse test (HIT), or head thrust test, is used to help identify an impaired vestibulo-ocular reflex (VOR) in patients with vertigo, particularly in suspected acute peripheral vestibulopathy.(1-4) The examiner briskly rotates the patient’s head while having the patient fixate on a target, usually the examiner’s nose.
What is a vestibular response test?
This test can provide site-specific information on vestibular system and its function. Another way of testing the VOR response is a caloric reflex test, which is an attempt to induce nystagmus (compensatory eye movement in the absence of head motion) by pouring cold or warm water into the ear.
What is a supranuclear gaze palsy?
It is an inability to look in a vertical direction as a result of cerebral impairment. There is a loss of the voluntary aspect of eye movements, but, as the brainstem is still intact, all the reflex conjugate eye movements are normal.
What is Parkinson PSP?
Progressive supranuclear palsy, or PSP, is a rare neurodegenerative disease that is often misdiagnosed as Parkinson’s disease because its symptoms are similar. Because of its rarity, PSP is mostly unknown by the general public.
What is Dorsal Guttering?
Dorsal guttering refers to the marked prominence of the extensor tendons on the
dorsal surface of the hand when intrinsic hand muscles (especially interossei) are
wasted, as may occur in an ulnar nerve lesion, a lower brachial plexus lesion,
or a T1 root lesion. Benign extramedullary tumours at the foramen magnum
may also produce this picture (remote atrophy, a ‘false-localizing sign’). In many
elderly people the extensor tendons are prominent in the absence of significant muscle wasting.
What is Double Elevator Palsy?
This name has been given to monocular elevation paresis. It may occur in association with pretectal supranuclear lesions either contralateral or ipsilateral to the
paretic eye interrupting efferents from the rostral interstitial nucleus of the medial
longitudinal fasciculus to the superior rectus and inferior oblique subnuclei.
Bell’s phenomenon may be preserved.
What is Bell’s phenomenon (also known as the palpebral oculogyric reflex)?
It is a medical sign that allows observers to notice an upward and outward movement of the eye, when an attempt is made to close the eyes. The upward movement of the eye is present in the majority of the population, and is a defensive mechanism.
What are the symptoms of Bell s palsy?
In rare cases, Bell’s palsy may affect both sides of your face. Other signs and symptoms of Bell’s palsy include: drooling. difficulty eating and drinking. an inability to make facial expressions, such as smiling or frowning. facial weakness. muscle twitches in the face.
What is Dropped Head Syndrome?
Dropped head syndrome (head droop or head drop) refers to forward flexion
of the head on the neck, such that the chin falls on to the chest
and the head cannot be voluntarily extended. This syndrome has a broad differential diagnosis, encompassing disorders which may cause axial truncal muscle weakness, especially of upper thoracic and paraspinous muscles.
• Neuropathy/Neuronopathy:
Motor neurone disease (the author has also seen this syndrome in a
patient with frontotemporal lobar degeneration with motor neurone
disease, FTLD/MND)
Guillain–Barré syndrome, chronic inflammatory demyelinating
polyneuropathy
Paraneoplastic motor neuronopathy
• Neuromuscular junction disorder:
Myasthenia gravis
• Myopathy:
Polymyositis
Myotonic dystrophy
Myopathy with rimmed vacuoles
‘Dropped head syndrome’, or ‘isolated neck extensor myopathy’, a
condition of uncertain aetiology but which may on occasion be steroid responsive (‘bent spine syndrome’ or camptocormia may be a related
form of axial myopathy)
• Extrapyramidal disorders:
Parkinson’s disease
Multiple system atrophy
Progressive supranuclear palsy
Of these, probably MND and myasthenia gravis are the most common
causes.
Treatment of the underlying condition may be possible, hence investigation is
mandatory. If not treatable (e.g. MND), a head brace may keep the head upright.
What is Antecollis?
It is dystonia of the neck resulting in excessive forward flexion, often associated with dysphagia. It is generally associated with the later stages of Parkinson’s disease (PD) and is often refractory to medical and botulinum toxin therapy.
What is Camptocormia?
It is also known as bent spine syndrome (BSS), is a symptom of a multitude of diseases that is most commonly seen in the elderly. It is identified by an abnormal thoracolumbar spinal flexion, which is a forward bending of the lower joints of the spine, occurring in a standing position.
What is Drusen?
Drusen are hyaline bodies that are typically seen on and around the optic nerve
head and may be mistaken for papilloedema (‘pseudo papilloedema’). Drusen are
thought to result from altered axonal flow with axonal degeneration. They occur
sporadically or may be inherited in an autosomal dominant fashion, and are
common, occurring in 2% of the population. In children the drusen are buried
whilst in adults they are on the surface.
Drusen are usually asymptomatic but can cause visual field defects (typically
an inferior nasal visual field loss) or occasionally transient visual obscurations,
but not changes in visual acuity; these require investigation for an alternative
cause. When there is doubt whether papilloedema or drusen is the cause of a
swollen optic nerve head, retinal fluorescein angiography is required.
What is Pseudopapilloedema?
Anomalous elevation of the optic disc; seen in severe hyperopia and optic nerve drusen. A non-specific term used to describe those conditions in which the optic disc is elevated resembling papilloedema. All have normal intraocular pressure.
What causes pseudo papilledema?
The exact cause of this condition is unknown, but it may be associated with having too much cerebrospinal fluid in your skull. This fluid, which protects your brain and spinal cord, is normally absorbed into your bloodstream. Pseudotumor cerebri may occur when this fluid isn’t fully absorbed, which causes it to build up.
Which of the following causes papilledema?
Papilledema is usually caused by the following: Brain tumour or abscess. Head injury. Bleeding in the brain. Inflammation of the brain (encephalitis) or its tissue coverings (meningitis) Idiopathic intracranial hypertension.
What is Dynamic Aphasia?
Dynamic aphasia refers to an aphasia characterized by difficulty initiating speech
output, ascribed to executive dysfunction. There is a reduction in spontaneous
speech, but on formal testing there are no paraphasias, minimal anomia, preserved repetition, and automatic speech. ‘Incorporational echolalia’, when the
patient uses the examiner’s question to help form an answer, may be observed.
Dynamic aphasia may be conceptualized as a variant of transcortical motor
aphasia and may be seen with lesions of dorsolateral prefrontal cortex (‘frontal
aphasia’). It has also been reported in progressive supranuclear palsy. A division
into pure and mixed forms has been suggested, with additional phonological,
lexical, syntactical, and articulatory impairments in the latter.
What is Dysaesthesia?
Dysaesthesia is an unpleasant, abnormal or unfamiliar, sensation, often with
a burning and/or ‘electrical’ quality. Some authorities reserve the term for
provoked positive sensory phenomena, as opposed to spontaneous sensations
(paraesthesia). Dysaesthesia differs from paraesthesia in its unpleasant quality,
but may overlap in some respects with allodynia, hyperalgesia, and hyperpathia (the latter phenomena are provoked by stimuli, either non-noxious or
noxious).
There are many causes of dysaesthesia, both peripheral (including small
fibre neuropathies, neuroma, and nerve trauma) and central (e.g. spinal multiple
sclerosis). Dysaesthetic sensations may be helped by agents such as carbamazepine,
amitriptyline, gabapentin, and pregabalin.
Damage to which structures results in hyperacusis?

1. Facial nerve (VII)—innervates the stapedius muscle, which retracts the stapes from the round window. 2. Trigeminal nerve (V)—supplies the tensor tympani, which inserts into the malleus and tenses the tympanic membrane,

What is Dysarthria?
Dysarthria is a disorder of speech, as opposed to language (cf. aphasia), because
of impairments in the actions of the speech production apparatus per se, due to
paralysis, ataxia, tremor, or spasticity, in the presence of intact mental function,
comprehension, and memory of words. In its most extreme form, anarthria, there
is no speech output.
Dysarthria is a symptom, which may be caused by a number of different conditions, all of which ultimately affect the function of pharynx, palate,
tongue, lips, and larynx, be that at the level of the cortex, lower cranial nerve
nuclei or their motor neurones, neuromuscular junction, or bulbar muscles themselves. Dysarthrias affect articulation in a highly reliable and consistent manner,
the errors reflecting the muscle group involved in the production of specific
sounds. There are various syndromes of dysarthria, which have been classified as
follows:
• Flaccid or nasal dysarthria:
hypernasal, breathy, whining output, as in bulbar palsy, e.g. myasthenia
gravis.
• Spastic dysarthria:
slow, strained (‘strangled’) output, monotonous, as in pseudobulbar
palsy; may coexist with Broca’s aphasia.
• Ataxic or cerebellar dysarthria:
altered rhythm of speech, uneven irregular output, slurred speech (as if
inebriated), improper stresses; seen in acute cerebellar damage due to
asynergia of speech muscle contractions (cf. scanning speech).
• Hypokinetic dysarthria:
monotonic pitch, hypophonic volume, as in parkinsonism.
• Hyperkinetic dysarthria:
several varieties are described, including choreiform (as in
Huntington’s disease), dystonic (as in tardive dyskinesia, and
other dystonic syndromes), tremulous (tremor syndromes), and the
dysarthria with vocal tics (including coprolalia) in Tourette syndrome.
What is the treatment for dysarthria?
Treatment of the underlying cause may improve dysarthria (e.g. nasal
dysarthria of myasthenia gravis). Baclofen has been suggested for dysarthria of
upper motor neurone type. Speech and language therapy may provide symptomatic benefit.
What is Dysdiadochokinesia?
Dysdiadochokinesia or adiadochokinesia is a difficulty in performing rapid
alternating movements, for example, pronation/supination of the arms, tapping
alternately with the palm and dorsum of the hand, tapping the foot on the floor.
Dysdiadochokinesia is a sign of cerebellar dysfunction, especially hemisphere disease, and may be seen in association with asynergia, ataxia, dysmetria, and excessive rebound phenomenon. It may reflect the impaired checking
response seen in cerebellar disease. Dysdiadochokinesia may also be seen with
disease of the frontal lobes (‘frontal apraxia’) or basal ganglia.
What is the Holmes rebound phenomenon?
The Holmes rebound phenomenon is a reflex that occurs when one attempts to move a limb against resistance that is suddenly removed. It is the inability to prevent large over-shoot movements of a limb when resistance to strong muscle contraction is suddenly removed.
What are Cerebellar disorders?
The main clinical features of cerebellar disorders include incoordination, imbalance, and troubles with stabilizing eye movements. There are two distinguishable cerebellar syndromes — midline and hemispheric. Midline cerebellar syndromes are characterized by imbalance.
What is Dysexecutive Syndrome?
The term executive function encompasses a range of cognitive processes including sustained attention, fluency and flexibility of thought, problem-solving skills,
and planning and regulation of adaptive and goal-directed behaviour. Some
authors prefer to use these individual terms, rather than ‘lump’ them together
as executive function. Deficits in these various functions, the dysexecutive
syndrome, are typically seen with lateral prefrontal cortex lesions.
What is Dysgeusia?
Dysgeusia is a complaint of distorted taste perception. It may occur along with
anosmia as a feature of upper respiratory tract infections and has also been
described with various drug therapies, in psychiatric diseases, and as a feature
of zinc deficiency.
What is Dyskinesia?
Dyskinesia may be used as a general term for excessive involuntary movements, encompassing tremor, myoclonus, chorea, athetosis, tics, stereotypies, and hyperekplexia. The term may be qualified to describe a number of other syndromes of excessive movement, e.g.:
• Drug-induced dyskinesia:
Fluid, restless, fidgety movements seen in patients with Parkinson’s
disease after several years of levodopa therapy, and often described
according to their relationship to timing of tablets (e.g. peak dose,
diphasic), although others are unpredictable (freezing, yo-yo-ing). In
MPTP-induced parkinsonism, dyskinesias tend to occur early, hence
it may be the depth of dopamine deficiency rather than chronicity
of treatment which is the key determinant; reduction in overall levodopa use (increased frequency of smaller doses, controlled-release
preparations, addition of dopamine agonists) may reduce these effects;
amantadine is sometimes helpful.
• Tardive dyskinesia:
A form of drug-induced dyskinesia developing after long-term use
of neuroleptic (dopamine antagonist) medication, typically involving
orolingual musculature (buccolingual syndrome, rabbit syndrome,
‘bon-bon sign’) and occasionally trunk and arms; usually persists
after withdrawal of causative therapy; clonazepam, baclofen, and
tetrabenazine may help.
• Paroxysmal dyskinesias:
Paroxysmal kinesigenic choreoathetosis/dystonia (PKC; usually
responds to carbamazepine) and paroxysmal non-kinesigenic dystonia/
choreoathetosis (PDC; does not respond to carbamazepine).
• Focal dyskinesias:
Oro-facial dyskinesia, belly dancer’s dyskinesia, moving ear syndrome.
What is Dyslexia?
Dyslexia is difficulty or impairment in reading, usually applied to developmental
abnormalities of reading ability. A loss of previously acquired reading ability is
probably better termed alexia.
What is Dysmentia?
The term dysmentia has been suggested as an alternative to dementia, to
emphasize the possibility of treating and preventing cognitive decline.
What is Dysmetria?
Dysmetria, or past-pointing, is a disturbance in the control of range of movement in voluntary muscular action and is one feature of the impaired checking
response seen in cerebellar lesions (especially cerebellar hemisphere lesions).
Dysmetria may also be evident in saccadic eye movements: hypometria
(undershoot) is common in parkinsonism; hypermetria (overshoot) is more
typical of cerebellar disease (lesions of dorsal vermis and fastigial nuclei).
In cerebellar disorders, dysmetria reflects the asynergia of coordinated
muscular contraction.
What is Dysmorphopsia?
The term dysmorphopsia has been proposed for impaired vision for shapes, a
visual recognition defect in which visual acuity, colour vision, tactile recognition, and visually guided reaching movements are intact. These phenomena have
been associated with bilateral lateral occipital cortical damage (e.g. after carbon
monoxide poisoning) and are thought to reflect a selective loss of the magnocellular visual pathway. Whether this condition is an agnosia for shape or visual form,
or a perceptual problem (‘pseudoagnosia’), remains a subject of debate and the
term dysmorphopsia has been suggested as a compromise between the different
strands of thought.
What is Dysphagia?
Dysphagia is difficulty swallowing. This may have local mechanical causes which
are usually gastroenterological in origin (tumour; peptic ulceration/stricture, in
which case there may be additional pain on swallowing – odynophagia) but sometimes vascular (aberrant right subclavian artery – dysphagia lusoria) or due to
connective tissue disease (systemic sclerosis). Dysphagia of neurological origin
may be due to pathology occurring anywhere from cerebral cortex to muscle.
Neurological control of swallowing is bilaterally represented and so unilateral
upper motor neurone lesions may cause only transient problems. Poststroke
dysphagia is common, but there is evidence of cortical reorganization (neuroplasticity) underpinning recovery. Bilateral upper motor neurone lesions cause
persistent difficulties. Dysphagia of neurological origin may be accompanied by
dysphonia, palatal droop, and depressed or exaggerated gag reflex.
What are the causes of dysphagia?
Dysphagia may be
• Neurogenic:
CNS:
Cerebrovascular disease: hemisphere, brainstem stroke
Extrapyramidal disease: Parkinson’s disease, progressive supranuclear palsy, Huntington’s disease, Wilson’s disease, tardive dyskinesia, dystonia
Inflammatory disease: multiple sclerosis
Neoplasia: primary, secondary; cerebral, brainstem (skull base)
Other structural disorders of the brainstem: syringobulbia, cerebellar disease
Developmental disorders: cerebral palsy syndromes, Chiari malformations
Neuronopathy:
Motor neurone disease
Neuropathy:
Guillain–Barré syndrome
Autonomic neuropathy (diabetes mellitus, amyloidosis, Chagas’
disease, autonomic failure, Riley Day syndrome)
Lower motor neurone pathology: bulbar palsy, isolated vagus (X)
nerve palsy, jugular foramen syndrome
Neuromuscular:
Myasthenia gravis
• Myogenic:
Inflammatory muscle disease: polymyositis, inclusion body myositis
Myotonia: myotonic dystrophy
Muscular dystrophy: oculopharyngeal muscular dystrophy
Symptomatic oesophageal peristalsis (‘nutcracker oesophagus’)
• Functional:
‘Hysterical’, globus hystericus (diagnosis of exclusion)
Gastrointestinal causes of dysphagia include
• Intrinsic:
Oesophageal carcinoma
Metastatic or extrinsic tumour spread
Peptic (post inflammatory) stricture
Hiatus hernia
• Extrinsic:
Thoracic aortic aneurysm
Abnormal origin of right subclavian artery (dysphagia lusoria)
Posterior mediastinal mass
Large goitre
Retropharyngeal mass
If swallowing is compromised with a risk of aspiration, feeding may need to
be undertaken via nasogastric tube, percutaneous gastrostomy or jejunostomy
placed endoscopically (PEG or PEJ), or even parenterally.
What is Dysphasia?
’The inaccuracy of applying an absolute negation [i.e. aphasia] to a partial defect
[of language] has led to the suggestion of ‘dysphasia’ as a frequent substitute.
The term does not, however, seem likely to come into use, a matter of little
regret, since the word has not the merit of unimpeachable exactness, and it has
an unfortunate resemblance in sound to ‘dysphagia’.’
What is Dysphonia?
Dysphonia is a disorder of the volume, pitch, or quality of the voice resulting
from dysfunction of the larynx, i.e. a disorder of phonation or sound generation.
Hence this is a motor speech disorder and could be considered as a dysarthria if
of neurological origin.
Dysphonia manifests as hoarseness or a whispering breathy quality to the
voice. Diplophonia may occur. At the extreme, there may be complete loss of the
voice (aphonia).
What are the causes of dysphonia?
Recognized causes of dysphonia include
• Infection (laryngitis);
• Structural abnormalities, e.g. polyp, nodule, papilloma of vocal cord;
• Neurological causes:
Focal dystonic syndrome: spasmodic dysphonia or laryngeal dystonia
(either abductor or adductor); the voice may have a strained and harsh
quality, with low volume and pitch, vocal tremor, and irregularly distributed stoppages; with continuing speech, or if holding a single note,
the voice may fade away entirely. These syndromes may be amenable to
treatment with botulinum toxin.
Flaccid dysphonia, due to superior laryngeal nerve or vagus nerve
(recurrent laryngeal nerve) palsy, bulbar palsy.
What is Diplophonia?
It means “double voice,” and refers to a phenomenon in which two (or more) pitches are sounded simultaneously. Dispelling vocal myths. part iv: “Talk higher!” The physical examination was notable for a raspy voice with obvious diplophonia and mild inspiratory stridor. Unusual paratracheal masses presenting with vocal fold paralysis
What is Dyspraxia?
Dyspraxia is difficulty or impairment in the performance of a voluntary motor
act despite an intact motor system and level of consciousness. This may be developmental in origin (‘clumsy child’), but in adult practice reflects a loss of function (hence apraxia is a better term).
What is Dystonia?
Dystonia, a term first used by Oppenheim in 1911, is a motor syndrome of
sustained involuntary muscle contractions causing twisting and repetitive movements, sometimes tremor, and/or abnormal postures. Dystonic movements may
initially appear with voluntary movement of the affected part (‘action dystonia’) but may eventually occur with voluntary movement elsewhere in the body
(‘overflow’). The severity of dystonia may be reduced by sensory tricks (geste
antagoniste), using tactile or proprioceptive stimuli to lessen or eliminate posturing; this feature is unique to dystonia. Dystonia may develop after muscle
fatiguing activity, and patients with focal dystonias show more rapid fatigue than
normal. Dystonic disorders may be classified according to:
• Age of onset: the most significant predictor of prognosis: worse with earlier
onset.
• Distribution: focal, segmental, multifocal, generalized; hemidystonia.
• Aetiology: primary/idiopathic vs. secondary/symptomatic.
Primary/idiopathic dystonias include the following:
• Primary torsion dystonia (idiopathic torsion dystonia);
• Severe generalized dystonia (dystonia musculorum deformans);
• Segmental, multifocal, and focal dystonias (e.g. torticollis, blepharospasm,
writer’s cramp);
• Dopa-responsive dystonia (DRD; Segawa’s syndrome);
• Myoclonic dystonia.
What is the differential diagnosis of symptomatic dystonia?
Secondary/symptomatic dystonia: the differential diagnosis is broad, with more
than 40 known causes, including
• Heredodegenerative disorders: Wilson’s disease, Huntington’s disease, neurodegeneration with brain iron accumulation, mitochondrial disorders,
X-linked dystonia–parkinsonism (lubag);
• Paroxysmal dystonias/dyskinesias: paroxysmal kinesigenic choreoathetosis/dystonia (PKC; usually responds to carbamazepine) and paroxysmal
non-kinesigenic dystonia/choreoathetosis (PDC; does not respond to carbamazepine);
• Metachromatic leucodystrophy;
• Gangliosidoses (GM1, GM2);
• Perinatal cerebral injury;
• Encephalitis;
• Head trauma;
• Multiple sclerosis;
• Drugs/toxins, e.g. antipsychotic, antiemetic, and antidepressant drugs;
• Psychogenic.
Appropriate investigations to exclude these symptomatic causes (especially Wilson’s disease) are appropriate.
What is the treatment of dystonias?
From the therapeutic point of view, one of the key questions relates to
response to levodopa: dopa-responsive dystonia (DRD) responds very well to
levodopa (and response fluctuations do not develop over time; as in Parkinson’s
disease). Other treatments which are sometimes helpful include anticholinergics, dopamine antagonists, dopamine agonists, and baclofen. Drug-induced dystonia following antipsychotic, antiemetic, or antidepressant drugs is often relieved within 20 min by intramuscular biperiden (5 mg) or procyclidine (5 mg). Botulinum toxin may be very helpful in some focal dystonias (e.g. blepharospasm). Surgery for dystonia using deep brain stimulation is still at the experimental stage.
What is geste antagoniste?
It (moving an arm to the face or head) is a well-known clinical feature in cervical dystonia (CD) to alleviate the abnormal posture. The clinical phenomenology of these manoeuvres has not so far been assessed systematically.
What is Eastchester Clapping Sign?
The Eastchester clapping sign is advocated as an early and sensitive sign of
hemispatial egocentric neglect. Patients are asked to clap: those with neglect perform one-handed motions which stop at the midline. Hemiplegic patients without neglect reach across the midline and clap against their plegic hand.
What is Echolalia?
Echolalia is the involuntary automatic repetition of an interviewer’s speech. This
may be observed in a variety of clinical situations:
• Transcortical sensory aphasia:
In the context of a fluent aphasia with repetition often well or normally
preserved, usually as a result of a vascular lesion of the left hemisphere
although an analogous situation may be encountered in Alzheimer’s
disease; ‘incorporational echolalia’, when the patient uses the examiner’s question to help form an answer, may be observed as a feature of ‘dynamic aphasia’ which bears resemblance to transcortical motor aphasia, but may result from a frontal lesion.
• Transcortical motor aphasia:
‘Effortful echolalia’ has been reported in the context of infarction of
the left medial frontal lobe, including the supplementary motor area,
showing that neither the ability to repeat nor fluent speech is required
for echolalia.
• Tourette syndrome:
As a complex vocal tic, along with coprolalia.
• Alzheimer’s disease, frontotemporal lobar degeneration:
As a symptom of cognitive impairment/dementia.
• Epilepsy:
From a left frontal lobe focus.
• Schizophrenia:
As a catatonic symptom.
• Early infantile autism, mental retardation:
As a reflection of pathological mental development.
• Frontal lobe lesions:
As a feature of imitation behaviour.
• Normal children:
At a particular stage of language acquisition.
What is Imitation behaviour?
A type of pathological behaviour, imitation behaviour (JB), is newly described. In this behaviour patients imitate the examiner’s gestures, although not instructed to do so. Patients explain that they thought they had to imitate the examiner.
What is Echopraxia?
Echopraxia is the involuntary, automatic, imitation of an interviewer’s movements. This may be observed as a feature of apraxic syndromes such as corticobasal degeneration, as a complex motor tic in Tourette syndrome, and in frontal lobe disorders (imitation behaviour).
What causes Mirror writing?
Writing letters backward and in reverse order, sometimes called mirror writing, may be a sign of a deteriorating brain, but in one woman’s case, researchers found that the unusual condition was actually caused by anxiety.
What is Eidetic Memory?
Photographic, or eidetic, memory is an enhancement of memory to prodigious
capacity, beyond hypermnesia. Synaesthesia may be linked to eidetic memory;
synaesthesia being used as a mnemonic aid.
What is One and a half syndrome?
One-and-a-half syndrome is a gaze abnormality characterized by a conjugate horizontal gaze palsy in one direction plus an internuclear ophthalmoplegia in the other.
What is Eight-and-a-Half Syndrome?
The combination of a facial (VII) nerve palsy with a one-and-a-half syndrome
due to a pontine lesion has been labelled the eight-and-a-half syndrome. Patients
may develop oculopalatal myoclonus months to years after the onset of the
ocular motility problem.
What does synesthesia look like?
Synesthetes — or people who have synesthesia — may see sounds, taste words or feel a sensation on their skin when they smell certain scents. They may also see abstract concepts like time projected in the space around them, like the image on the right. Many synesthetes experience more than one forms of the condition.
What is Ekbom’s Syndrome?
Patients with Ekbom’s syndrome or delusional parasitosis believe with absolute certainty that insects, maggots, lice, or other vermin infest their skin or other parts of the body. Sometimes other psychiatric features may be present, particularly if the delusions are part of a psychotic illness such as schizophrenia or depressive psychosis. Females are said to be more commonly affected. Clinical examination may sometimes show evidence of skin picking, scratching, or dermatitis caused by repeated use of antiseptics. The patient may produce skin fragments or other debris as ‘evidence’ of infestation. Treatment should be aimed at the underlying condition if appropriate; if the delusion is isolated, antipsychotics such as pimozide may be tried. Reference
What is Emotionalism, Emotional Lability?
Emotionalism, or emotional lability, or emotional incontinence, implies both
frequent and unpredictable changes in emotional expression, for example, tearfulness followed shortly by elation, and an inappropriate expression of emotion,
for example, uncontrollable (‘uninhibited’ or disinhibited) laughter or crying.
A distinction may be drawn between the occurrence of these phenomena spontaneously or without motivation, or in situations which although funny or sad are
not particularly so. Also, a distinction may be made between such phenomena
when there is congruence of mood and affect, sometimes labelled with terms such
as moria or witzelsucht (e.g. laughing when feeling happy or elated), and when
there is no such congruence (e.g. laughing when not feeling happy or elated),
sometimes labelled as pathological, forced, or inappropriate laughter and crying.
The neurobehavioral state of emotional lability reflects frontal lobe (especially orbitofrontal) lesions, often vascular in origin, and may coexist with disinhibited behaviour. It is more common in vascular dementia than in Alzheimer’s disease. It may also be seen in delirium and in psychiatric disorders (mania).
Pathological laughter and crying may occur as one component of pseudobulbar palsy (‘pseudobulbar affect’).
What is Emposthotonos?
Emposthotonos is an abnormal posture consisting of flexion of the head on the trunk and the trunk on the knees, sometimes with flexion of the limbs (cf. opisthotonos). Such attacks of ‘bowing’ may be seen in infantile epilepsy syndromes such as West’s syndrome, sometimes called salaam seizures or jack-knife spasms.
What is Encephalopathy?
Encephalopathy is a general term referring to any acute or chronic diffuse disturbance of brain function. Characteristically it is used to describe an altered
level of consciousness, which may range from drowsiness to a failure of selective
attention, to hypervigilance; with or without: disordered perception, memory
(i.e. cognitive deficits); epileptic seizures; headache; abnormal movements such
as tremor, myoclonus, or asterixis; and focal neurological deficits (less common).
Clearly, these features overlap with those of delirium.
As with terms such as coma and stupor, it is probably better to give a
description of the patient’s clinical state rather than use a term that is open to
variable interpretation. Although the term encephalopathy is sometimes reserved
for metabolic causes of diffuse brain dysfunction, this usage is not universal.
What are the causes of encephalopathy?
Conditions which may be described as an encephalopathy include
• Metabolic disorders: hypoxia/ischaemia, hypoglycaemia; organ failure, electrolyte disturbances, hypertension;
• Drug/toxin ingestion;
• Brain inflammation/infection (e.g. encephalitis);
• Miscellaneous conditions, e.g. Alzheimer’s disease, Creutzfeldt–Jakob disease.
What is Opisthotonos?
It is a symptom of some cases of severe cerebral palsy and traumatic brain injury or as a result of the severe muscular spasms associated with tetanus. It can be a feature of severe acute hydrocephalus, poisoning, and drowning.
Opisthotonus is more pronounced in infants. Opisthotonus in the neonate may be a symptom of meningitis, tetanus, severe kernicterus, or the rare maple syrup urine disease.
What is Asterixis?
It is a tremor of the hand when the wrist is extended, sometimes said to resemble a bird flapping its wings. This motor disorder is characterized by an inability to maintain a position, which is demonstrated by jerking movements of the outstretched hands when bent upward at the wrist.
What are the risk factors of asterixis?
1 Stroke. A stroke occurs when blood flow to a part of the brain is restricted. … 2 Liver disease. Liver diseases that put you at high risk of asterixis include cirrhosis or hepatitis. Both these conditions can cause scarring of the liver. 3 Kidney failure. Like the liver, the kidneys also remove toxic materials from the blood. … 4 Wilson’s disease. In Wilson’s disease, the liver doesn’t adequately process the mineral copper. If left untreated and allowed to build up, copper can damage the brain.
What are the types of New-born Reflexes?
There are other involuntary motions vital to your little one’s healthy development. Most reflexes will disappear between 3 months and 6 months of age.
Palmar grasp: If you touch the palm of your baby’s hand, his fingers will automatically curl around and cling to your finger. In other words, the new born will “hold” your hand. It’s also known as the Darwinian reflex. You can imagine how it is important it has been throughout human history for a baby to maintain a hold on his mother.
Moro reflex (or startle reflex): This reflex is why your little one reacts to a loud noise. He will involuntarily extend his arms, legs and fingers and arc
Sucking reflex: the baby will automatically begin sucking if you touch the roof of his mouth with your finger, a pacifier or a nipple.
Rooting reflex: This reflex helps your little one locates the breast or bottle to begin feeding. Try it: Stroke your new-born’s cheek. He’ll automatically open his mouth and turn his head toward the side that was stroked.
Stepping reflex: new born will look like he’s “walking,” placing one foot in front of the other when you place his feet on a flat surface.
What is the fencing reflex?
This motion causes babies to assume the “fencing position” when placed on their backs. Your baby may look like he is challenging an opponent “en garde” with an invisible foil.
What is Enophthalmos?
Enophthalmos is an inward displacement of the eyeball (sinking or withdrawal)
into the eye socket (cf. exophthalmos). It is classically described as one of
the cardinal features of Horner’s syndrome (along with miosis, ptosis, and
anhidrosis) but is seldom actually measured. Enophthalmos may also occur in
dehydration (probably the most common cause), orbital trauma (e.g. orbital
floor fracture), senile orbital fat atrophy, hemifacial atrophy, and orbital tumour
causing tethering and posterior traction on the eyeball.
What is Entomopia?
Entomopia (literally ‘insect eye’) is the name given to a grid-like pattern of multiple copies of the same visual image; hence, this is a type of polyopia. This
phenomenon has been reported in migraine; its pathogenesis is uncertain.
What is Environmental dependency syndrome?
It is also called Zelig syndrome or Zelig-like syndrome from the name of the protagonist of Woody Allen ‘s Zelig, is a syndrome where the affected individual relies on environmental cues in order to accomplish goals or tasks.
What is Cerebral diplopia?
Cerebral diplopia or polyopia describes seeing two or more images arranged in ordered rows, columns, or diagonals after fixation on a stimulus. The polyopic images occur monocular bilaterally (one eye open on both sides) and binocularly (both eyes open), differentiating it from ocular diplopia or polyopia. or polyopia describes seeing two or more images arranged in ordered rows, columns, or diagonals after fixation on a stimulus. The polyopic images occur monocular bilaterally (one eye open on both sides) and binocularly (both eyes open), differentiating it from ocular diplopia or polyopia.
What is Utilization behaviour (UB)?
It is a type of neurobehavioral disorder that involves patients grabbing objects in view and starting the ‘appropriate’ behaviour associated with it at an ‘inappropriate’ time. Utilization behaviour patients have difficulty resisting the impulse to operate or manipulate objects which are in their visual field and within reach. Characteristics of UB include unintentional, unconscious actions triggered by the immediate environment. The unpreventable excessive behaviour has been linked to lesions in the frontal lobe. UB has also been referred to as “bilateral magnetic apraxia” and “hyper metamorphosis
What is Environmental Tilt?
Environmental tilt, also known as tortopia, is the sensation that visual space is tilted on its side or even upside down (‘floor-on-ceiling’ phenomenon, ‘upside-down’ reversal of vision, verkehrtsehen). This may last seconds to minutes. The temptation to dismiss such bizarre symptoms as functional should be resisted, since environmental tilt is presumed to reflect damage to connections between cerebellar and central vestibular-otolith pathways. It has been reported in the following situations:
• Lateral medullary syndrome of Wallenberg
• Transient ischaemic attacks in basilar artery territory
• Demyelinating disease
• Head injury
• Encephalitis
• Following third ventriculostomy for hydrocephalus
What is Epiphora?
Epiphora is overflow of tears down the cheek. This may be not only due to a
blocked nasolacrimal duct, or irritation to the cornea causing increased lacrimation, but it may also be neurological in origin, e.g. due to the sagging of the lower eyelid (ectropion) in a peripheral facial (VII) nerve (Bell’s) palsy, or the ‘crocodile tears’ following aberrant facial nerve regeneration. Lacrimation is also a feature of trigeminal autonomic cephalalgias such as cluster headache.
What is Epley maneuver?
The Epley maneuver is a simple technique used to treat benign paroxysmal position vertigo (BPPV), one of the most common types of vertigo. It is safe and easy to perform at home and often relieves the dizziness, spinning, and other symptoms that make vertigo so frustrating and even harmful to those at risk of falls.
The Epley maneuver involves shifting your head in a series of rotational positions to dislodge calcium crystals (called otoliths) from the semicircular canals that cause vertigo. Some doctors recommend doing this several times daily until the symptoms fully resolve. Alternatively, a physical therapist that specializes in vestibular therapy can often do this with just one session.
What is Dix Hallpike test?
The Dix-Hallpike test (also called Nylen-Barany test) determines whether vertigo is triggered by certain head movements. Your doctor will carefully observe any involuntary eye movements (nystagmus) that may occur during this test to determine if the cause of your vertigo is central or peripheral.
What does crocodile tear mean?
It is spontaneous tearing initiated by tasting or chewing food, occurring as a result of facial paralysis.
What is Erythropsia?
This name has been given to a temporary distortion of colour vision in which
objects take on an abnormal reddish hue. This has been characterized as a
visual illusion. There are various causes, including drug use, visual diseases, and
pseudophakia.
What is Esophoria?
Esophoria is a variety of heterophoria in which there is a tendency for the
visual axes to deviate inward (latent convergent strabismus). Clinically this may
be observed using the cover–uncover test as an outward movement of the covered eye as it is uncovered. Esophoria may occur in individuals with hyperopia (long-sightedness).
What is Esotropia?
Esotropia is a variety of heterotropia in which there is manifest inward turning
of the visual axis of one eye; the term is synonymous with convergent strabismus.
It may be demonstrated using the cover test as an outward movement of the eye
which is forced to assume fixation by occlusion of the other eye.
Esotropia may be associated with congenital latent nystagmus (i.e. nystagmus appearing when one eye is covered) in the presence of amblyopia; the slow
phase in the viewing eye is towards the nose.
With lateral rectus muscle paralysis, the eyes are esotropic or crossed on
attempted lateral gaze towards the paralyzed side, but the images are uncrossed.
Acute esotropia has been described following contralateral thalamic infarction.
What is Eutonia?
Kinnier Wilson used this term to describe an emotional lack of concern associated with the dementia of multiple sclerosis. It may perhaps reflect the cognitive anosognosia of a dementia syndrome.
What is Ewart Phenomenon?
This is the elevation of ptotic eyelid on swallowing, a synkinetic movement. The
mechanism is said to be aberrant regeneration of fibres from the facial (VII)
nerve to the oculomotor (III) nerve innervating the levator palpebrae superioris
muscle.
What is Exophoria?
Exophoria is a variety of heterophoria in which there is a tendency for the
visual axes to deviate outward (latent divergent strabismus). Clinically this may
be observed in the cover–uncover test as an inward movement as the covered
eye is uncovered. Exophoria may occur in individuals with myopia and may be
physiological in many subjects because of the alignment of the orbits.
What is Exophthalmos?
Exophthalmos is forward displacement of the eyeball. The definition and the
causes overlap with proptosis. The most common cause is dysthyroid eye disease
(Graves’ disease).
What is Exosomaesthesia?
The sensory disturbance associated with parietal lobe lesions may occasionally
lead the patient to refer the source of a stimulus to some point outside the body,
exosomaesthesia. A possible example occurs in Charles Dickens’s novel Hard
Times (1854) in which Mrs Gradgrind locates her pain as ‘somewhere in the
room’.
What is Exotropia?
Exotropia is a variety of heterotropia in which there is manifest outward turning
of the visual axis of an eye; the term is synonymous with divergent strabismus.
It may be demonstrated using the cover test as an inward movement of the eye
which is forced to assume fixation by occlusion of the other eye.
When the medial rectus muscle is paralyzed, the eyes are exotropic (walleyed) on attempted lateral gaze towards the paralyzed side, and the images are crossed.
What is extensor posturing?
Decerebrate posturing is also called decerebrate response, decerebrate rigidity, or extensor posturing. It describes the involuntary extension of the upper extremities in response to external stimuli. In decerebrate posturing, the head is arched back, the arms are extended by the sides, and the legs are extended.
What is Extinction?
Extinction is the failure to respond to a novel or meaningful sensory stimulus on
one side when a homologous stimulus is given simultaneously to the contralateral
side (i.e. double simultaneous stimulation); it is sometimes called ‘suppression’.
The stimuli may be visual, auditory, or tactile, e.g. asking the patient to say
which hand is touched when the eyes are shut? It is important to show that the
patient responds appropriately to each hand being touched individually, but then
neglects one side when both are touched simultaneously. With repeated testing
the phenomenon may break down: extinguishing of extinction.
What is Eyelid Apraxia?
Eyelid apraxia is an inability to open the eyelids at will, although they may open
spontaneously at other times (i.e. voluntary–automatic dissociation). Eyelids
may be opened manually or by a backwards head thrust. The term has
been criticized on the grounds that this may not always be a true ‘apraxia’,
in which case the term ‘levator inhibition’ may be preferred since the open
eyelid position is normally maintained by tonic activity of the levator palpebrae superioris. Clinically there is no visible contraction of orbicularis oculi, which distinguishes eyelid apraxia from blepharospasm (however, perhaps paradoxically, the majority of cases of eyelid apraxia occur in association with blepharospasm). Neurophysiological studies do in fact show abnormal muscle contraction in the pretarsal portion of orbicularis oculi, which has prompted the suggestion that ‘focal eyelid dystonia’ may be a more appropriate term.
Although the phenomenon may occur in isolation, associations have been
reported with:
• Progressive supranuclear palsy (Steele–Richardson–Olszewski syndrome)
• Parkinson’s disease
• Huntington’s disease
• Multiple system atrophy
• MPTP intoxication
• Motor neurone disease
• Acute phase of non-dominant hemisphere cerebrovascular event
• Wilson’s disease
• Neuroacanthocytosis
The precise neuroanatomical substrate is unknown but the association with
basal ganglia disorders points to involvement of this region. The underlying
mechanisms may be heterogeneous, including involuntary inhibition of levator
palpebrae superioris. Botulinum toxin injections may be helpful in some patients.
What is the Face-Hand Test?
It is a quick and simple neurological test which can be used to detect organic mental disorders. It is based on the principle that when light touch stimuli are simultaneously applied to the cheek and the hand, patients with organic mental disorders frequently report only the face stimulus.
What is drop arm sign test?
It is a diagnostic test for a tear in the supraspinatus tendon. The result is positive if the patient is unable to lower the affected arm slowly and smoothly from a position of 90 degrees of abduction.
What is Facial Paresis, Facial Weakness?
Facial paresis, or prosopoplegia, may result from:
• Central (upper motor neurone) lesions
• Peripheral (lower motor neurone; facial (VII) nerve) lesions
• Neuromuscular junction transmission disorders
• Primary disease of muscle (i.e. myogenic)
Facial paresis is clinically heterogeneous which may be helpful with lesion
localization.
• Upper motor neurone facial weakness (‘central facial palsy’):
The ability to raise the eyebrow is preserved due to bilateral supranuclear connections to the frontalis muscle. A dissociation between
volitional and emotional facial movements may also occur. Emotional
facial palsy refers to the absence of emotional facial movement but
with preserved volitional movements, as may be seen with frontal lobe
(especially non-dominant hemisphere) precentral lesions (as in abulia,
Fisher’s sign) and in medial temporal lobe epilepsy with contralateral
mesial temporal sclerosis. Volitional paresis without emotional paresis
may occur when corticobulbar fibres are interrupted (precentral gyrus,
internal capsule, cerebral peduncle, upper pons).
What are Causes of upper motor neurone facial paresis?
Unilateral:
Hemisphere infarct (with hemiparesis)
Lacunar infarct (facio-brachial weakness, +/− dysphasia)
Space-occupying lesions: intrinsic tumour, metastasis, abscess
Bilateral:
Motor neurone disease
Diffuse cerebrovascular disease
Pontine infarct (locked-in syndrome)
What are signs of Lower motor neurone facial weakness (peripheral origin)?
If this is due to facial (VII) nerve palsy, it results in ipsilateral
weakness of frontalis (cf. upper motor neurone facial paresis), orbicularis oculi, buccinator, orbicularis oris, and platysma. Clinically this
produces drooping of the side of the face with loss of the nasolabial fold;
widening of the palpebral fissure with failure of lid closure (lagophthalmos);
eversion of the lower lid (ectropion) with excessive tearing (epiphora);
inability to raise the eyebrow, close the eye, frown, blow out the
cheek, show the teeth, laugh, and whistle;
+/− dribbling of saliva from the paretic side of the mouth;
depression of the corneal reflex (efferent limb of reflex arc affected);
speech alterations: softening of labials (p, b).
Depending on the precise location of the facial nerve injury, there may also
be paralysis of the stapedius muscle in the middle ear, causing sounds to seem
abnormally loud (especially low tones: hyperacusis), and impairment of taste sensation on the anterior two-thirds of the tongue if the chorda tympani is affected
(ageusia, hypogeusia). Lesions within the facial canal distal to the meatal segment cause both hyperacusis and ageusia; lesions in the facial canal between the
nerve to stapedius and the chorda tympani cause ageusia but no hyperacusis;
lesions distal to the chorda tympani cause neither ageusia nor hyperacusis (i.e.
facial motor paralysis only). Lesions of the cerebellopontine angle cause ipsilateral hearing impairment and corneal reflex depression (afferent limb of reflex arc
affected) in addition to facial weakness. There is also a sensory branch to the
posterior wall of the external auditory canal which may be affected resulting in
local hypoaesthesia (Hitselberg sign).
What are the Causes of lower motor neurone facial paresis?
• Bell’s palsy: idiopathic lower motor neurone facial weakness, assumed to
result from a viral neuritis
• Herpes zoster (Ramsey Hunt syndrome)
• Diabetes mellitus
• Lyme disease (neuroborreliosis, Bannwarth’s disease)
• Sarcoidosis
• Leukaemic infiltration, lymphoma
• HIV seroconversion
• Neoplastic compression (e.g. cerebellopontine angle tumour; rare)
• Facial nerve neuroma
These latter conditions may need to be differentiated from Bell’s palsy.
Causes of recurrent facial paresis of lower motor neurone type include
• Diabetes mellitus
• Lyme disease (neuroborreliosis, Bannwarth’s disease)
• Sarcoidosis
• Leukaemia, lymphoma
In myasthenia gravis, a disorder of neuromuscular transmission at the neuromuscular junction, there may be concurrent ptosis, diplopia, bulbar palsy, and
limb weakness and evidence of fatigable weakness.
Myogenic facial paresis may be seen in facioscapulohumeral (FSH) dystrophy, myotonic dystrophy, and mitochondrial disorders. In primary disorders of
muscle the pattern of weakness and family history may suggest the diagnosis.
What is Facilitation?
Facilitation is an increase in muscle strength following repeated contraction.
Clinically, facilitation may be demonstrated by the appearance of tendon reflexes
which are absent at rest after prolonged (ca. 30 s) forced maximal contractions
against resistance, e.g. the biceps jerk after elbow flexion, knee jerk after knee
extension; and by Lambert’s sign (increased force grip with sustained contraction; this increase in strength of affected muscles detected in the first few seconds
of maximal voluntary contraction may also be known as augmentation).
This phenomenon of post tetanic potentiation is most commonly seen in
the Lambert–Eaton myasthenic syndrome (LEMS), a disorder of neuromuscular junction transmission associated with the presence of autoantibodies directed
against presynaptic voltage-gated calcium ion (Ca2+) channels (VGCC). The
mechanism is thought to be related to an increased build-up of Ca2+ ions within
the presynaptic terminal with the repetitive firing of axonal action potentials,
partially overcoming the VGCC antibody-mediated ion channel blockade, and
leading to release of increasing quanta of acetylcholine.
What is Lambert’s sign “?
Strength improves further with repeated testing, e.g. improvement of power on repeated hand grip (a phenomenon known as ” Lambert’s sign “). At rest, reflexes are typically reduced; with muscle use, reflex strength increases. This is a characteristic feature of LEMS. The pupillary light reflex may be sluggish.
What is Lambert-Eaton myasthenic syndrome (LEMS)?
Lambert-Eaton myasthenic syndrome (LEMS) is a rare presynaptic disorder of neuromuscular transmission in which quantal release of acetylcholine (ACh) is impaired, causing a unique set of clinical characteristics, which include proximal muscle weakness, depressed tendon reflexes, post tetanic potentiation, and autonomic changes.
What is False-Localizing Signs?
Neurological signs may be described as ‘false-localizing’ when their appearance reflects pathology distant from the expected anatomical locus. The classic
example, and probably the most frequently observed, is abducens nerve palsy
(unilateral or bilateral) in the context of raised intracranial pressure, presumed
to result from stretching of the nerve over the ridge of the petrous temporal
bone. Many false-localizing signs occur in the clinical context of raised intracranial pressure, either idiopathic (idiopathic intracranial hypertension [IIH]) or
symptomatic (secondary to tumour, haematoma, abscess). A brief topographical
overview of false-localizing signs (more details may be found in specific entries)
includes
• Motor system:
Kernohan’s notch syndrome: false-localizing hemiparesis
Cerebellar syndrome with anterior cerebral artery territory infarction
damaging frontocerebellar pathways
Brainstem compression causing diaphragm paralysis
• Sensory system:
Sensory level with parietal lobe lesion
• Cranial nerves:
Proptosis with middle cranial fossa tumour
Oculomotor (III) nerve palsy with contralateral supratentorial lesion
Divisional oculomotor nerve palsy with brainstem or subarachnoid
space pathology
Trochlear nerve palsy with IIH
Trigeminal nerve palsy with IIH
Abducens nerve palsy with IIH
Facial nerve palsy with IIH
Vestibulocochlear nerve dysfunction with IIH.
• Spinal cord and roots:
Foramen magnum/upper cervical cord lesion causing hand muscle
wasting (‘remote atrophy’)
Lower cervical/upper thoracic myelopathy producing midthoracic girdle sensation
Urinary retention with rostral spinal cord compression
Radiculopathy with IIH, may even mimic Guillain–Barré syndrome
What is fan sign?
Signe de l’éventail is the fanning of the toes on eliciting Babinski’s plantar sign.
What is Kernohan’s notch?
It is a cerebral peduncle indentation associated with some forms of transtentorial herniation (uncal herniation). It is a secondary condition caused by a primary injury on the opposite hemisphere of the brain. Kernohan’s notch is an ipsilateral condition, in that a left-sided primary lesion (in which Kernohan’s notch would be on the right side) evokes motor impairment in the left side of the body and a right-sided primary injury evokes motor impairment in the right side of the body.
What is Fasciculation?
Fasciculations are rapid, flickering, twitching, involuntary movements within a
muscle belly resulting from spontaneous activation of a bundle, or fasciculus, of
muscle fibres (i.e. a motor unit), insufficient to move the joint. Fasciculations may
also be induced by lightly tapping over a partially denervated muscle belly. The
term was formerly used synonymously with fibrillation, but the latter term is now
reserved for contraction of a single muscle fibre or a group of fibres smaller than
a motor unit.
Brief and localized fasciculations can be a normal finding
Fasciculations may be seen in:
• Motor neurone disease with lower motor neurone involvement (i.e. progressive muscular atrophy, progressive bulbar atrophy variants)
• Spinal muscular atrophy
• Cervical radiculopathy (restricted to myotomal distribution)
• Multifocal motor neuropathy with conduction block
• Benign fasciculation syndrome: typically seen only after exercise and without associated muscle atrophy or weakness
• Cramp fasciculation syndrome
• Spinal and bulbar muscular atrophy (Kennedy’s disease), especially perioral
• Almost any lower motor neurone disease, especially compression
• Metabolic causes: thyrotoxicosis, tetany, after acetylcholinesterase
inhibitors, anaesthetic muscle relaxants
Fasciculations may need to be distinguished from myokymia or neuromyotonia.
What is Fast Micrographia?
In ‘fast’ micrographia, written letters are microscopic from the outset, sometimes approximating to a straight line, though produced at normal speed without fatigue. This pattern has been observed in progressive supranuclear palsy and with globus pallidus lesions, and contrasts with the ‘slow’ micrographia, meaning writing which becomes progressively slower and smaller, as seen in idiopathic Parkinson’s disease.
What is Fatigue?
The term fatigue may be used in different contexts to refer to both a sign and a symptom.
The sign of fatigue, also known as peripheral fatigue, consists of a reduction in muscle strength or endurance with repeated muscular contraction. This
most characteristically occurs in disorders of neuromuscular junction transmission (e.g. myasthenia gravis), but it may also be observed in disorders of muscle
(e.g. myopathy, polymyositis) and neurogenic atrophy (e.g. motor neurone disease). In myasthenia gravis, fatigue may be elicited in the extraocular muscles
by prolonged upgaze causing eyelid drooping; in bulbar muscles by prolonged
counting or speech causing hypophonia; and in limb muscles by repeated contraction, especially of proximal muscles (e.g. shoulder abduction, ‘wing flaps’)
leading to weakness in previously strong muscles. Fatigue in myasthenia gravis is
thought to be caused by a decline in the amount of acetylcholine released from
motor nerve terminals with successive neural impulses, along with a reduced
number of functional acetylcholine receptors (AChR) at the motor end-plates,
due to binding of AChR antibodies and/or complement-mediated destruction of
the postsynaptic folds.
Fatigue as a symptom, or central fatigue, is an enhanced perception of effort
and limited endurance in sustained physical and mental activities. This may
occur in multiple sclerosis (MS), post-polio syndrome, post-stroke syndromes,
and chronic fatigue syndrome (CFS). In MS and CFS, fatigue may be a prominent and disabling complaint even though neurological examination reveals little
or no clinical deficit. This type of fatigue is ill-understood: in MS, frequency dependent conduction block in demyelinated axons has been suggested, as has hypothalamic pathology.
Current treatment is symptomatic (amantadine, modafinil, 3,4-diaminopyridine) and rehabilitative (graded exercise).
What is Femoral Stretch Test?
The femoral stretch test, or reverse straight leg raising test, consists of extension of the hip with the knee straight with the patient lying prone, a manoeuvre which puts traction on the femoral nerve or L3 root and may exacerbate pain in a femoral neuropathy or L3 radiculopathy, perhaps caused by a retroperitoneal haemorrhage.
What is Fencer’s Posture, Fencing Posture?
Epileptic seizures arising in or involving the supplementary motor area may lead to adversial head and eye deviation, abduction and external rotation of the contralateral arm, flexion at the elbows, and posturing of the legs, with maintained consciousness, a phenomenon christened by Penfield as the ‘fencing posture’ because of its resemblance to the en garde position. These may also be known as ‘salutatory seizures’.
What is Festinant Gait, Festination?
Festinant gait or festination is a gait disorder characterized by rapid short steps (Latin: festinare, to hurry, hasten, accelerate) due to inadequate maintenance of the body’s centre of gravity over the legs. To avoid falling and to maintain balance the patient must ‘chase’ the centre of gravity, leading to an increasing speed of gait and a tendency to fall forward when walking (propulsion). A similar
phenomenon may be observed if the patient is pulled backwards (retropulsion).
Festination may be associated with freezing of gait.
Festination is common in idiopathic Parkinson’s disease; it is associated with
longer duration of disease and higher Hoehn & Yahr stage. Festination may be
related to the flexed posture and impaired postural reflexes commonly seen in
these patients. It is less common in symptomatic causes of parkinsonism, but has
been reported, for example, in aqueduct stenosis.
What is Fibrillation?
Fibrillation was previously synonymous with fasciculation, but the term is now
reserved for the spontaneous contraction of a single muscle fibre, or a group of
fibres smaller than a motor unit, hence this is more appropriately regarded as an
electrophysiological sign without clinical correlate.
What is Finger Agnosia?
Finger agnosia is a type of tactile agnosia, in which there is inability to identify
which finger has been touched when the eyes are closed, despite knowing that
a finger has been touched; or inability to point to or move a finger when it is
named; or inability to name the fingers (patient’s own fingers or those of another
person). This is a disorder of body schema and may be regarded as a partial form
of autotopagnosia.
Finger agnosia is most commonly observed with lesions of the dominant
parietal lobe. It may occur in association with acalculia, agraphia, and right–
left disorientation, with or without alexia and difficulty spelling words, hence as
one feature of Gerstmann syndrome. Isolated cases of finger agnosia in association with left cortico subcortical posterior parietal infarction have been reported.
Since this causes no functional deficit, it may be more common than reported.
What is finger chase test?
Proband is asked to point repeatedly with his index finger from his nose to examiner’s finger which is in front of the proband at about 90 % of proband’s reach. Movements are performed at moderate speed. Average performance of movements is rated according to the amplitude of the kinetic tremor. Finger chase (0 to 4) Nose-finger test (0 to 4) Fast alternating hand movements (0 to 4) Heel-shin slide (0 to 4) Limb kinetic functions (items 5 to 8) are rated independently for both body sides, and its arithmetic mean is included in total score. Ataxic stroke: (Kim et al, 2011; n=52; mean age= 61.63 ± 15.30 years; Independent gait group= 26, Q-Cane gait group= 8, Independent walker gait group= 12, etc
What is finger drop?
It is an avulsion, partial or complete, of the long finger extensor from the base of the distal phalanx, resulting in the inability to fully extend the distal interphalangeal joint actively. Synonym(s): baseball finger, drop finger, hammer finger.
What is Finger–Floor Distance?
In patients with leg (+/−low back) pain suspected of having lumbosacral nerve
root compression, a finger–floor distance of >25 cm when the patient bends forward and attempts to touch the floor with the fingers has been found to be an
independent predictor of radiological (MR imaging) compression. This was not
the case for the straight leg raising test.
What is Fisher’s Sign?
Fisher’s sign is the paucity of facial expression conveying emotional states or
attitudes (emotional facial paresis). It follows non-dominant (right) hemisphere
lesions and may accompany emotional dysprosody of speech.
What is Fist-Edge-Palm Test?
In the fist-edge-palm test, sometimes known as the Luria test or three-step motor
sequence, the patient is requested to place the hand successively in three positions, imitating movements made by the examiner and then doing them alone:
fist, vertical palm, palm resting flat on table. Copying motor sequences assesses
motor programming ability. Defects in this programming, such as lack of kinetic
melody, loss of sequence, or repetition of previous pose or position, are especially conspicuous with anterior cortical lesions. This test is incorporated into the Frontal Assessment Battery.
What is Flaccidity?
Flaccidity is a floppiness which implies a loss of normal muscular tone (hypotonia). This may occur transiently after acute lesions of the corticospinal tracts
(flaccid paraparesis), before the development of spasticity, or as a result of lower
motor neurone syndromes. It is difficult to separate the change in tone from
weakness.
What is Flail Arm?
Flail arm refers to a severe and symmetric wasting and weakness of the
arms without significant functional involvement of other regions, seen in one
variant of motor neurone disease, the ‘flail arm syndrome’, also known as
Vulpian–Bernhart’s form. Men are reported to be much more frequently affected
than women, and this group may show improved survival compared to other
MND patients. Alternative designations for this syndrome include amyotrophic
brachial diplegia, dangling arm syndrome, and neurogenic man-in-a-barrel syndrome. It has been suggested that prognosis may be relatively good in this variant
as compared to other manifestations of MND. Cognition may be relatively well
preserved.
What is Man-in-the-barrel syndrome?
It is a neurological syndrome characterized by bilateral brachial muscular weakness.
What is Flexion–Adduction Sign?
Neuralgic amyotrophy (Parsonage–Turner syndrome) may cause arm pain,
which may be prevented by holding the arm flexed at the elbow and adducted
at the shoulder.
What are types of posturing?
Three types of abnormal posturing are decorticate posturing, with the arms flexed over the chest; decerebrate posturing, with the arms extended at the sides; and opisthotonos, in which the head and back are arched backward.
What do the posturing indicate?
Decorticate posturing indicates that there may be damage to areas including the cerebral hemispheres, the internal capsule, and the thalamus. Decerebrate posturing indicates brain stem damage, specifically damage below the level of the red nucleus (e.g. mid-collicular lesion). It is exhibited by people with lesions or compression in the midbrain and lesions in the cerebellum. Opisthotonus is a symptom of some cases of severe cerebral palsy and traumatic brain injury or as a result of the severe muscular spasms associated with tetanus.
What is Flexor Posturing?
Decorticate rigidity or decorticate posturing is a type of abnormal posturing also called as flexor posturing, colloquially or mummy baby. It is characterized by the 4+ sustained contraction response and posturing of the upper limbs in flexion and the lower limbs in extension.
What is Flick Sign?
A flicking, shaking movement of the hands made by patients with carpal tunnel
syndrome to try to relieve the paraesthesia and pain caused by the condition,
typically noted on waking at night. This may be the most sensitive and specific
of the various signs described in carpal tunnel syndrome.
What is Carphologia?
Carphologia (or carphology) is a lint-picking behaviour that is often a symptom of a delirious state. Often seen in delirious or semiconscious patients, carphologia describes the actions of picking or grasping at imaginary objects, as well as the patient’s own clothes or bed linens. This can be a grave symptom in cases of extreme exhaustion or approaching death.
What is Flynn Phenomenon?
Flynn phenomenon is paradoxical constriction of the pupils in darkness. This
has been documented in various conditions including congenital achromatopsia,
following optic neuritis, and in autosomal dominant optic atrophy.
What is Foot Drop?
Foot drop, often manifest as the foot dragging during the swing phase of the
gait, causing tripping and/or falls, may be due to upper or lower motor neurone
lesions, which may be distinguished clinically.
• Stiff foot drop, with upper motor neurone lesions:
leads to a circumducting gait; it may be possible to see or hear the foot
dragging or scuffing along the floor, and this may cause excessive wear
on the point of the shoe. There will be other upper motor neurone signs
(hemiparesis; spasticity, clonus, hyperreflexia, Babinski’s sign).
• Floppy foot drop, with lower motor neurone lesions:
leads to a stepping gait (steppage) to try to lift the foot clear of the
floor in the swing phase, and a slapping sound on planting the foot. At
worst, there is a flail foot in which both the dorsiflexors and the plantar
flexors of the foot are weak (e.g. in high sciatic nerve or sacral plexus
lesions). Other lower motor neurone signs may be present (hypotonia,
areflexia, or hyporeflexia).
What are the causes of floppy foot drop?
Causes of floppy foot drop include
• Common peroneal nerve palsy
• Sciatic neuropathy
• Lumbosacral plexopathy
• L4/L5 radiculopathy
• Motor or sensorimotor polyneuropathy (e.g. hereditary motor and sensory
neuropathy)
• Motor neuronopathy (anterior horn cell disease)
• Mononeuropathy multiplex
These may be distinguished on clinical and/or neurophysiological grounds
What is Forced Ductions?
Forced ductions, performed by grasping the anaesthetized sclera with forceps
and then moving the eye through its range of motions, may be used to determine
whether restricted eye movement is mechanical, due to a lesion within the orbit,
such as thyroid ophthalmopathy or superior oblique tendon sheath (Brown’s)
syndrome.
What is Forced Groping?
Forced groping describes involuntary movements of a hand, as if searching for
an object or item which has touched or brushed against it; the hand may follow
the object around if it moves (magnetic movements). There may be an accompanying grasp reflex. This type of behaviour may be displayed by an alien hand,
most usually in the context of corticobasal degeneration. Forced groping may
be conceptualized as an exploratory reflex which is ‘released’ from frontal lobe
control by a pathological process, as in utilization behaviour.
What is Forced Upgaze?
Tonic upward gaze deviation, forced upgaze, may be seen in coma after diffuse
hypoxic–ischaemic brain injury with relative sparing of the brainstem. Forced
upgaze may also be psychogenic, in which case it is overcome by cold caloric
stimulation of the ear drums. Forced upgaze must be differentiated clinically from
oculogyric crisis.
What is Forearm and Finger Rolling?
The forearm and finger rolling tests detect subtle upper motor neurone lesions
with high specificity and modest sensitivity. Either the forearms or the index fingers are rapidly rotated around each other in front of the torso for about 5 s, then the direction reversed. Normally the appearance is symmetrical but with a unilateral upper motor neurone lesion one arm or finger remains relatively stationary, with the normal rotating around the abnormal limb. Thumb rolling might also be a sensitive test for subtle upper motor neurone pathology.
What is Foreign Accent Syndrome?
The foreign accent syndrome is a rare phonological disorder, such that speech
production includes non-native vowels or consonants and hence sounds as
though it is foreign, or different from the speakers native intonation. There is
no language disorder since comprehension of spoken and written language is
preserved; hence it is qualitatively different from Broca’s aphasia. This syndrome
probably overlaps with other disorders of speech production, labelled as phonetic
disintegration, pure anarthria, aphemia, apraxic dysarthria, verbal or speech
apraxia, and cortical dysarthria. Case heterogeneity is noted; some cases may
be non-organic.
What is Formication?
Formication is a tactile hallucination, as of ants crawling over the skin.
What is Fortification Spectra?
Fortification spectra, also known as teichopsia, are visual hallucinations which
occur as an aura, either in isolation (migraine aura without headache) or prior to
an attack of migraine (migraine with aura; ‘classical migraine’). The appearance is a radial array likened to the design of medieval castles, not simply of battlements. Hence these are more complex visual phenomena than simple flashes of light (photopsia) or scintillations. They are thought to result from spreading depression, of possible ischaemic origin, in the occipital cortex. The visions of Hildegard von Bingen (1098–1179), illustrated in the twelfth century, are thought possibly to reflect migrainous fortification spectra.
What is Foster Kennedy Syndrome?
The Foster Kennedy syndrome consists of optic atrophy in one eye with optic disc
oedema in the other eye, Anosmia ipsilateral to optic atrophy may also be found.
This is classically due to a tumour, typically an olfactory groove meningioma,
which compresses the ipsilateral optic nerve to cause atrophy, and raises intracranial pressure to cause contralateral papilloedema. Similar clinical appearances
may occur with sequential anterior ischaemic optic neuropathy, sometimes called
a pseudo-Foster Kennedy syndrome.
What is Fou Rire Prodromique?
Fou rire prodromique, or laughing madness, first described by Féré in 1903,
is pathological laughter which heralds the development of a brainstem stroke,
usually as a consequence of basilar artery occlusion.
What is ‘folles larmes prodromiques’.?
Pathological crying as a prodrome of brainstem stroke has also been described (‘folles larmes prodromiques’).
What is Freezing?
Freezing is the sudden inability in a patient with parkinsonism to move or to
walk, i.e. gait failure, as though the patient were turned to ice or the feet were
nailed to the floor. This is one of the unpredictable motor fluctuations in late
Parkinson’s disease (associated with longer duration of disease and treatment)
which may lead to falls, usually forward onto the knees, and injury. It may occur
in confined spaces (e.g. doorways), when trying to turn, or when trying to do two
things at once. It is not seen in the early years of levodopa therapy. Two variants
are encountered, occurring either during an off period or wearing off period, or
randomly, i.e. unrelated to drug dosage or timing.
Treatment strategies include use of dopaminergic agents and, anecdotally,
L-threodops, but these agents are not reliably helpful, particularly in random
freezing. Use of visual targets (real or imagined) may help, e.g. stepping over
a line. Freezing may also occur in multiple system atrophy and has also been
reported as an isolated phenomenon.
What is Fregoli delusion?
Fregoli delusion is a disorder in which the affected individual forms a delusional belief that several different people, usually people close to the individual, are in fact just one single person who repeatedly changes their appearance or form.
What are the symptoms of Cotard’s syndrome?
The list of signs and symptoms mentioned in various sources for Cotard syndrome includes the symptoms listed below: Depression. Suicidal thoughts. Negative thoughts. Belief that their body doesn’t exist. Belief they are already dead. Belief they are immortal.
What are the symptoms of Capgras delusion?
The list of signs and symptoms mentioned in various sources for Capgras’ syndrome includes Delusions and belief that a relative or friend has been replace by an imposter.
What is Frey’s Syndrome?
Frey’s Syndrome is a syndrome that includes sweating while eating (gustatory sweating) and facial flushing. It is caused by injury to a nerve, called the auriculotemporal nerve, typically after surgical trauma to the parotid gland.
What is Froment’s Sign?
Froment has two eponymous signs:
• Activated rigidity or synkinesis; sometimes known as Froment’s manoeuvre.
• In an ulnar nerve lesion, flexion of the distal phalanx of the thumb (flexor
pollicis longus, innervated by the median nerve) is seen when attempting
to squeeze a sheet of paper between the thumb and the index finger, as
a compensation for the weakness of thumb adduction (adductor pollicis,
innervated by the ulnar nerve), also known as Froment’s prehensile thumb
sign or the signe du journal. The term is also sometimes used for weakness
of little finger adduction (palmar interossei), evident when trying to grip a
piece of paper between the ring and little finger.
What is Wartenberg s sign?
Wartenberg’s sign is a neurological sign consisting of involuntary abduction of the fifth (little) finger, caused by unopposed action of the extensor digiti minimi. This commonly results from weakness of some of the ulnar nerve innervated intrinsic hand muscles -in particular the palmar interosseous muscle.
What is Frontal Lobe Syndromes?
The frontal lobes of the brain have enlarged greatly during phylogeny; their
diverse connections with the basal ganglia, basal forebrain, and cerebellum, as
well as other cortical areas, reflect their multiple motor and behavioural functions. Damage to the frontal lobes may produce a variety of clinical signs, most frequently changes in behaviour. Such changes may easily be overlooked with the traditional neurological examination, although complained of by patient’s relatives, and hence specific bedside tests of frontal lobe function should be utilized, for example:
• Verbal fluency: e.g. letter/phonemic (F, A, S) probably a more specific test
than category/semantic (animals, foods).
• Proverb interpretation: e.g. ‘Make hay while the sun shines’’ Too many cooks
spoil the broth’; interpretation tends to be concrete in frontal lobe disorders.
• Cognitive estimates: e.g. height of the Post Office Tower, length of a man’s
spine, distance from London to Edinburgh; may be grossly abnormal or
inappropriate.
A useful clinico-anatomical classification of frontal lobe syndromes which
reflects the functional subdivisions of the frontal lobes is as follows:
• Orbitofrontal syndrome (‘disinhibited’):
disinhibited behaviour (including sexual disinhibition), impulsivity
inappropriate affect, witzelsucht, euphoria
emotional lability (moria)
lack of judgement, insight
distractibility, lack of sustained attention; hyper metamorphosis
motor perseverations are not a striking feature
• Frontal convexity syndrome (‘apathetic’):
apathy; abulia, indifference
motor perseveration
difficulty set-shifting, stimulus boundedness
reduced verbal fluency
deficient motor programming, e.g. three-step hand sequence, rhythmical tapping (go/no-go test).
• Medial frontal syndrome (‘akinetic’):
little spontaneous movement, bradykinesia, hypokinesia
sparse verbal output (akinetic mutism)
urinary incontinence
sensorimotor signs in lower limbs
indifference to pain
Overlap between these regional syndromes may occur.
A ‘dysexecutive syndrome’ has also been defined, consisting of difficulty
planning, adapting to changing environmental demands (impaired cognitive flexibility, e.g. in set-shifting tests), and directing attentional resources. This may be
seen with dorsolateral (prefrontal) damage.
These frontal lobe syndromes may be accompanied by various neurological
signs (frontal release signs or primitive reflexes). Other phenomena associated
with frontal lobe pathology include imitation behaviours (echophenomena) and,
less frequently, utilization behaviour, features of the environmental dependency
syndrome.
What are the causes of frontal lobe syndrome?
Frontal lobe syndromes may occur as a consequence of various pathologies:
• Neurodegenerative diseases: especially frontal or behavioural variant frontotemporal lobar degeneration; occasionally in Alzheimer’s disease;
• Structural lesion: tumour (intrinsic, extrinsic), normal pressure hydrocephalus;
• Cerebrovascular event;
• Head injury;
• Inflammatory metabolic disease: multiple sclerosis, X-linked adrenoleucodystrophy.
What is Dysexecutive Syndrome?
Dysexecutive syndrome (DES) consists of a group of symptoms, usually resulting from brain damage, that fall into cognitive, behavioural and emotional categories and tend to occur together. The term was introduced by Alan Baddeley to describe a common pattern of dysfunction in executive functions, such as planning, abstract thinking, flexibility and behavioural control. It is thought to be Baddeley’s hypothesized working memory system and the central executive that are the hypothetical systems impaired in DES. The syndrome was once known as frontal lobe syndrome, however dysexecutive syndrome is preferred because it emphasizes the functional pattern of deficits (the symptoms) over the location of the syndrome in the frontal lobe, which is often not the only area affected.
What is Witzelsucht?
It is a set of pure and rare neurological symptoms characterized by a tendency to make puns, or tell inappropriate jokes or pointless stories in socially inappropriate situations. It makes one unable to read sarcasm. A less common symptom is hypersexuality, the tendency to make sexual comments at inappropriate times or situations.
What is Utilization behaviour?
It is a type of neurobehavioral disorder that involves patients grasping or using objects that are within reach or in the field of vision and starting the ‘appropriate’ Behavior associated with it at an ‘inappropriate’ time. While objects may be used correctly, the behaviour occurs in a context that is inappropriate.
What is Frontal Release Signs?
Frontal release signs are so named because of the belief that they are released from frontal inhibition by diffuse pathology within the frontal lobes (usually vascular or degenerative) with which they are often associated, although they may be a feature of normal ageing. Some of these responses are present during infancy but disappear during childhood, hence the terms ‘primitive reflexes’ or ‘developmental signs’ are also used (Babinski’s sign may therefore fall into this category).
The term ‘psychomotor signs’ has also been used since there is often accompanying change in mental status. The frontal release signs may be categorized as:
• Prehensile:
Sucking reflex (tactile, visual)
Grasp reflex: hand, foot
Rooting reflex (turning of the head towards a tactile stimulus on the
face)
• Nociceptive:
Snout reflex
Pout reflex
Glabellar (blink) reflex
Palmomental reflex
The corneomandibular and nuchocephalic reflexes may also be categorized
as ‘frontal release’ signs.
Some are of little clinical value (e.g. palmomental reflex). Concurrent clinical
findings may include dementia, gait disorder (frontal gait, marche à petit pas),
urinary incontinence, akinetic mutism, and gegenhalten. Common causes of these
findings are diffuse cerebrovascular disease and motor neurone disease, and they
may be more common in dementia with Lewy bodies than other causes of an
extrapyramidal syndrome. All increase with age in normal individuals.
What is Fugue?
Fugue, and fugue-like state, is used to refer to a syndrome characterized by loss of
personal memory (hence the alternative name of ‘twilight state’), automatic and
sometimes repetitive behaviours, and wandering or driving away from normal
surroundings. Fugue may be:
• Psychogenic: associated with depression (sometimes with suicide); alcoholism, amnesia; ‘hysteria’
• Epileptic: complex partial seizures
• Narcoleptic
Some patients with frontotemporal dementia may spend the day walking
long distances, and may be found a long way from home, unable to give an
account of themselves, and aggressive if challenged; generally, they are able to
find their way home (spared topographical memory) despite their other cognitive
deficits.
What is Poriomania?
Impulsive, aimless wandering, especially as a manifestation of epilepsy and accompanied by retrograde amnesia; an instance of this.
What is Functional Weakness and Sensory Disturbance?
Various signs have been deemed useful indicators of functional or ‘non-organic’
neurological illness, including
• Collapsing or ‘give way’ weakness
• Hoover’s sign
• Babinski’s trunk–thigh test
• ‘Arm drop’
• Belle indifference
• Sternocleidomastoid sign
• Midline splitting sensory loss
• Functional postures, gaits:
monoplegic ‘dragging’
fluctuation of impairment
excessive slowness, hesitation
‘psychogenic Romberg’ sign
‘walking on ice’
uneconomic posture, waste of muscle energy.
sudden knee buckling
Although such signs may be suggestive, their diagnostic utility has never
been formally investigated in prospective studies, and many, if not all, have been
reported with ‘organic’ illness. Hence it is unwise to rely on them as diagnostic
indicators.
What does it mean to have tunnel vision?
Tunnel vision occurs when one loses visual acuity in the peripheral visual fields while retaining visual acuity in the central regions. The vision can be considered to be constricted and concentrated in the central area, as when one is inside a tunnel looking out.
What is Sternocleidomastoid test?
As the sternocleidomastoid is often over-active and the upper trapezius Manual muscle testing (MMT) will often highlight marked weakness in those. An Applied Kinesiology doctor performs manual muscle tests to evaluate the function of the nervous system.
What is the significance of Hoover s sign?
Hoover’s sign (leg paresis) Hoover’s sign of leg paresis is one of two signs named for Charles Franklin Hoover. It is a maneuver aimed to separate organic from non-organic paresis of the leg. The sign relies on the principle of synergistic contraction. Hoover’s sign in pulmonology is one of two signs named for Charles Franklin Hoover. It refers to inward movement of the lower rib cage during inspiration, – instead of outward as is normal – implying a flat, but functioning, diaphragm, often associated with COPD.
What does Hawthorne effect mean?
Hawthorne effect. The Hawthorne effect (also referred to as the observer effect) is a type of reactivity in which individuals modify an aspect of their behaviour in response to their awareness of being observed.
What is an example of the Hawthorne effect?
The Hawthorne Effect is a phenomenon in which individuals alter their behaviour in response to being observed, and usually refers to positive changes. Workers participating in a study might, for example, temporarily become more productive as a result of being observed.
What is Harvey’s sign?
English physician who discovered the mechanism of the human blood circulation, in which blood flows away from the heart in arteries and towards the heart in veins.
What is Collapsing weakness?
A common finding in functional weakness is that of “collapsing weakness,” in which a limb collapses from a normal position with a light touch (or occasionally, even before your hand has touched the limb). Normal power can often be achieved transiently with encouragement.
What is Gag Reflex?
The gag reflex is elicited by touching the posterior pharyngeal wall, tonsillar
area, or the base of the tongue, with the tip of a thin wooden (‘orange’) stick.
Depressing the tongue with a wooden spatula, and the use of a torch for illumination of the posterior pharynx, may be required to get a good view. There
is a palatal response (palatal reflex), consisting of upward movement of the soft
palate with ipsilateral deviation of the uvula; and a pharyngeal response (pharyngeal reflex or gag reflex) consisting of visible contraction of the pharyngeal wall.
Dysphagia is common after a stroke, and the gag reflex is often performed
to assess the integrity of swallowing. Some argue that absence of the reflex does
not predict aspiration and is of little diagnostic value, since this may be a normal
finding in elderly individuals, whereas pharyngeal sensation (feeling the stimulus
at the back of the pharynx) is rarely absent in normals and is a better predictor
of the absence of aspiration. Others find that even a brisk pharyngeal response
in motor neurone disease may be associated with impaired swallowing. Hence
the value of the gag reflex remains debatable. A video swallow may be a better
technique to assess the integrity of swallowing.
What is Gait Apraxia?
Gait apraxia is a name given to an inability to walk despite intact motor systems
and sensorium. Patients with gait apraxia are often hesitant, seemingly unable to
lift their feet from the floor (‘magnetic gait’) or put one foot in front of the other.
Arms may be held out at the sides to balance for fear of falling; fear may be so
great that the patient sits in a chair gripping its sides. These phenomena may be
observed with lesions of the frontal lobe and white matter connections, with or
without basal ganglia involvement, for example, in diffuse cerebrovascular disease and normal pressure hydrocephalus. A syndrome of isolated gait apraxia
has been described with focal degeneration of the medial frontal lobes. In modern classifications of gait disorders, gait apraxia is subsumed into the categories
of frontal gait disorder, frontal disequilibrium, and isolated gait ignition failure.
Gait apraxia is an important diagnosis to establish since those afflicted generally respond poorly, if at all, to physiotherapy; moreover, because both patient
and therapist often become frustrated because of lack of progress, this form of
treatment is often best avoided.
What is Gambling?
Gambling may be defined as pathological when greater risks are taken and potential losses are
correspondingly greater; this may be classified as an impulse control disorder.
Pathological gambling may occur in patients with Parkinson’s disease treated
with various dopamine agonists and in frontal variant frontotemporal dementia
patients who display risky decision-making, even in early disease and without
evidence of behavioural disinhibition or impulsiveness.
What is Punding?
It is a compulsive need to carry out a repetitive motor behaviour such as sorting materials that you are no longer using, counting small objects, lining them up and then counting them again, or taking everything out of a drawer, examining it, and then doing it all over again.
What is Autoimmune autonomic ganglionopathy (AAG)?
It is a rare autoimmune disorder in which the body’s immune system mistakenly attacks and damages certain parts of the autonomic nervous system.
What is Ganser Phenomenon, Ganser Syndrome?
The Ganser phenomenon consists of giving approximate answers to questions
which can at times verge on the absurd (Q: ‘How many legs does a cow have?’; A:
‘Three’), also known as paralogia or vorbereiden. This may occur in psychiatric
disease such as depression, schizophrenia, and malingering, and sometimes in
neurological disease (head injury, epilepsy). A Ganser syndrome of hallucinations, conversion disorder, cognitive disorientation, and approximate answers is
also described but of uncertain nosology.
What is Gaping?
Gaping, or involuntary opening of the mouth, may occur as a focal dystonia of
the motor trigeminal nerve, also known as Brueghel syndrome after that artist’s
painting De Gaper (‘Yawning man’, ca. 1558) which is said to illustrate a typical case. Afflicted individuals may also demonstrate paroxysmal hyperpnoea and
up beating nystagmus, suggesting a brainstem (possibly pontine) localization of
pathology. The condition should be distinguished from other cranial dystonias
with blepharospasm (Meige syndrome).
What is Autonomic neuropathy?
Autonomic neuropathy occurs when the nerves that control involuntary bodily functions are damaged. It can affect blood pressure, temperature control, digestion, bladder function and even sexual function.
The nerve damage interferes with the messages sent between the brain and other organs and areas of the autonomic nervous system, such as the heart, blood vessels and sweat glands.
While diabetes is the most common cause of autonomic neuropathy, other health conditions — even an infection — can be to blame. Some medications also might cause nerve damage. Symptoms and treatment vary based on which nerves are damaged
What is Gaze-Evoked Phenomena?
A variety of symptoms have been reported to be evoked, on occasion, by
alteration of the direction of gaze:
• Amaurosis: lesion, usually intraorbital, compressing central retinal artery;
• Laughter;
• Nystagmus: usually indicative of a cerebellar lesion; may occur as a side effect of medications; also, convergence–retraction nystagmus on upgaze in
dorsal midbrain (Parinaud’s) syndrome;
• Phosphenes: increased mechanosensitivity in demyelinated optic nerve;
• Segmental constriction of the pupil (Czarnecki’s sign) following aberrant
regeneration of the oculomotor (III) nerve to the iris sphincter;
• Tinnitus: may develop after resection of cerebellopontine angle tumours,
may be due to abnormal interaction between vestibular and cochlear nuclei;
• Vertigo.
What is Gaze Palsy?
Gaze palsy is a general term for any impairment or limitation in conjugate
(yoked) eye movements. This may be supranuclear, nuclear, or infranuclear
in origin. Preservation of the vestibulo-ocular reflexes may help differentiate
supranuclear gaze palsies from nuclear/infranucelar causes.
What is Gegenhalten?
Gegenhalten, or paratonia, or paratonic rigidity, is a variable resistance to passive
movement of a limb when changing its posture or position, which is evident in
both flexor and extensor muscles (as in rigidity, but not spasticity), which seems
to increase further with attempts to get the patient to relax, such that there is a
resistance to any applied movement (German: to counter, stand ones ground).
However, this is not a form of impaired muscle relaxation akin to myotonia and
paramyotonia. For instance, when lifting the legs by placing the hands under the
knees, the legs may be held extended at the knees despite encouragement on the
part of the examiner for the patient to flex the knees. Generally, tendon reflexes
are normal, plantar responses down going, and there is no clonus. Gegenhalten is
a sign of bilateral frontal lobe dysfunction, especially mesial cortex and superior
convexity (premotor cortex, area 6). It is not uncommon in otherwise healthy
elderly individuals with diffuse frontal lobe cerebrovascular disease.
What is Geophagia, Geophagy?
Geophagia or geophagy describes earth or clay eating, reports of which dating
back to Hippocrates have been found. This may also fall under the rubric of
pica, or pagophagia, a morbid craving for unusual or unsuitable food. Besides
the obvious risk of infection from ingesting potentially contaminated material,
geophagia may be associated with neurological complications. Cases of flaccid
quadriparesis and of proximal myopathy associated with profound hypokalaemia
in the context of geophagia have been reported, which may lead to walking
difficulty.
What is Gerstmann Syndrome?
The Gerstmann syndrome, or angular gyrus syndrome, consists of acalculia,
agraphia (of central type), finger agnosia, and right–left disorientation; there may
in addition, be alexia and difficulty spelling words but these are not necessary
parts of the syndrome.
Gerstmann syndrome occurs with lesions of the angular gyrus and supramarginal gyrus in the posterior parietotemporal region of the dominant (usually left) hemisphere, for example, infarction in the territory of the middle cerebral artery.
All the signs comprising Gerstmann syndrome do fractionate or dissociate,
i.e. they are not causally related, or representative of a unitary neuropsychological function, as was once suggested. Hence this may be an example of a
disconnection syndrome. Nonetheless the Gerstmann syndrome remains useful
for the purposes of clinical localization.
What is Geste Antagoniste?
Geste antagoniste is a sensory ‘trick’ which alleviates, and is characteristic of,
dystonia. Geste antagoniste consists of a tactile or proprioceptive stimulus, which
is learned by the patient, which reduces or eliminates the dystonic posture. For
example, touching the chin, face, or neck may overcome cervical dystonia (torticollis), and singing may inhibit blepharospasm. Gestes may also modify tremor.
They are almost ubiquitous in sufferers of cervical dystonia and have remarkable
efficacy. The geste phenomenon is said to be absent in psychogenic dystonia.
The mechanism is unknown: although afferent feedback from the periphery
may be relevant, it is also possible that concurrent motor output to generate the
trick movement may be the key element, in which case the term ‘sensory trick’ is a misnomer.
What is reverse” sensory geste?
Cervical Dystonia is substantially worsened with sensory input to the back of the head and neck in different body postures, a phenomenon recently termed “reverse” sensory geste
What is Gibbus?
Angulation of the spine due to vertebral collapse may be due to osteoporosis,
metastatic disease, or spinal tuberculosis. There may be associated myelopathy.
Camptocormia (bent spine syndrome) enters the differential diagnosis.
What is myelopathy?
When inflammatory, it is known as myelitis. Disease that is vascular in nature is known as vascular myelopathy. The most common form of myelopathy in human, cervical spondylotic myelopathy (CSM), is caused by arthritic changes ( spondylosis) of the cervical spine, which result in narrowing of the spinal canal ( spinal stenosis) Patients with myelopathy commonly experience stabbing pain in their arm, elbow, wrist, or fingers, a dull ache in the arm, or numbness. Myelopathy can also cause position sense loss, which makes you unable to know where your arms are without looking at them, and incontinence.
Camptocormia, also known as bent spine syndrome (BSS), is a symptom of a multitude of diseases that is most commonly seen in the elderly. It is identified by an abnormal thoracolumbar spinal flexion, which is a forward bending of the lower joints of the spine, occurring in a standing position.
What is Girdle Sensation?
Compressive lower cervical or upper thoracic myelopathy may produce spastic
paraparesis with a false-localizing midthoracic sensory level or ‘girdle sensation’
(cf. cuirasse). The pathophysiology is uncertain, but ischaemia of the thoracic
watershed zone of the anterior spinal artery from compression at the cervical
level has been suggested.
What is give way weakness?
Give-way weakness is often used as a diagnostic test of hysterical paralyses, but it is unreliable. Unilateral functional weakness of a leg, if severe, tends to produce a characteristic gait in which the leg is dragged behind the body as a single unit, like a sack of potatoes.
What is Suspended Sensory Loss?
The suspended sensory loss of central cord lesions is the most powerful diagnostic sensory syndrome of the spinal cord. The disruption of the pain and temperature pathways in the anterior white commissure as they cross the cord causes a profound loss of these modalities in all segments so affected
What is Glabellar Tap Reflex?
The glabellar tap reflex, also known as Myerson’s sign or the nasopalpebral
reflex, is elicited by repeated gentle tapping with a finger on the forehead, preferably with irregular cadence and so that the patient cannot see the finger (to avoid
blinking due to the threat or menace reflex), whilst observing the eyelids blink
(i.e. blink reflex). Usually, reflexive blinking in response to tapping habituates
quickly, but in extrapyramidal disorders it may not do so. This sign was once
thought useful for the diagnosis of idiopathic Parkinson’s disease but in fact it is
fairly non-specific, occurring in many akinetic-rigid disorders.
What is Glossolalia?
Glossolalia, or speaking in tongues, may be considered a normal phenomenon in
certain Christian denominations, as divinely inspired, since it is mentioned in the
Bible (1 Corinthians, 14:27–33, although St Paul speaks of the importance of an
interpreter, since ‘God is not the author of confusion’), but it is not confined to
Christianity or even overtly religious environments. Others conceptualize glossolalia as a form of automatic speech, usually of a pseudo language which may be
mistaken for a foreign tongue. Such happenings may occur in trance-like states
or in pathological states such as schizophrenia.
What is ‘Glove and Stocking’ Sensory Loss?
Sensory loss, to all or selected modalities, confined to the distal parts of the limbs
(‘glove and stocking’) implies the presence of a peripheral sensory neuropathy.
If the neuropathy involves both sensory and motor fibres, motor signs (distal
weakness, reflex diminution or loss) may also be present.
What is goose bumps?
The formation of goose bumps in humans under stress is considered to be a vestigial reflex. Its function in other apes is to raise the body’s hair, and would have made human ancestors appear larger to scare off predators or to increase the amount of air trapped in the fur to make it more insulating. The reflex of producing goose bumps is known as piloerection or the pilomotor reflex, o
What is Gordon’s Sign?
Gordon’s sign is an extensor plantar response in response to squeezing the calf
muscles, also called the paradoxical flexor response. As with Chaddock’s sign and
Oppenheim’s sign, this reflects an expansion of the receptive field of the reflex.
What is Gowers’ Manoeuvre, Gowers’ Sign?
Gowers’ sign is a characteristic manoeuvre used by patients with proximal lower
limb and trunk weakness to rise from the ground. From the lying position, the
patient rolls to the kneeling position, pushes on the ground with extended forearms to lift the hips and straighten the legs, so forming a triangle with the hips
at the apex with hands and feet on the floor forming the base (known in North
America as the ‘butt-first manoeuvre’). Then the hands are used to push on the
knees and so lift up the trunk (‘climbing up oneself’).
This sign was originally described by Gowers in the context of Duchenne
muscular dystrophy but may be seen in other causes of proximal leg and trunk
weakness, e.g. Becker muscular dystrophy, spinal muscular atrophy. Gowers was
not the first to describe the sign; Bell had reported it almost 50 years before
Gowers’ account.
Gowers’ name is also associated with a manoeuvre to stretch the sciatic nerve
and hence exacerbate sciatic symptoms.
What is Graefe sign?
Von Graefe’s sign. Von Graefe’s sign is the lagging of the upper eyelid on downward rotation of the eye, indicating exophthalmic goitre (Graves’ Disease). It is a dynamic sign, whereas lid lag is a static sign which may also be present in cicatricial eyelid retraction or congenital ptosis.
What is pseudo Graefe’s sign?
It occurs in paramyotonia congenita. A pseudo Graefe’s sign is most commonly manifested in just one eye but can occasionally be observed in both. The reason only one eye is affected is not yet clear. Hyperthyroidism, as lid lag may be in hyperthyroid patients lacking Graves’ disease.
What is Grandchild Sign?
This sign is present if the child of an individual with dementia answers in the
negative when asked if they would allow the patient to drive their own children
(i.e. the patient’s grandchildren). It is said to be an indicator that the demented
patient should not be driving.
What is Graphaesthesia?
Graphaesthesia is the ability to identify numbers or letters written or traced on
the skin, first described by Head in 1920. Loss of this ability (agraphaesthesia,
dysgraphaesthesia, or graphanaesthesia; sometimes referred to as agraphognosia) is typically observed with parietal lobe lesions, for example, in conditions
such as corticobasal degeneration. Such a cortical sensory syndrome may also
cause astereognosis and impaired two-point discrimination.
What is Writer’s cramp?
It is a poorly understood condition that results in spasm of the hand and forearm muscles when trying to write – sufferers tend to grip the pen too tightly and try and push it through the paper making writing impossible.
What is Grasp Reflex?
The grasp reflex consists of progressive forced closure of the hand (contraction of
flexor and adductor muscles) when tactile stimulation (e.g. the examiner’s hand)
is moved slowly, exerting pressure, across the patient’s palm in an upward direction. Once established, the patient is unable to release the grip (forced grasping),
allowing the examiner to draw the arm away from the patient’s body. There
may also be accompanying groping movements of the hand, once touched, in
search of the examiner’s hand or clothing (forced groping, magnetic movement).
Although categorized as a reflex, it may sometimes be accessible to modification
by will (so-called alien grasp reflex). It is usually bilateral, even with unilateral
pathology. Foot grasping (i.e. flexion and adduction of the toes and curling of
the sole in response to pressure on the sole) may coexist, as may another frontal
release signs (e.g. pout reflex, palmomental reflex, gegenhalten).
The grasp reflex may be categorized as a frontal release sign (or primitive
reflex) of prehensile type, since it is most commonly associated with lesion(s) in
the frontal lobes or deep nuclei and subcortical white matter.
What is Groucho Marx Manoeuvre?
Named for the American comic actor Julius Henry ‘Groucho’ Marx (1890–1977),
this manoeuvre requires the forehead to be wrinkled quickly two or three times,
so, testing the frontalis muscle innervated by the facial nerve.
What is Gustatory Sweating?
Gustatory sweating, Frey’s syndrome, is perspiration of the cheek, jaw, temple,
and neck when eating, following aberrant regeneration of damaged autonomic
fibres travelling in the glossopharyngeal and Vagus nerves, for example, following neck dissection. This is an autonomic synkinesis. It may be treated with botulinum toxin injections.
What is Guttmann’s Sign?
Guttmann’s sign is facial vasodilatation associated with nasal congestion, hypertension, bradycardia, sweating, mydriasis, and piloerection, due to autonomic
overactivity occurring as a feature of the acute phase of high spinal cord lesions.
What is Gynaecomastia?
Gynaecomastia is inappropriate breast development in males. It may be observed
in chronic liver disease and in certain neurological diseases:
• Excessive pituitary prolactin release secondary to impaired dopamine
release from the hypothalamus due to local tumour or treatment with
dopaminergic antagonist drugs (e.g. antipsychotic medications);
• Spinal and bulbar muscular atrophy (Kennedy’s syndrome, X-linked);
• Klinefelter’s syndrome;
• POEMS syndrome.
What is habit spasm?
Habitual, repeated contraction of certain muscles, resulting in stereotyped individualized actions that can be voluntarily suppressed for only brief periods, for example, clearing the throat, sniffing, pursing the lips, excessive blinking; especially prominent when the person is under …
What is Hallpike Manoeuvre, Hallpike Test?
The Hallpike manoeuvre (Nylen–Bárány manoeuvre, positioning manoeuvre,
Dix–Hallpike positioning test) is a test used in the investigation of vertigo to
induce (or to modify) nystagmus by stimulating the otolith organs of the inner
ear. It most usually consists of briskly tilting the patient’s head backwards to
30–45◦ below the horizontal (‘head hanging position’) and turning it 45◦ to one
side or the other, thus stimulating the posterior semicircular canal. Prior to performing the manoeuvre, the examiner should warn the patient that s/he may feel
‘giddy’ or vertiginous, and to keep their eyes open throughout, since the development of nystagmus with the symptoms of vertigo is the observation of interest to the examiner.
With a peripheral lesion (e.g. benign paroxysmal positional vertigo, diseases
of the labyrinth), nausea, vomiting, and rotational–vertical nystagmus occurs several seconds after the manoeuvre and then rapidly fatigue (usually <30 s), only
to recur when the patient is returned to the upright position, with the nystagmus
now in the opposite direction. Repetition of the manoeuvre (if the patient can be
persuaded to undergo it) causes less severe symptoms (habituation). This is the
diagnostic test for benign paroxysmal positional vertigo (BPPV). Central lesions
(disorders of the vestibular connections) tend to produce isolated nystagmus
which does not fatigue or habituate with repetition.
Variants of the Hallpike manoeuvre are described for BPPV of anterior or
horizontal semicircular canal origin. Caloric testing may be required to elicit the
causes of dizziness if the Hallpike manoeuvre is uninformative.
What is Hallucination?
A hallucination is a perception in the absence of adequate peripheral stimulus (cf. illusion, although there may be some overlap). Such perceptions are
substantial, constant, occur in objective space, and are usually not accompanied
by insight (cf. pseudo hallucination). They most usually occur in the visual and
auditory domains.
Visual hallucinations may range in complexity. They may be ‘simple’, spots
or flashes of light (photopsia, photism, scintillation), or ‘complex’, ranging from
patterns (fortification spectra, epileptic aura) to fully formed objects or individuals. They may be transient, such as brief visions of a person or animal (passage
hallucinations, for example, in Parkinson’s disease) or long lasting. Visual hallucinations may be normal, especially when falling asleep or waking (hypnogogic,
hypnopompic). There are many other associations including both psychiatric and
neurological disease, including
• Delirium: especially hyperalert/agitated subtype
• Withdrawal states: e.g. delirium tremens; hypnotics, anxiolytics
• Drug overdose: e.g. anticholinergic drugs
• Neurodegenerative disorders: dementia with Lewy bodies (a diagnostic criterion) more often than Alzheimer’s disease: these may be associated with
cholinergic depletion and improved with cholinesterase inhibitor drugs;
idiopathic Parkinson’s disease (with or without treatment)
• Narcolepsy–cataplexy
• Peduncular hallucinosis
• Migraine aura: usually visual or somaesthetic; less often auditory of olfactory
• Charles Bonnet syndrome (visual hallucinations of the visually impaired)
• Schizophrenia
• Epilepsy: complex partial seizures
• ‘Alice in Wonderland’ syndrome
Different mechanisms may account for visual hallucinations in different
conditions: defective visual input and processing may occur in visual pathway
lesions, whereas epilepsy may have a direct irritative effect on brain function; visual hallucinations associated with brainstem lesions may result from
neurotransmitter abnormalities (cholinergic, serotonergic).
Auditory hallucinations may be simple (tinnitus) or complex (voices, music)
and may be associated with focal pathology in the temporal cortex. Third person hallucinations, commenting on a person’s actions, are one of the first rank symptoms of schizophrenia.
What are the symptoms of Charles Bonnet syndrome?
She probably has the Charles Bonnet syndrome, which is sometimes called “release visual hallucinations,” in which elderly, blind individuals, who are not demented or psychologically disturbed, have frequent benign visual hallucinations. The condition probably results from blindness, that is, sensory deprivation.
Which drugs can cause hallucinations?
High levels of dopamine cause hallucinations and other emotional symptoms in people with PD. Drugs that may contribute to hallucinations or delusions in people with PD include: dopamine agonists, including rotigotine, pramipexole, ropinirole, pergolide, and bromocriptine
What is Photopsia?
It is the presence of perceived flashes of light. It is most commonly associated with posterior vitreous detachment, migraine with aura, migraine aura without headache, retinal break or detachment, occipital lobe infarction, and sensory deprivation (ophthalmopathy hallucinations).
What is Pseudo hallucination?
A pseudo hallucination (from Ancient Greek: “false, lying” + “hallucination”) is an involuntary sensory experience vivid enough to be regarded as a hallucination, but considered by the person as subjective and unreal, unlike “true” hallucinations, which are considered real by patients with psychological disorders. Unlike normal hallucinations, which occurs when one sees, hears, smells, tastes or feels something that is not there, with a compelling feeling or thought that it is real, pseudo hallucinations are recognised by the person as unreal. In other words, it is a hallucination that is recognized as a hallucination, as opposed to a “normal” hallucination which would be perceived as real.
What is Hammer Toes?
Hammer toes are a feature of hereditary neuropathies, e.g. Charcot–Marie–
Tooth disease, some cases of hereditary neuropathy with liability to pressure
palsies, and Friedreich’s ataxia. There may be associated pes cavus.
What is Hand Elevation Test?
This is one of the provocative tests for carpal tunnel syndrome: it is positive if
paraesthesia in the distribution of the median nerve develop after raising the
hand over the head for up to 2 min.
What is Harlequin Sign, Harlequin Syndrome?
The harlequin sign or syndrome refers to asymmetrical facial flushing with
sweating after exercise. That it reflects localized autonomic dysfunction may
be indicated by its associations with congenital Horner’s syndrome, and as
one element in the spectrum of Holmes–Adie syndrome and Ross’s syndrome.
Harlequin sign has on occasion been described in association with multiple
sclerosis and superior mediastinal neurinoma.
What is Harvey’s Sign?
A high-frequency tuning fork (440–1,024 Hz) applied to the mucosa overlying
the nasal septum produces a painful stimulus which has been advocated as useful
in differentiating true from simulated coma or status epilepticus.
What is Hawthorne Effect?
Hawthorne’s original observation was that children with learning disability only began to make progress when notice was taken of them, even though the intervention was unskilled or non-specific (which prompted Critchley to dare to wonder if this were the effect of speech therapy in chronic aphasics). The term Hawthorne effect has come to stand for any situation in which behaviour is altered by observation, or being the object of attention. In the neurological examination, certain
signs may be evident when the patient is being observed, but absent when observation is only surreptitious, an inconsistency which may point to signs being ‘non-organic’, functional, or part of illness behaviour. A similar effect may be apparent in unblinded clinical trials.
What is Head Impulse Test?
The head impulse test, also known as the head thrust test, assesses the vestibuloocular reflex. It consists of a rapid turning of the head to one side by about
15◦, sufficiently rapid to ensure that smooth pursuit eye movements do not compensate for head turning. The examiner observes the ability of the subject to
maintain fixation on a distant target; if the vestibulo-ocular reflex is intact fixation is maintained. If the vestibulo-ocular reflex is impaired, then an easily visible
saccade back to the target occurs at the end of the movement. Tilting the head
down by 20◦ and moving the head unpredictably may optimize testing. This test
is recommended in patients suffering a first attack of acute spontaneous vertigo.
Sensitivity and specificity of around 80% for detecting a peripheral vestibular
lesion such as acute unilateral vestibular neuritis has been reported. To avoid
false negatives, it has been suggested that the test should be performed with high
acceleration, 5–10 times. If the test is normal in suspected vestibular neuritis, then
a central cause such as cerebellar infarction needs to be excluded.
What is Head Tilt?
Head tilt may be observed with:
• Diplopia, cranial nerve palsies (IV, VI); skew deviation
• Neck dystonia (laterocollis)
• Incipient tonsillar herniation with cerebellar tumours, sometimes associated
with neck stiffness and limitation of neck movement.
What is Bielschowsky sign?
It, is due to paralysis of a superior oblique muscle, tilting the head to the side of the involved eye causes that eye to rotate upward.
What is Parks–Bielschowsky test?
The Parks–Bielschowsky three-step test, also known as Park’s three-step test or Bielschowsky head tilt test, is a method used to isolate the paretic extraocular muscle, particularly superior oblique muscle and trochlear nerve (IVth cranial nerve), in acquired vertical double vision. It was originally described by Marshall M. Parks.
What causes a head tilt?
A head tilt causes stimulation of both anterior semi-circular canals and the posterior semi-circular canals resulting in excitation of ipsilateral intorters (superior oblique and superior rectus) and contralateral extorters (inferior oblique and inferior rectus) while their antagonists are simultaneously inhibited.
What is the Ocular tilt reaction (OTR)?
it, comprises skew deviation, head tilt and ocular torsion involving structures of the inner ear responsible for maintenance of balance of the body i.e. the semi-circular canals (SCC), utricle and saccule
What is Head Tremor?
Head tremor may be characterized as ‘yes–yes’ (nodding, tremblement affirmative)
when predominantly in the vertical plane, or ‘no–no’ (side-to-side, tremblement
negative) when predominantly in the horizontal plane. Head tremor may occur in
isolation or with evidence of tremor elsewhere (e.g. postural limb tremor, vocal
tremor, in essential tremor), or dystonia (e.g. torticollis). In essential tremor the
head movements are often intermittent, ‘yes–yes’, and of frequency about 7 Hz.
Dystonic head tremor is often jerky and disorganized, with a frequency of less
than 5 Hz. Cerebellum and brainstem disease such as multiple sclerosis can also
produce head tremor (or titubation). Head tremor is an exceptionally rare symptom of Parkinson’s disease. It may also be seen as a consequence of aortic valve regurgitation (De Musset’s sign).
What is the treatment of head tremor?
Treatment of head tremor varies with cause. Possible treatments, of variable efficacy, include
• Essential tremor: propranolol, topiramate, primidone, nicardipine,
gabapentin;
• Dystonic tremor: levodopa, anticholinergics, propranolol, botulinum toxin
injections;
• Cerebellar tremor: isoniazid, carbamazepine, ondansetron.
What is Head Turning Sign?
It is often observed that patients who are cognitively impaired turn their head
towards their spouse, partner, or carer to seek assistance when asked to give a
history of their problems, or during tests of neuropsychological function. It is a
non-specific sign of cognitive impairment.
What is Autoscopy?
It is the experience in which an individual perceives the surrounding environment from a different perspective, from a position outside of their own body.
What is Heautoscopy?
This term was coined to denote seeing oneself, encountering ones alter ego or doppelgänger. Hence unlike the situation in autoscopy, there are two selves, a reduplicated body rather than a mirror image; egocentric and body-centred perspectives do not coincide. According to Critchley, the condition used to be called
‘specular hallucinosis’, and the Swedish naturalist Linnaeus (1707–1788) apparently had episodes, seeing himself sitting in his study or gazing at a flower and plucking it.
What is Heel–Knee–Shin Test, Heel–Shin Test?
A frequently used test of coordination in which the patient, sitting on the examination couch, is asked to lift the heel onto the contralateral knee, then run it
smoothly down the shin bone towards the foot. Jerky performance, or a tendency
for the heel to slide off the shin, may be seen in an ataxic limb.
What is Hemeralopia?
Hemeralopia, or day blindness, is worsening of vision in bright light (cf. nyctalopia). This phenomenon may reflect severe impairment of blood flow to the
eye, such that photo stressing the macula by exposure to bright light is followed by only slow regeneration of the bleached photopigments. If due to retinal
ischaemia, hemeralopia may be accompanied by neovascularization of the retina.
Impoverished perfusion pressure may be demonstrated by pressing on the eyeball
(e.g. with the thumb) during ophthalmoscopy (‘digital ophthalmodynamometry’) and observing the collapse of retinal arteries: thumb pressure greater than
diastolic retinal artery pressure causes intermittent collapse; thumb pressure
greater than systolic pressure leads to a cessation of pulsation.
Hemeralopia may also occur in retinal diseases such as cone–rod dystrophies,
and with cataract.
What is Nyctalopia?
It is also called night-blindness, is a condition making it difficult or impossible to see in relatively low light. It is a symptom of several eye diseases. Night blindness may exist from birth, or be caused by injury or malnutrition (for example, vitamin A deficiency).
What is Hemiakinesia?
Hemi akinesia is akinesia or hypokinesia (inability or difficulty initiating movement) confined to one side of the body. Although hemiakinesia is the norm at the
onset of idiopathic Parkinson’s disease (‘hemi parkinsonism’), persistent hemiakinesia should prompt a re-evaluation of this diagnosis. Corticobasal degeneration
often remains unilateral; a search for structural lesions of the basal ganglia
should also be undertaken. Hemiakinesia may also indicate motor neglect, usually with right-sided lesions. Lesions of the basal ganglia, ventral (‘motor’)
thalamus, limbic system, and frontal lobes may cause hemiakinesia.
What is Hemi alexia?
This is the inability to read words in the visual left half-field in the absence of
hemianopia. It may occur after callosotomy (complete or partial involving only
the splenium) and represents a visual disconnection syndrome.
What is Hemianomia?
This is the absence of verbal report of stimuli presented in the visual left half-field
in the absence of hemianopia. It may occur after callosotomy (complete or partial
involving only the splenium) and represents a visual disconnection syndrome.
What is Hemianopia?
Hemianopia (hemianopsia) is a defect of one-half of the visual field: this may be
vertical or horizontal (= altitudinal field defect). Hemianopic defects may be congruent (homonymous) or non-congruent (heteronymous) and may be detected by
standard confrontational testing of the visual fields or by automated means (e.g.
Goldman perimetry). These tests of the visual fields are an extension of the tests
for visual acuity which assess areas away from the fovea. Because of the strict
topographic arrangement of neural pathways within the visual system, particular
abnormalities of the visual fields give a very precise indication of the likely site of
pathology.
What is Homonymous hemianopia?
Reflects a postchiasmal lesion.
Commonly, homonymous hemianopias result from cerebrovascular disease-causing occipital lobe infarction, or intraparenchymal tumour, but they may be ‘false-localizing’ due to raised intracranial pressure if temporal lobe herniation causes posterior cerebral artery compromise.
What is Heteronymous hemianopia?
The most common of these is a bitemporal hemianopia due to chiasmal compression, for example, by a pituitary lesion or craniopharyngioma.
Bilateral homonymous hemianopia or double hemianopia may result in
cortical blindness.
What is Hemiataxia?
Hemiataxia is ataxia confined to one-half of the body. The vast majority of
isolated hemiataxia syndromes reflect a lesion of the ipsilateral cerebellar hemisphere, but on occasion supratentorial lesions may cause hemiataxia (posterior
limb of the internal capsule, thalamus). However, in almost all of these cases
hemiataxia coexists with ipsilateral hemiparesis (ataxic hemiparesis), hemisensory disturbance (hemiataxia–hypaesthesia), or both.
What is cerebellopontine angle syndrome?
The cerebellopontine angle syndrome is a distinct neurological syndrome of deficits that can arise due to the closeness of the cerebellopontine angle to specific cranial nerves. Indications include unilateral hearing loss (85%), speech impediments, disequilibrium, tremors or other loss of motor control.
Ataxic hemiparesis is weakness of one side of the body with incoordination and unsteadiness that result from the brain’s failure to regulate the body’s posture and the strength and direction of limb movements
What is Hemiballismus?
Hemiballismus is unilateral ballismus, an involuntary hyperkinetic movement
disorder in which there are large amplitude, vigorous (‘flinging’) irregular movements. Hemiballismus overlaps clinically with hemichorea (‘violent chorea’);
the term hemiballismus–hemichorea is sometimes used to reflect this overlap.
Hemiballismic limbs may show a loss of normal muscular tone (hypotonia).
Neuropathologically, vascular events (ischaemia,
haemorrhage) are the most common association but hemiballismus has also been
reported with space-occupying lesions (tumour, arteriovenous malformation),
inflammation (encephalitis, systemic lupus erythematosus, post-streptococcal
infection), demyelination, metabolic causes (hyperosmolal non-ketotic hyperglycaemia), infection (toxoplasmosis in AIDS), drugs (oral contraceptives, phenytoin, levodopa, neuroleptics), and head trauma.
Hemiballismus of vascular origin usually improves spontaneously, but drug
treatment with neuroleptics (haloperidol, pimozide, sulpiride) may be helpful. Other drugs which are sometimes helpful include tetrabenazine, reserpine, clonazepam, clozapine, and sodium valproate.
What is Hemichorea?
Hemichorea is unilateral chorea, an involuntary movement disorder which overlaps with hemiballismus, and with which it shares a similar pathophysiology and
aetiology. It may replace hemiballismus during recovery from a contralateral
subthalamic lesion.
What is Hemidystonia?
Hemidystonia is dystonia affecting the whole of one side of the body, a pattern which mandates structural brain imaging because of the chance of finding
a causative structural lesion (vascular, neoplastic), which is greater than with
other patterns of dystonia (focal, segmental, multifocal, generalized). Such a
lesion most often affects the contralateral putamen or its afferent or efferent
connections.
What is Parry Romberg syndrome?
Parry–Romberg syndrome is a rare disease characterized by progressive shrinkage and degeneration of the tissues beneath the skin, usually on only one side of the face (hemifacial atrophy) but occasionally extending to other parts of the body. An autoimmune mechanism is suspected, and the syndrome may be a variant.
Can Parry Romberg syndrome cause seizures?
Individuals with Parry Romberg syndrome may have more prolonged migraines with associated pupillary abnormalities (the black part of the eye). Less often, perhaps one in ten individuals with Parry-Romberg syndrome can experience episodes of uncontrolled electrical disturbances in the brain (epileptic seizures).
What is Hemifacial Spasm?
Hemifacial spasm is an involuntary dyskinetic (not dystonic) movement disorder
consisting of painless contractions of muscles on one side of the face, sometimes triggered by eating or speaking, and exacerbated by fatigue or emotion.
The movements give a twitching appearance to the eye or side of the mouth,
sometimes described as a pulling sensation. Patients often find this embarrassing
because it attracts the attention of others. The movements may continue during
sleep. Paradoxical elevation of the eyebrow as orbicularis oris contracts and the
eye closes may be seen (Babinski’s ‘other sign’). Very rarely, movements may be
bilateral.
Hemifacial spasm may be idiopathic, or associated with neurovascular compression of the facial (VII) nerve, usually at the root entry zone, often by a
tortuous anterior or posterior inferior cerebellar artery. Other causes include
intrapontine lesions (e.g. demyelination), following a Bell’s palsy, and mass
lesions (tumour, arteriovenous malformation) located anywhere from the facial
nucleus to the stylomastoid foramen. Very rarely, contralateral (false-localizing)
posterior fossa lesions have been associated with hemifacial spasm, suggesting
that kinking or distortion of the nerve, rather than direct compression, may be
of pathogenetic importance.
What is treatment of Hemifacial Spasm?
Structural lesions may be amenable to surgical resection. For idiopathic
hemifacial spasm, or patients declining surgery, botulinum toxin injections are
the treatment of choice.
What is Hemiparesis?
Hemiparesis is a weakness affecting one side of the body, less severe than a hemiplegia. Characteristically this affects the extensor muscles of the upper limb more
than flexors, and the flexors of the leg more than extensors (‘pyramidal’ distribution of weakness), producing the classic hemiparetic/hemiplegic posture with
flexed arm and extended leg, the latter permitting standing and a circumducting
gait.
Hemiparesis results from damage (most usually vascular) to the corticospinal
pathways anywhere from motor cortex to the cervical spine. Accompanying
signs may give clues as to localization, the main possibilities being hemisphere,
brainstem, or cervical cord.
Hemisphere lesions may also cause hemisensory impairment, hemianopia,
aphasia, agnosia, or apraxia; headache, and incomplete unilateral ptosis, may
sometimes feature. Spatial neglect, with or without anosognosia, may also occur,
particularly with right-sided lesions producing a left hemiparesis. Pure motor
hemiparesis may be seen with lesions of the internal capsule, corona radiata,
and basal pons (lacunar/small deep infarct), in which case the face and arm are
affected more than the leg; such facio-brachial predominance may also be seen
with cortico–subcortical lesions laterally placed on the contralateral hemisphere.
Crural predominance suggests a contralateral paracentral cortical lesion or one
of the lacunar syndromes.
Brainstem lesions may produce diplopia, ophthalmoplegia, nystagmus,
ataxia, and crossed facial sensory loss or weakness in addition to hemiparesis
(‘alternating hemiplegia’).
Spinal lesions are more likely to show bilateral long tract signs (e.g. bilateral Babinksi’s sign) and may have accompanying spinal or root pain, sphincter
disturbance, and a sensory or motor level.
Hemiparesis is most usually a consequence of a vascular event (cerebral infarction). Tumour may cause a progressive hemiparesis (although
meningiomas may produce transient ‘stroke-like’ events). Hemiparetic multiple
sclerosis is rare but well described. Transient hemiparesis may be observed as
an ictal phenomenon (Todd’s paresis), or in familial hemiplegic migraine which
is associated with mutations in a voltage-gated Ca2+ ion channel gene. Mills
syndrome is an ascending or descending hemiplegia which may represent a
unilateral form of motor neurone disease or primary lateral sclerosis.
What is Hemi-parkinsonism?
Hemi-parkinsonism describes the finding of parkinsonian signs restricted to one
side of the body, most usually akinesia, in which case the term hemiakinesia
may be used. Idiopathic Parkinson’s disease may present with exclusively or predominantly unilateral features (indeed, lack of asymmetry at onset may argue
against this diagnosis) but persistent hemi-parkinsonism, particularly if unresponsive to adequate doses of levodopa, should alert the clinician to other possible
diagnoses, including corticobasal degeneration or structural lesions.
What is Hemiakinesia?
It is a disorder of action in which subjects with a brain lesion exhibit difficulty in moving the contralesional body that cannot be attributed to hemiparesis or peripheral nervous system dysfunction.
What is Hemiplegia?
Hemiplegia is a complete weakness affecting one side of the body, i.e. clinically a
more severe picture than hemiparesis.
What is Hemiplegia Cruciata?
Cervico-medullary junction lesions where the pyramidal tract decussates may
result in paresis of the contralateral upper extremity and ipsilateral lower
extremity. There may be concurrent facial sensory loss with onion skin pattern,
respiratory insufficiency, bladder dysfunction, and cranial nerve palsies. Such
cases are very rare.
What is Hennebert’s Sign?
Hennebert’s sign is the induction of vertigo and nystagmus by pressure changes
in the external auditory canal, such as when using pneumatic otoscopy or simply
with tragal pressure. These findings are highly suggestive of the presence of a
bony labyrinthine fistula. There may be a history of chronic otitis media.
What is Henry and Woodruff Sign?
Evidence of visual fixation, reported to be helpful in differentiating pseudo seizures from epileptic seizures: the patient is rolled from one side on to the other
whilst note is taken of whether the eyes remain directed towards the ground.
What is Hertwig–Magendie Sign?
It is skew deviation of the eyes in acute cerebellar lesions.
Also See- (Bell-Magendie law – Synonym(s): Bell law
Magendie foramen – Synonym(s): medial aperture of the fourth ventricle
Magendie law – Synonym(s): Bell law
Magendie spaces – space between the pia and arachnoid at the level of the fissures of the brain.
Magendie-Hertwig sign – skew deviation of the eyes in acute cerebellar lesions. Synonym(s): Magendie-Hertwig syndrome
Magendie-Hertwig syndrome – Synonym(s): Magendie-Hertwig sign)
What is Heterochromia Iridis?
Different colour of the irides may be seen in congenital Horner’s syndrome
and in Waardenburg syndrome of nerve deafness, white forelock, abnormal skin
pigmentation, and synophrys.
What is Heterophoria?
Heterophoria is a generic term for a latent tendency to imbalance of the ocular
axes (latent strabismus; cf. heterotropia). This may be clinically demonstrated
using the cover–uncover test: if there is movement of the covered eye as it is
uncovered and takes up fixation, this reflects a phoria. Phorias may be in the
horizontal (esophoria, exophoria) or vertical plane (hyperphoria, hypophoria).
What is Heterotropia?
Heterotropia is a generic term for manifest deviation of the eyes (manifest strabismus; cf. heterophoria), synonymous with squint. This may be obvious; an
amblyopic eye, with poor visual acuity and fixation, may become deviated.
Sometimes it may be more subtle, coming to attention only with the patient’s
complaint of diplopia.
Using the alternate cover (cross-cover) test, in which binocular fixation is not
permitted, an imbalance in the visual axes may be demonstrated, but this will not
distinguish between heterotropia and heterophoria. To make this distinction the
cover test is required: if the uncovered eye moves to adopt fixation then heterotropia is confirmed. Tropias may be in the horizontal (esotropia, exotropia)
or vertical plane (hypertropia, hypotropia).
What is Hiccups?
A hiccup (hiccough) is a brief burst of inspiratory activity involving the
diaphragm and the inspiratory intercostal muscles with reciprocal inhibition of
expiratory intercostal muscles. The sound (‘hic’) and discomfort result from glottic closure immediately after the onset of diaphragmatic contraction, i.e. the latter
is insufficient or asynchronous. Hiccups may be characterized as a physiological
form of myoclonus (or singultus).
Most episodes of hiccups are self-limited, but prolonged or intractable hiccupping (hocquet diabolique) should prompt a search for a structural or functional
cause, either gastroenterological or neurological. Hiccupping is seldom the only
abnormality if the cause is neurological since it usually reflects pathology within
the medulla or affecting the afferent and efferent nerves of the respiratory
muscles. Hiccups are sudden, involuntary contractions of the diaphragm muscle. As the muscle contracts repeatedly, the opening between the vocal cords snaps shut to check the inflow of air and makes the hiccup sound. Irritation of the nerves that extend from the neck to the chest can cause hiccups.
What are the causes of hiccough?
Drinking carbonated beverages
Drinking too much alcohol
Eating too much
Excitement or emotional stress
Sudden temperature changes
Swallowing air with chewing gum or sucking on candy
Hiccups that last more than 48 hours may be caused by a variety of factors, which can be grouped into the following categories.
Nerve damage or irritation
A cause of long-term hiccups is damage to or irritation of the Vagus nerves or phrenic nerves, which serve the diaphragm muscle. Factors that may cause damage or irritation to these nerves include:
A hair or something else in your ear touching your eardrum
A tumor, cyst or goitre in your neck
Gastroesophageal reflux
Sore throat or laryngitis
Central nervous system disorders
A tumor or infection in your central nervous system or damage to your central nervous system as a result of trauma can disrupt your body’s normal control of the hiccup reflex. Examples include:
Encephalitis
Meningitis
Multiple sclerosis
Stroke
Traumatic brain injury
Tumors
Metabolic disorders and drugs
Long-term hiccups can be triggered by:
Alcoholism
Anesthesia
Barbiturates
Diabetes
Electrolyte imbalance
Kidney disease
Steroids
Tranquilizers
Medullary causes include
• Infarction (posterior inferior cerebellar artery territory; lateral medullary
syndrome, especially middle level and dorsolateral lesion locations)
• Tumour
• Abscess
• Tuberculoma
• Syrinx
• Haematoma
• Demyelination
• CNS infection, e.g. viral encephalitis.
What is the treatment of hiccough?
Treatment should be aimed at the underlying cause. If none is identified,
physical measures to stop the hiccups such as rebreathing may then be tried. Of
the many various pharmacotherapies tried, the best are probably baclofen and
chlorpromazine.
What are the phases of walking?
The typical walk consists of a repeated gait cycle. The cycle itself contains two phases – a stance phase and a swing phase: Stance phase: Accounts for 60% of the gait cycle. It can be divided into the heel strike, support, and toe-off phases.
What is Steppage gait?
It (High stepping, Neuropathic gait) is a form of gait abnormality characterised by foot drop or ankle equinus due to loss of dorsiflexion. The foot hangs with the toes pointing down, causing the toes to scrape the ground while walking, requiring someone to lift the leg higher than normal when walking.
What is Hip Abduction Sign?
The hip abduction sign refers to abduction of the thighs when attempting to
rise from the ground, due to relative weakness of hip adductors with preserved
strength in hip abductors. The sign was first described in patients with sarcoglycanopathies, a group of autosomal recessive limb-girdle muscular dystrophies,
and is reported to have a sensitivity of 76% and a specificity of 98% for this diagnosis. It may perhaps be envisaged as the equivalent to Gowers’ sign but with hip
adductor, rather than gluteal, weakness.
What is Hippus?
Hippus is excessive pupillary unrest, i.e. rhythmic, oscillatory, contraction and
dilatation of the pupil. It may reflect an imbalance between afferent pupillary
sympathetic and parasympathetic autonomic activity. Hippus may be a normal
phenomenon; it may be observed during recovery from an oculomotor (III) nerve
palsy, but otherwise is of no localizing significance.
What is Hitselberg Sign?
Hypoaesthesia of the posterior wall of the external auditory canal may be seen
in facial paresis since the facial nerve sends a sensory branch to innervate this
territory.
What are intractable hiccups?
They occurred as part of the symptomatology of multiple sclerosis. In one patient intractable hiccups were the presenting complaint, and in another patient exacerbations of symptoms were almost always heralded by intractable hiccups. Intractable hiccups occur in a variety of diseases, including many that affect the brainstem and cervical cord,
What is Hoffmann’s Sign?
Hoffmann’s sign or reflex is a digital reflex consisting of flexion of the thumb
and index finger in response to snapping or flicking the distal phalanx of the
middle finger, causing a sudden extension of the joint. Although sometimes a
normal finding, for example, in the presence of generalized hyperreflexia (anxiety,
hyperthyroidism), it may be indicative of a corticospinal tract lesion above C5 or
C6, particularly if present unilaterally.
What is the Hoffman and Tromner signs?
They are most commonly clinically used corticospinal tract signs of upper extremities similar to the Babinski reflex in the lower extremity. Although, these reflexes can be elicited in normal subjects but importantly indicate a pyramidal tract lesion, especially if asymmetric and accompanied by other pathological reflexes. Flicking or nipping the nail of either the second, third or fourth finger will, if the reflex is present, cause a flexion of these fingers and maybe the thumb. Its presence indicates tendon reflexes are hyperactive.
What does positive Tinel’s sign mean?
Tinel’s sign: The sign that a nerve is irritated. Tinel’s sign is positive when lightly banging (percussing) over the nerve elicits a sensation of tingling, or ‘pins and needles,’ in the distribution of the nerve.
What is Holmes–Adie Pupil, Holmes–Adie Syndrome?
The Holmes–Adie, or tonic, pupil is an enlarged pupil which, in a darkened
environment, is unresponsive to a phasic light stimulus, but may respond slowly
to a tonic light stimulus. Reaction to accommodation is preserved (partial iridoplegia), hence this is one of the causes of light-near pupillary dissociation.
A Holmes–Adie pupil is usually unilateral, and hence a cause of anisocoria.
Holmes–Adie pupil may be associated with other neurological features
(Holmes–Adie syndrome). These include loss of lower limb tendon reflexes (especially ankle jerks); impaired corneal sensation; chronic cough; and localized
or generalized anhidrosis, sometimes with hyperhidrosis (Ross’s syndrome).
Holmes–Adie syndrome is much more common in women than men.
What is Anhidrosis?
It or hypohidrosis is a dysfunction in which a person is unable to sweat. Anhidrosis may affect one part of the body only, two or more parts, or the whole body.
What is Holmes’ Tremor?
Holmes’ tremor, also known as rubral tremor, or midbrain tremor, has been
defined as a rest and intention tremor, of frequency <4.5 Hz. The rest tremor
may resemble parkinsonian tremor and is exacerbated by sustained postures
and voluntary movements. Hence there are features of rest, postural and kinetic
(intention) tremor. Once attributed to lesions of the red nucleus (hence ‘rubral’),
the anatomical substrate is now thought to be interruption of fibres of the superior cerebellar peduncle (hence ‘midbrain’) carrying cerebellothalamic and/or
cerebello-olivary projections; lesions of the ipsilateral cerebellar dentate nucleus
may produce a similar clinical picture. Recognized causes include multiple sclerosis, head injury, and stroke. If a causative lesion is defined, there is typically a delay before tremor appearance (4 weeks to 2 years).
What is Hoover’s Sign?
Hoover’s sign may be used to help differentiate organic from functional hemiplegia or monoplegia. It is based on the fact that when a recumbent patient
attempts to lift one leg, downward pressure is felt under the heel of the other leg,
hip extension being a normal synergistic or synkinetic movement. The finding
of this synkinetic movement, detected when the heel of the supposedly paralyzed leg presses down on the examiner’s palm, constitutes Hoover’s sign: no
increase in pressure is felt beneath the heel of a paralyzed leg in an organic hemiplegia.
In addition, the synkinetic hip extension movement is accentuated when
attempting to raise a contralateral paretic leg, whereas in functional weakness
it is abolished.
What is Horner’s Syndrome?
Horner’s syndrome, or Bernard–Horner syndrome, is defined by a constellation
of clinical findings, most usually occurring unilaterally, viz.:
• partial ptosis, due to weakness of Müller’s muscle;
• miosis, due to the unopposed action of the sphincter pupillae muscle, innervated by the parasympathetic nervous system; this is most obvious in a dimly
lit room;
• anhidrosis, a loss of sweating (if the lesion is distal to the superior cervical
ganglion);
• enophthalmos, retraction of the eyeball (though this is seldom measured).
The first two mentioned signs are usually the most evident and bring the
patient to medical attention; the latter two are usually less evident or absent.
Additional features which may be seen include
• heterochromia iridis, different colour of the iris (if the lesion is congenital);
• elevation of the inferior eyelid due to a weak inferior tarsal muscle (‘reverse
ptosis’ or ‘upside-down ptosis’).
Horner’s syndrome results from impairment of ocular sympathetic innervation. The sympathetic innervation of the eye consists of a long, three neurones,
pathway, extending from the diencephalon down to the cervicothoracic spinal
cord, then back up to the eye via the superior cervical ganglion and the internal carotid artery, and the ophthalmic division of the trigeminal (V) nerve. A
wide variety of pathological processes, spread across a large area, may cause a
Horner’s syndrome, although many examples remain idiopathic despite intensive investigation. Hence Horner’s syndrome is a good lateralizing but a poor
localizing sign.
What are causes of Horner’s Syndrome?
Recognized causes include
• brainstem/cervical cord disease (vascular, demyelination, syringomyelia);
• Pancoast tumour;
• malignant cervical lymph nodes;
• carotid aneurysm, carotid artery dissection;
• involvement of T1 fibres, e.g. in T1 radiculopathy, or lower trunk brachial
plexopathy;
• cluster headache;
• congenital.
However, this is not particularly helpful in determining cause, whereas accompanying neurological features are as follows: contralateral hemiparesis would mandate investigation for carotid dissection (MRI, MRA, angiography), and this is probably sensible for any painful Horner’s syndrome of acute onset.
Arm symptoms and signs in a smoker mandate a chest radiograph for Pancoast tumour. If the Horner’s syndrome is isolated and painless, then no investigation may be required. In this situation, a symptomatic cause is seldom identified despite investigation. Syringomyelia presenting with isolated Horner’s syndrome has been reported.
Unilateral miosis may be mistaken for contralateral mydriasis if ptosis is subtle, leading to suspicion of a partial oculomotor nerve palsy on the ‘mydriatic’
side. Observation of anisocoria in the dark will help here, since increased anisocoria indicates a sympathetic defect (normal pupil dilates) whereas less anisocoria
suggests a parasympathetic lesion. Applying to the eye 10% cocaine solution will
also diagnose a Horner’s syndrome if the pupil fails to dilate after 45 min in the
dark (normal pupil dilates).
What is Hoyt–Spencer Sign?
This name is given to the triad of findings characteristic of chronic optic nerve
compression, especially due to spheno-orbital optic nerve sheath meningiomas:
• Optociliary shunt vessels
• Disc pallor
• Visual loss
What is Woltman’s sign?
It (also called Woltman’s sign of hypothyroidism or, in older references, myxedema reflex) is a delayed relaxation phase of an elicited deep tendon reflex, usually tested in the Achilles tendon of the patient. Woltman’s sign is named for Henry Woltman, an American neurologist.
What is hung-up reflex?
It is a deep tendon reflex in which, after a stimulus is given and the reflex action takes place, the limb slowly returns to its neutral position. This prolonged relaxation phase is characteristic of reflexes in persons with hypothyroidism.
What is Hutchinson’s Pupil?
Hutchinson’s pupil is unilateral pupillary dilatation ipsilateral to a supratentorial (usually extrinsic) space-occupying lesion, which may be the earliest sign
of raised intracranial pressure. It reflects involvement of peripheral pupilloconstrictor fibres in the oculomotor (III) nerve, perhaps due to compression on the margin of the tentorium.
What is Hyperacusis?
Hyperacusis is an abnormal loudness of sounds, especially low tones, due to
paralysis of the stapedius muscle, whose normal reflex function is to damp conduction across the ossicular chain of the middle ear. This most commonly occurs
with lower motor neurone facial (VII) nerve (Bell’s) palsy, located proximal to
the nerve to stapedius. Ageusia may also be present if the chorda tympani branch
of the facial nerve is involved. Hyperacusis may occasionally occur with central
(brainstem) lesions.
Reduction or absence of the stapedius reflex may be tested using the stethoscope loudness imbalance test: with a stethoscope placed in the patients ears, a
vibrating tuning fork is placed on the bell. Normally the perception of sound is
symmetrical, but sound lateralizes to the side of facial paresis if the attenuating
effect of the stapedius reflex is lost.
What is Hyperaesthesia?
Hyperaesthesia is increased sensitivity to sensory stimulation of any modality,
e.g. pain (hyperalgesia), touch.
What is Hyperalgesia?
Hyperalgesia is the exaggerated perception of pain from a stimulus which is
normally painful (cf. allodynia). This may result from sensitization of nociceptors (paradoxically this may sometimes be induced by morphine) or abnormal
ephaptic cross-excitation between primary afferent fibres.
What is Hyperekplexia?
Hyperekplexia (literally, to jump excessively) is an involuntary movement disorder in which there is a pathologically exaggerated startle response, usually to
sudden unexpected auditory stimuli, but sometimes also to tactile (especially
trigeminal) and visual stimuli. The startle response is a sudden shock-like movement which consists of eye blink, grimace, abduction of the arms, and flexion
of the neck, trunk, elbows, hips, and knees. The muscular jerk of startle satisfies the definition of myoclonus. Ideally for hyperekplexia to be diagnosed there
should be a physiological demonstration of exaggerated startle response, but
this criterion is seldom adequately fulfilled.
What are the causes of Hyperekplexia syndromes?
Hyperekplexia syndromes may be
classified as:
• Idiopathic: the majority.
• Hereditary/familial:
An autosomal dominant disorder with muscular hypertonia in infancy,
leg jerks, and gait disorder. Familial cases have been associated with
mutations in the α1 subunit of the inhibitory glycine receptor gene.
• Symptomatic:
perinatal ischaemic–hypoxic encephalopathy;
brainstem lesions (encephalitis, haemorrhage);
thalamic lesions (inflammation, vascular);
drugs (cocaine, amphetamines);
Tourette syndrome.
Attacks may respond to the GABA agonist clonazepam.
What is Hypergraphia?
Hypergraphia is a form of increased writing activity. It has been suggested
that it should refer specifically to all transient increased writing activity with a
non-iterative appearance at the syntactic or lexicographemic level
Hypergraphia may be seen as part of the interictal psychosis which sometimes develops in patients with complex partial seizures from a temporal lobe
(especially non-dominant hemisphere) focus, or with other non-dominant temporal lobe lesions (vascular, neoplastic, demyelinative, neurodegenerative), or
psychiatric disorders (schizophrenia). Hypergraphia is a feature of Geschwind’s
syndrome, along with Hyperreligiosity and hyposexuality.
What is automatic writing?
Automatic writing, in spiritualism, writing produced involuntarily when the subject’s attention is ostensibly directed elsewhere. The phenomenon may occur when the subject is in an alert waking state or in a hypnotic trance, usually during a séance.
What is automatic handwriting?
Automatic writing or psychography is a claimed psychic ability allowing a person to produce written words without consciously writing. The words purportedly arise from a subconscious, spiritual or supernatural source.
Is automatic writing a trance?
Automatic writing can happen in a trance or waking state. The Surrealist poet Robert Desnos claimed he was among the most gifted in automatic writing. Some psychical researchers such as Thomson Jay Hudson have claimed no spirits are involved in automatic writing and the subconscious mind is the explanation.
What is Hyperreligiosity?
It is a psychiatric disturbance in which a person experiences intense religious beliefs or experiences that interfere with normal functioning. Hyperreligiosity generally includes abnormal beliefs and a focus on religious content or even atheistic content, which interferes with work and social functioning.
What is Hyperhidrosis?
Hyperhidrosis is excessive (unphysiological) sweating. This may be ‘essential’ (i.e.
without obvious cause), or seen as a feature of acromegaly, Parkinson’s disease,
or occurring in a band above a spinal cord injury. Localized hyperhidrosis caused
by food (gustatory sweating) may result from aberrant connections between nerve
fibres supplying sweat glands and salivary glands. Other causes of hyperhidrosis include mercury poisoning, pheochromocytoma, and tetanus. Transient
hyperhidrosis contralateral to a large cerebral infarct in the absence of autonomic dysfunction has also been described. Regional syndromes of hyperhidrosis
(hands, feet, axillae) are also described.
Treatment is difficult. Symptoms may be helped (but not abolished) by low
dose anticholinergic drugs, clonidine, or propantheline. For focal syndromes,
botulinum toxin injections or sympathectomy may be helpful.
What is Hyperkinesia?
Hyperkinesia indicates an involuntary movement disorder characterized by
excessive amplitude of movement, such as ballism, or chorea, or the speech
disorders occurring with them.
What is Hyperlexia?
Hyperlexia has been used to refer to the ability to read easily and fluently (i.e.
decode printed text to sound) without necessarily comprehending the meaning
of the text which has been read, not infrequent in cases of autism.
What is Hyper metamorphosis?
Hyper metamorphosis is an over attention to external stimuli. Patients with
hyper metamorphosis may explore compulsively and touch everything in their
environment. This is one element of the environmental dependency syndrome
and may be associated with other forms of utilization behaviour, imitation
behaviour (echolalia, echopraxia), and frontal release signs such as the grasp
reflex. It occurs with severe frontal lobe damage and may be observed following
recovery from herpes simplex encephalitis and in frontal lobe dementias including Pick’s disease. Bitemporal lobectomy may also result in hyper metamorphosis, as a feature of the Klüver–Bucy syndrome.
What is Kluver -Bucy syndrome?
Klüver-Bucy syndrome is a rare behavioral impairment that is associated with damage to both of the anterior temporal lobes of the brain. It causes individuals to put objects in their mouths and engage in inappropriate sexual behaviour.
What is post traumatic Kluver Bucy syndrome?
Bilateral temporal lobe disorder; Post-encephalitic Kluver Bucy syndrome (type); Post-traumatic Kluver Bucy syndrome (type); Bilateral temporal lobe disorder; Post-encephalitic Kluver Bucy syndrome (type); Post-traumatic Kluver Bucy syndrome (type); Memory loss, extreme sexual behavior, placidity, and visual distractibility
What is Hyperorality?
Hyperorality is a neurobehavioral abnormality consisting of drinking more
than usual, eating excessively, eating anything in sight, and putting objects inappropriately into the mouth. It is a feature of frontal lobe pathology. It is one element of the Kluver–Bucy syndrome, along with hypersexuality.
Why do Toddlers eat dirt?
This pattern of eating or habit of eating dirt and rocks is medically termed as PICA or geophagy which is a disorder in which usually children between the age of 2-4 yrs. have a persistent and compulsive craving to eat non-food items. It occurs due to loss of certain nutrients such as iron deficiency anaemia, zinc deficiency.
What is Hyperpathia?
Hyperpathia is an unpleasant sensation, often a burning pain, associated with
elevated threshold for cutaneous sensory stimuli such as light touch or hot
and cold stimuli, especially repetitive stimuli. Even light stimuli may produce
pain.
Hyperpathia is a feature of thalamic lesions, and hence tends to involve the
whole of one side of the body following a unilateral lesion such as a cerebral
haemorrhage or thrombosis. Generalized hyperpathia may also be seen in variant
Creutzfeldt–Jakob disease, in which posterior thalamic (pulvinar) lesions are said
to be a characteristic neuroradiological finding.
What is Hyperphagia?
Hyperphagia is increased or excessive eating. Binge eating, particularly of sweet
things, is one of the neurobehavioral disturbances seen in certain of the
frontotemporal dementias. Hyperphagia may be one feature of a more general tendency to put things in the mouth (hyperorality), for example, in the Klüver–Bucy syndrome.
What is Hyperphoria?
Hyperphoria is a variety of heterophoria in which there is a latent upward deviation of the visual axis of one eye. Using the cover–uncover test, this may be observed clinically as the downward movement of the eye as it is uncovered.
What is Hyperpronation?
It is a condition afflicting the foot and ankle. It is characterized by excessive inward rolling of the foot at the ankle and consequent flattening of the arch during gait movements.
What is Hyperpilaphesie?
The name given to the augmentation of tactile faculties in response to other
sensory deprivation, for example, touch sensation in the blind.
What is Hyperreflexia?
Hyperreflexia is an exaggerated briskness of the tendon reflexes. This may be
physiological in an anxious patient (reflexes often denoted ++), or pathological
in the context of corticospinal pathway pathology (upper motor neurone syndrome, often denoted +++). It is sometimes difficult to distinguish normally
brisk reflexes from pathologically brisk reflexes. Hyperreflexia (including a jaw
jerk) in isolation cannot be used to diagnose an upper motor neurone syndrome,
and asymmetry of reflexes is a soft sign. On the other hand, upgoing plantar
responses are a hard sign of upper motor neurone pathology; other accompanying signs (weakness, sustained clonus, and absent abdominal reflexes) also
indicate abnormality.
‘Hyperreflexia’ of the bladder detrusor muscle may be a cause of urinary urge
incontinence
What is Hyperreligiosity?
Hyper religiosity is a neurobehavioral symptom, manifest as sudden religious conversion, or increased and unswerving orthodoxy in devotion to religious rituals. It may be encountered along with hypergraphia and hyposexuality as a feature of Geschwind’s syndrome. It has also been observed in some patients with frontotemporal dementia; the finding is cross-cultural, having been described in Christians, Muslims, and Sikhs. In the context of refractory epilepsy, it has been associated with reduced volume of the right hippocampus, but not right amygdala.
What is Hypoactive sexual desire disorder (HSDD)?
It, hyposexuality or inhibited sexual desire (ISD), is considered a sexual dysfunction and is characterized as a lack or absence of sexual fantasies and desire for sexual activity, as judged by a clinician.
What is Hypersexuality
Hypersexuality is a pathological increase in sexual drive and activity. Recognized
causes include bilateral temporal lobe damage, as in the Klüver–Bucy syndrome,
septal damage, hypothalamic disease (rare) with or without subjective increase in
libido, and dopaminergic drug treatment in Parkinson’s disease. Hypersexuality
is also a feature of the Kleine–Levin syndrome. Sexual disinhibition may be a
feature of frontal lobe syndromes, particularly of the orbitofrontal cortex.
What does hypergraphia mean?
Hypergraphia may compel someone to keep a voluminous journal, to jot off frequent letters to the editor, to write on toilet paper if nothing else is available, and perhaps even to compile a dictionary. Hypergraphia is the opposite of writer’s block.
What is Hypersomnolence?
Hypersomnolence is characterized by excessive daytime sleepiness, with a tendency to fall asleep at inappropriate times and places, for example, during
meals, telephone conversations, at the wheel of a car.
What are the causes of hypersomnolence?
Causes of hypersomnolence include
• Narcolepsy or the narcoleptic syndrome: may be accompanied by other
features such as sleep paralysis, hypnagogic hallucinations, cataplexy
• Midbrain lesions
• Idiopathic CNS hypersomnia
• Kleine–Levin syndrome
• Nocturnal hypoventilation, due to:
Obstructive sleep apnoea–hypopnoea syndrome (OSAHS; Pickwickian
syndrome)
Chest wall anomalies
Neuromuscular and myopathic disorders affecting the respiratory muscles, especially the diaphragm, for example:
motor neurone disease
myotonic dystrophy
metabolic myopathies, e.g. acid maltase deficiency
mitochondrial disorders
• Drugs: benzodiazepines, ergot-derivative dopamine agonists
• Post-stroke sleep-related disorders
Nocturnal hypoventilation as a consequence of obstructed breathing, often
manifest as snoring, causes arterial oxygen desaturation as a consequence of
hypopnoea/apnoea which may lead to disturbed sleep, repeated arousals associated with tachycardia, and hypertension. Clinical signs may include a bounding
hyperdynamic circulation and sometimes papilloedema, as well as features of any
underlying neuromuscular disease. OSAHS may present in the neurology clinics
with loss of consciousness (sleep secondary to hypersomnolence), stroke, morning headaches, and cognitive impairment (slowing). Investigations may reveal a
raised haematocrit and early morning hypoxia. Sleep studies confirm nocturnal hypoventilation with dips in arterial oxygen saturation.
Treatment is with nocturnal intermittent positive pressure ventilation. Modafinil is also licensed for this indication.
What is Hyperthermia?
Body temperature is usually regulated within narrow limits through the coordinating actions of a centre for temperature control (‘thermostat’), located in
the hypothalamus (anterior–preoptic area), and effector mechanisms (shivering, sweating, panting, vasoconstriction, vasodilation), controlled by pathways
located in or running through the posterior hypothalamus and peripherally in the
autonomic nervous system. Lesions of the anterior hypothalamus (e.g. trauma,
ischaemia, inflammation, tumour) may result in hyperthermia (cf. hypothermia).
What are the causes of hyperthermia?
Other recognized causes of hyperthermia include
• Infection: bacteria, viruses (pyrogens, e.g. interleukin-1)
• Malignant hyperthermia
• Neuroleptic malignant syndrome (hyperthermia, rigidity, autonomic dysfunction)
• Heatstroke
• Hyperthyroidism
• Pheochromocytoma crisis
What is Hypothermia?
Hypothermia is defined as a body core temperature below 35.0 °C (95.0 °F) in humans. Symptoms depend on the temperature. In mild hypothermia, there is shivering and mental confusion. In moderate hypothermia, shivering stops and confusion increases. In severe hypothermia, there may be paradoxical undressing, in which a person removes their clothing, as well as an increased risk of the heart stopping.
Hypothermia has two main types of causes. It classically occurs from exposure to extreme cold.[1] It may also occur from any condition that decreases heat production or increases heat loss.[1] Commonly this includes alcohol intoxication but may also include low blood sugar, anorexia, and advanced age.
What is Hypertonia, Hypertonus?
Hypertonia or hypertonus is an exaggeration of normal muscular tone, manifest as resistance to passive movement. It usually implies spasticity of corticospinal (pyramidal) pathway origin, rather than (leadpipe) rigidity of extrapyramidal origin.
Clasp-knife response refers to a Golgi tendon reflex with a rapid decrease in resistance when attempting to flex a joint, usually during a neurological examination. It is one of the characteristic responses of an upper motor neuron lesion. It gets its name from the resemblance between the motion of the limb and the sudden closing of a clasp knife after sufficient pressure is applied.
What is paratonia?
Paratonia is the inability to relax muscles during muscle tone assessment. There are two types of paratonia: oppositional and facilitatory. Oppositional paratonia (“gegenhalten”) occurs when subjects involuntarily resist to passive movements, while facilitatory paratonia (“mitgehen”) occurs when subjects involuntary assist passive movements.
What is Hypertropia?
Hypertropia is a variety of heterotropia in which there is manifest upward vertical
deviation of the visual axis of one eye. Using the cover test, this manifests as
downward movement of the uncovered eye. Depending on the affected eye, this
finding is often described as a ‘left-over right’ or ‘right-over left’. Asymptomatic
hypertropia on lateral gaze is often congenital or physiological.
What is Hypoaesthesia?
Hypoaesthesia (hypaesthesia, hypesthesia) is decreased sensitivity to, or diminution of, sensory perception in any modality, most frequently used to describe pain (hypoalgesia) or touch.
What is Hypoalgesia?
Hypoalgesia is a decreased sensitivity to, or diminution of, pain perception in
response to a normally painful stimulus.
What is Hypokinesia?
Hypokinesia is a reduction in the speed of initiation of voluntary movements,
which at worst may progress to an inability to initiate voluntary movement (akinesia). Repeated apposition of finger and thumb or foot tapping may be useful in
demonstrated hypokinesia of gradual onset (‘fatigue’). It may often coexist with
bradykinesia and hypometria and is a feature of disorders of the basal ganglia
(akinetic-rigid or parkinsonian syndromes), for example:
• Parkinson’s disease
• Multiple system atrophy
• Progressive supranuclear palsy (Steele–Richardson–Olszewski syndrome)
• Some variants of prion disease
What is Hypometria?
Hypometria is a reduction in the amplitude of voluntary movements. It may be
demonstrated by asking a patient to make repeated, large amplitude, opposition
movements of thumb and forefinger, or tapping movements of the foot on the
floor. A gradual decline in amplitude (which may be referred to as fatiguability; cf. fatigue) denotes hypometria. Voluntary saccadic eye movements may also
show a ‘step’, as a correcting additional saccade compensates for the undershoot
(hypometria) of the original movement. Hypometria is a feature of parkinsonian
syndromes such as idiopathic Parkinson’s disease.
What is Hypomimia?
Hypomimia, or amimia, is a deficit or absence of expression by gesture or
mimicry. This is usually most obvious as a lack of facial expressive mobility
(‘mask-like facies’). This is a feature of frontal–subcortical disease, e.g. basal
ganglia disease producing akinetic-rigid or parkinsonian syndromes, and frontal
lobe lesions (especially of the non-dominant hemisphere).
What is Hypophonia?
Hypophonia is a quiet voice, as in hypokinetic dysarthria. It is often a feature
of parkinsonian syndromes (e.g. idiopathic Parkinson’s disease, multiple system
atrophy) and may occur early in progressive supranuclear palsy. In isolation,
other causes of dysphonia may need to be considered.
What is Hypophoria?
Hypophoria is a variety of heterophoria in which there is a latent downward
deviation of the visual axis of one eye. Using the cover–uncover test, this may be
observed clinically as the upward movement of the eye as it is uncovered.
What is Hyporeflexia?
Hyporeflexia is a diminution of tendon reflexes, short of their total absence (areflexia). This may be physiological, as with the diminution of the ankle jerks with
normal ageing; or pathological, most usually as a feature of peripheral lesions
such as radiculopathy or neuropathy.
Hyporeflexia is an accompaniment of hemiballismus, and may also be noted in brain stem
encephalitis (Bickerstaff’s encephalitis), in which the presence of a peripheral
nerve disorder is debated. Hyporeflexia is not a feature of myasthenia gravis but
may occur in Lambert–Eaton myasthenic syndrome (cf. facilitation); it is not seen
in most muscle diseases unless they are advanced.
What is Hyposexuality?
Hyposexuality is a lack of sexual drive, interest, or activity. It may be associated with many diseases, physical or psychiatric, and/or medications which
affect the central nervous system. Along with hypergraphia and hyper religiosity,
hyposexuality is one of the defining features of the Geschwind syndrome.
What is Hypothermia?
Hypothalamic damage, particularly in the posterior region, can lead to hypothermia (cf. hyperthermia) or poikilothermia (body temperature varying with
ambient temperature, as in reptiles). There are many pathological causes,
including tumour, trauma, infarct, haemorrhage, neurosarcoidosis, Wernicke’s
encephalopathy, fat embolism, histiocytosis X, and multiple sclerosis (rare). A
rare syndrome of paroxysmal or periodic hypothermia has been described and
labelled as diencephalic epilepsy. Non-neurological causes of hypothermia are
more common, including hypothyroidism, hypopituitarism, hypoglycaemia, and
drug overdose.
What is Spontaneous periodic hypothermia?
It is a rare syndrome of recurrent, centrally mediated hypothermia without an identifiable systemic cause or brain lesion. Most patients defend a temporarily lowered temperature “set point” during episodes of hypothermia, despite manifesting many well-known systemic consequences of core
What is Hypotonia, Hypotonus?
Hypotonia (hypotonus) is a diminution or loss of normal muscular tone, causing floppiness of the limbs. This is particularly associated with peripheral nerve or muscle pathology, as well as lesions of the cerebellum and certain basal ganglia disorders such as hemiballismus–hemichorea. Weakness preventing voluntary activity rather than a reduction in stretch reflex activity appears to be the mechanism of hypotonia.
What is Hypotropia?
Hypotropia is a variety of heterotropia in which there is manifest downward vertical deviation of the visual axis of one eye. Using the cover test, this manifests as upward movement of the uncovered eye. Depending on the affected eye, this finding is often described as a ‘left-over-right’ or ‘right-over-left’.
What is Ice Pack Test?
The ice pack test, or ice-on-eyes test, is performed by holding an ice cube,
wrapped in a towel or a surgical glove, over the levator palpebrae superioris
muscle of a ptotic eye for 2–10 min. Improvement of ptosis is said to be specific for myasthenia gravis, perhaps because cold improves transmission at the
neuromuscular junction (myasthenic patients often improve in cold as opposed
to hot weather). This phenomenon is generally not observed in other causes of
ptosis, although it has been reported in Miller Fisher syndrome. A pooled analysis of several studies gave a test sensitivity of 89% and specificity of 100% with correspondingly high positive and negative likelihood ratios. The test is easy to perform and without side effects (cf. tensilon test). Whether the ice pack test is also applicable to myasthenic diplopia has yet to be determined: false positives have been documented.
What is Illusion?
An illusion is a misinterpretation of a perception (cf. delusion, hallucination).
Illusions occur in normal people when they are tired, inattentive, in conditions
of poor illumination, or if there is sensory impairment. They also occur in
disease states, such as delirium, and psychiatric disorders (affective disorders,
schizophrenia). Examples of phenomena which may be labelled illusory include
• Visual: illusory visual spread, metamorphopsia, palinopsia, polyopia,
teleopsia, Pulfrich phenomenon, visual alloaesthesia, visual perseveration;
• Auditory: palinacusis;
• Vestibular: vertigo.
What is Palinopsia?
It is the persistent recurrence of a visual image after the stimulus has been removed. Palinopsia is not a diagnosis, it is a diverse group of pathological visual symptoms with a wide variety of causes. Visual perseveration is synonymous with palinopsia.
In 2014, Gersztenkorn and Lee comprehensively reviewed all cases of palinopsia in the literature and subdivided it into two clinically relevant groups: illusory palinopsia and hallucinatory palinopsia.
What is illusory visual spread?
In illusory visual spread, objects within the visual field are often perceived as multiple copies, and neighbouring objects may appear to take on the colours and texture of these objects.
What is Imitation Behaviour?
Imitation behaviour is the reproduction by the patient of gestures (echopraxia)
and/or utterances (echolalia) made by the examiner in front of the patient; these
‘echophenomena’ are made by the patient without preliminary instructions to
do so.
Imitation behaviour occurs with frontal lobe damage; originally mediobasal
disease was thought the anatomical correlate, but more recent studies suggest
upper medial and lateral frontal cortex. Certainly, imitation behaviour never
occurs with retrorolandic cortical lesions.
A distinction has been drawn between ‘naïve’ imitation behaviour, which
ceases after a direct instruction from the examiner not to imitate his/her gestures, which may be seen in some normal individuals; and ‘obstinate’ imitation
behaviour which continues despite an instruction to stop; the latter is said to be
exclusive to frontotemporal dementia.
What is Synkinesis?
It is a neurological symptom in which a voluntary muscle movement causes the simultaneous involuntary contraction of other muscles. An example might be smiling inducing an involuntary contraction of the eye muscles, causing a person to squint when smiling. Facial and extraocular muscles are affected most often; in rare cases, a person’s hands might perform mirror movements. Synkinesis is usually caused by dysfunction of a particular nerve.
What is mirror movement?
The definition of mirror movement as involuntary, synkinetic mirror reversals of an intended movement of opposite side was coined by Cohen et al. in 1991.[1] These movements are soft, neurologic signs, seen uncommonly in clinical practice.
What are other names for mirror movement disorder?
The following are some additional synonyms for Congenital Mirror Movement Disorder: 1 Bimanual Synkinesis 2 Congenital Mirror Movements 3 Familial Congenital Mirror Movements 4 Hereditary Congenital Contralateral Synkinesia 5 Hereditary Congenital Mirror Movements 6 Isolated Congenital Mirror Movements
What is Impersistence?
Impersistence is an inability to sustain simple motor acts, such as conjugate gaze,
eye closure, protrusion of the tongue, or keeping the mouth open. It is most
commonly seen with lesions affecting the right hemisphere, especially central and
frontal mesial regions, and may occur in association with left hemiplegia, neglect,
anosognosia, hemianopia, and sensory loss. These patients may also manifest
perseveration, echolalia, and echopraxia.
What are the causes of impersistence?
Impersistence is most often observed following vascular events but may
also be seen in Alzheimer’s disease and frontal lobe dementias, and metabolic
encephalopathies. Impersistence of tongue protrusion and handgrip may be seen
in Huntington’s disease. Neuropsychologically, impersistence may be related to
mechanisms of directed attention which are needed to sustain motor activity.
What is Incontinence?
Urinary incontinence may result from neurological, as well as urological, disease. Neurological pathways subserving the appropriate control of micturition
encompass the medial frontal lobes, a micturition centre in the dorsal tegmentum of the pons, spinal cord pathways, Onuf’s nucleus in the spinal cord segments
S2–S4, the cauda equina, and the pudendal nerves. Thus, the anatomical differential diagnosis of neurological incontinence is broad. Moreover, incontinence may
be due to inappropriate bladder emptying or a consequence of loss of awareness of bladder fullness with secondary overflow. Other features of the history
and/or examination may give useful pointers as to localization. Incontinence of
neurological origin is often accompanied by other neurological signs, especially
if associated with spinal cord pathology. The pontine micturition centre lies close to the medial longitudinal fasciculus and local disease
may cause an internuclear ophthalmoplegia. However, other signs may be absent
in disease of the frontal lobe or cauda equina.
What are the causes of urinary incontinence?
• Idiopathic generalized epilepsy with tonic–clonic seizures; however, the differential diagnosis of ‘loss of consciousness with incontinence’ also encompasses syncopal attacks with or without secondary anoxic convulsions,
non-epileptic attacks, and hyperekplexia.
• Frontal lobe lesions: frontal lobe dementia; normal pressure hydrocephalus.
• Spinal cord pathways: urge incontinence of multiple sclerosis; loss of awareness of bladder fullness with retention of urine and overflow in tabes
dorsalis.
• Sacral spinal cord injury; degeneration of the sacral anterior horn cells in
Onuf’s nucleus (multiple system atrophy).
• Cauda equina syndrome; tethered cord syndrome (associated with spinal
dysraphism).
• Pelvic floor injury.
Neurogenic incontinence may be associated with urgency, which results
from associated abrupt increases in detrusor pressure (detrusor hyperreflexia);
this may be helped by anticholinergic medication (e.g. oxybutynin, tolterodine). In addition, there may be incomplete bladder emptying, which is
usually asymptomatic, due to detrusor sphincter dyssynergia; for postmicturition residual volumes of greater than 100 ml (assessed by in–out
catheterization or ultrasonography), this is best treated by clean intermittent
self-catheterization.
What are the signs of hyperekplexia?
The three main signs of hyperekplexia are generalized stiffness, excessive startle beginning at birth and nocturnal myoclonus. Affected individuals are fully conscious during episodes of stiffness, which consist of forced closure of the eyes and an extension of the extremities followed by a period of generalised stiffness and uncontrolled falling at times.
What is the best medicine for hyperekplexia?
Hereditary hyperekplexia is commonly treated with the anti-anxiety and anti-spastic drug clonazepam. Other medications which have been helpful for some people include carbamazepine, phenytoin, diazepam, valproate, 5-hydroxytryptophan, piracetam, phenobarbital, and fluoxetine.
What causes cauda equina syndrome?
Cauda equina syndrome can be caused by any condition that results in direct irritation or pinching of the nerves at the end of the spinal cord. Symptoms of cauda equina syndrome include low back pain, numbness and/or tingling in the buttocks and lower extremities (sciatica), weakness in the legs, and incontinence of bladder and/or bowels.
What are the symptoms of frontal lobe damage?
Symptoms of Frontal Lobe Damage are
Movement: Presence of tremors, dystonia, apraxia, gait disorder and clumsiness.
Emotional: Difficulty controlling emotions, excitement, anger and depression including difficulty in…
Behavioral: Difficulty in utilizing and perseveration of behavior,
Language: Presence of aphasia and expressive aphasia.
Can cauda equina syndrome be confirmed?
Cauda equina syndrome can be confirmed with neurologic and radiology testing but such testing should not be delayed. Specialized neurologic nerve testing of the lower extremities, such as nerve conduction velocity (NCV) and electromyography (EMG) tests can indicate nerve irritation effects in the low back.
How is intention myoclonus treated?
Clonazepam, a new benzodiazepine derivative, was used in the treatment of intention myoclonus with excellent results. Five patients, three with post anoxic encephalopathy and two with degenerative central nervous system disorders, all refractory to other therapy, responded with marked decrease in myoclonus.
What is Intermanual Conflict?
Intermanual conflict is a behaviour exhibited by an alien hand (le main étranger) in which it reaches across involuntarily to interfere with the voluntary activities of the contralateral (normal) hand. Diagonistic dyspraxia probably refers to the same phenomenon. The hand acts at cross purposes
to the other following voluntary activity. A ‘compulsive grasping hand’ syndrome has been described which may be related to intermanual conflict, the difference being grasping of the contralateral hand in response to voluntary movement.
Intermanual conflict is more characteristic of the callosal, rather than the
frontal, subtype of anterior or motor alien hand. It is most often seen in patients
with corticobasal degeneration, but may also occur in association with callosal
infarcts or tumours or following callosotomy.
What is Intermetamorphosis?
A form of delusional misidentification in which people known to the patient are
believed to exchange identities with each other (cf. Fregoli syndrome, in which
one person can assume different physical appearance).
What is Internuclear Ophthalmoplegia (INO)?
Internuclear ophthalmoplegia (INO), or medial longitudinal fasciculus syndrome, consists of ipsilateral weakness of eye adduction with contralateral
nystagmus of the abducting eye (ataxic or dissociated nystagmus), but with preserved convergence. This may be obvious with pursuit eye movements, but is
better seen when testing reflexive saccades or optokinetic responses when the
adducting eye is seen to ‘lag’ behind the abducting eye. INO may be asymptomatic or, rarely, may cause diplopia, oscillopsia, or a skew deviation. INO
may be unilateral or bilateral. The eyes are generally aligned in primary gaze,
but if there is associated exotropia this may be labelled wall-eyed monocular or
bilateral internuclear ophthalmoplegia.
What are the causes of INO?
The most common cause of INO by far is demyelination, particularly in young patients, but other causes include infarction (particularly older
patients), Wernicke–Korsakoff syndrome, infection, trauma, tentorial herniation,
haemorrhage, vasculitis, and paraneoplasia.
A similar clinical picture may be observed with pathology elsewhere, hence a
‘false-localizing’ sign and referred to as a pseudointernuclear ophthalmoplegia,
especially in myasthenia gravis.
What is Intrusion?
An intrusion is an inappropriate recurrence of a response (verbal, motor) to
a preceding test or procedure after intervening stimuli. Schnider characterizes
them as a form of confabulation. Intrusions are thought to reflect inattention
and may be seen in dementing disorders or delirium. These phenomena overlap
to some extent with the recurrent type of perseveration.
What is Lhermitte s sign?
It is sometimes called Lhermitte’s sign, though this is technically incorrect as a sign is something that can be observed on examination whereas a symptom is the subjective experience. Lhermitte’s phenomenon is subjective and therefore a symptom. Lhermitte phenomenon, also called the barber chair phenomenon, is an uncomfortable “electrical” sensation that runs through the back and into the limbs. The sensation can feel like it goes up or down the spine.
In many people, it is elicited by bending the head forward.[1] It can also be evoked when a practitioner pounds on the cervical spine while the neck is flexed; this is caused by involvement of the posterior columns. Lhermitte phenomenon is named for French neurologist Jean Lhermitte.
What is the opposite of Marcus Gunn phenomenon?
Inverse Marcus Gunn phenomenon, the opposite of the Marcus Gunn phenomenon, is characterised by eyelid closure on jaw opening. Few cases have been reported, most following peripheral facial paralysis.
What is perseveration speech?
Perseveration according to psychology, psychiatry, and speech-language pathology, is the repetition of a particular response (such as a word, phrase, or gesture) regardless of the absence or cessation of a stimulus.
What are the characteristics of confabulation?
There are several common characteristics of confabulation. There is a lack of awareness that a memory is false or distorted. When errors are pointed out, the patient is unconcerned about the apparent unreality of his or her account. There is no attempt to deceive or lie. There is no hidden motivation for the patient to misremember the information.
What is jaw winking Syndrome?
Although Marcus Gunn jaw-winking syndrome is usually unilateral, it can present bilaterally in rare cases. The wink reflex consists of a momentary upper eyelid retraction or elevation to an equal or higher level than the normal fellow eyelid upon stimulation of the ipsilateral pterygoid muscle.
What is an inverse Uhthoff syndrome?
This is called an Inverse Uhthoff’s syndrome. An unexpected improvement is experienced when the body temperature rises. It has also been described as a worsening of symptoms which occur when the body temperature drops.
What is Uhthoff’s phenomenon?
Uhthoff’s phenomenon (also known as Uhthoff’s syndrome, Uhthoff’s sign, and Uhthoff’s symptom) is the worsening of neurologic symptoms in multiple sclerosis (MS) and other neurological, demyelinating conditions when the body gets overheated from hot weather, exercise, fever, or saunas and hot tubs.. It is usually applied to optic neuritis and other visual symptoms but can also refer to fatigue, pain, balance, weakness, bladder issues, cognitive or sensory symptoms.
What is Inverted Reflexes?
A phasic tendon stretch reflex is said to be inverted when the movement elicited
is opposite to that normally seen, e.g. extension of the elbow rather than flexion
when eliciting the supinator (brachioradialis) jerk; flexion of the forearm when
tapping the triceps tendon (paradoxical triceps reflex); and flexion (hamstring
contraction) rather than extension of the knee when tapping the patellar tendon.
The finding of inverted reflexes may reflect dual pathology, but more usually
reflects a single lesion which simultaneously affects a root or roots, interrupting
the local reflex arc, and the spinal cord, damaging corticospinal (pyramidal tract)
pathways which supply segments below the reflex arc. Hence, an inverted supinator jerk is indicative of a lesion at C5/6, paradoxical triceps reflex occurs with C7
lesions; and an inverted knee jerk indicates interruption of the L2/3/4 reflex arcs,
with concurrent damage to pathways descending to levels below these segments.
What is Iridoplegia?
Paralysis of the iris, due to loss of pupillary reflexes. This may be partial, as in
Argyll Robertson pupil or Holmes–Adie pupil, or complete as in the internal
ophthalmoplegia of an oculomotor (III) nerve palsy.
What is Jacksonian March?
Jacksonian march is the sequential spread of a simple partial seizure to involve
other body parts, for example, jerking may spread from one hand up the arm,
to the ipsilateral side of the face. It may culminate in a secondary generalized
seizure. The pathophysiological implication is of electrical disturbance spreading
through the homunculus of the motor cortex. A sensory equivalent occurs but is
rare.
What is Jactitation?
Jactitation is literally ‘throwing about’, but may also imply restlessness. The term
has been used in various ways: to refer to jerking or convulsion of epileptic origin;
or jerking of choreic origin; or of myoclonic origin, such as ‘hypnagogic jactitation’ (physiological myoclonus associated with falling to sleep). It may also be
used to refer to the restlessness seen in acute illness, high fever, and exhaustion,
though differing from the restlessness implied by akathisia. Hence, it is essentially
a non-specific term.
What is Jamais Entendu?
A sensation of unfamiliarity akin to jamais vu but referring to auditory experiences.
What is Jamais Vu?
Jamais vu (literally ‘never seen’) and jamais vécu (‘never lived’) are complex auras
of focal onset epilepsy in which there is a sensation of strangeness or unfamiliarity about visual stimuli that have in fact been previously experienced (cf. déjà vu).
This is suggestive of seizure onset in the limbic system, but is not lateralizing
What is Jargon Aphasia?
Jargon aphasia is a fluent aphasia characterized by a jumbled, unintelligible and
meaningless (to the listener) output, with multiple paraphasias and neologisms,
and sometimes echolalia (as in transcortical sensory aphasia). There may be a
pressure of speech (logorrhoea). There is debate as to whether jargon aphasia is
simply a primary Wernicke/posterior/sensory type of aphasia with failure to self-monitor speech output, or whether additional deficits (e.g. pure word deafness,
intellectual impairment) are also required. Others suggest that jargon aphasia
represents aphasia and anosognosia, leading to confabulation and reduplicative
paramnesia.
What is Jaw Jerk?
The jaw jerk, or masseter reflex, is contraction of the masseter and temporalis
muscles in response to a tap on the jaw with the mouth held slightly open.
Both the afferent and efferent limbs of the arc run in the mandibular division
of the trigeminal (V) nerve, connecting centrally with the mesencephalic (motor)
nucleus of the trigeminal nerve. The reflex is highly reproducible; there is a linear
correlation between age and reflex latency and a negative correlation between age
and reflex amplitude.
Interruption of the reflex arc leads to a diminished or absent jaw jerk as
in bulbar palsy (although an absent jaw jerk may be a normal finding, particularly in the elderly). Bilateral supranuclear lesions cause a brisk jaw jerk, as in
pseudobulbar palsy (e.g. in motor neurone disease).
What is Jaw Winking?
Jaw winking, also known as the Marcus Gunn phenomenon, is widening of a
congenital ptosis when a patient is chewing, swallowing, or opening the jaw
(i.e. a trigemino-oculomotor synkinesis). It is believed to result from aberrant
innervation of the pterygoid muscles and levator palpebrae superioris.
Eyelid closure on jaw movement or opening of the mouth, the inverse
Marcus Gunn phenomenon, is also described, as the Marin-Amat syndrome,
thought to be due to aberrant facial (VII) nerve regeneration.
What is Jendrassik’s Manoeuvre?
Jendrassik’s manoeuvre is used to enhance or bring out absent or depressed tendon (phasic stretch) reflexes by isometric contraction of distant muscle groups,
e.g. clenching teeth, or making a fist, interlocking fingers, and pulling the hands
against one another. If previously absent reflexes are then elicited, this may
be denoted +/−. Cocontraction increases the gain in the monosynaptic reflex
arc, as distinct from facilitation or post tetanic potentiation which is seen in
Lambert−Eaton myasthenic syndrome following tetanic contraction of muscles
involved in the reflex.
What is Jitteriness?
Jitteriness implies an exaggerated startle response, reflecting CNS overactivity.
This may be confused in neonates with clonic seizures, but in the former there
is stimulus sensitivity and an absence of associated ocular movements. However,
both may occur in hypoxic−ischaemic or metabolic encephalopathies or with
drug withdrawal.
What is Jugular Foramen Syndrome?
The glossopharyngeal (IX), vagus (X), and accessory (XI) cranial nerves may
be damaged by lesions at or around the jugular foramen, producing a jugular
foramen (or Vernet’s) syndrome. This produces
• Dysphagia, dysphonia, palatal droop, impaired gag reflex; ipsilateral
reduced taste sensation on the posterior one-third of the tongue, and anaesthesia of the posterior one-third of the tongue, soft palate, pharynx, larynx,
and uvula, due to glossopharyngeal and vagus nerve involvement.
• Ipsilateral weakness and atrophy of sternocleidomastoid and trapezius due
to accessory nerve involvement (atrophy may be the more evident, hence the
importance of palpating the muscle bellies).
What are the causes of jugular foramen syndrome?
Recognized causes of the jugular foramen syndrome include
• Skull base trauma/fracture;
• Glomus jugulare tumour;
• Inflammatory/infective collection at the skull base;
• Ischaemia.
What are the differential diagnosis of jugular foramen syndrome?
The differential diagnosis includes retropharyngeal or retroparotid space
occupying lesions, which may in addition involve the hypoglossal nerve (XII;
Collet−Sicard syndrome) and the sympathetic chain with or without the facial
nerve (VII; Villaret’s syndrome).
What is Kayser–Fleischer Rings?
Kayser–Fleischer rings are deposits of copper, seen as a brownish discoloration,
in Descemet’s membrane. Although often visible to the naked eye (difficult in
people with a brown iris), they are best seen with slit-lamp examination. Since
they are a highly reliable sign of intracerebral copper deposition in Wilson’s disease (hepatolenticular degeneration), any patient suspected of this diagnosis (i.e.
with parkinsonism or dystonia presenting before age 50 years) should have a
slit-lamp examination (as well as blood copper and caeruloplasmin, and urinary
copper, measurements). Very occasionally cases of neurological Wilson’s disease
without Kayser–Fleischer rings have been reported.
What is Kernig’s Sign?
Kernig’s sign is pain in the lower back (and also sometimes the neck) and
resistance to movement with passive extension of the knee on the flexed thigh
in a recumbent patient. It is indicative of meningeal mechanosensitivity due
to inflammation, either infective (meningitis) or chemical (subarachnoid haemorrhage), in which case it may coexist with nuchal rigidity and Brudzinski’s
(neck) sign. If unilateral it may indicate irritation of the lumbosacral nerve roots
from a ruptured intervertebral disc (in which case Lasègue’s sign may also be
present).
What is the Lasegue sign?
A clinical sign of pressure on nerve roots in the lumbar region in SCIATICA. With the patient lying on his or her back there is limitation of thigh bending (flexion) on the affected side, on attempts to raise the straight leg. The sign can also be elicited by attempting to flex the ankle with the straight leg raised.
What is Brudzinski’s sign?
Jozef Brudzinski (1874–1917), a Polish pediatrician, is credited with several signs in meningitis. The most commonly used sign (Brudzinski’s neck sign) is positive when the forced flexion of the neck elicits a reflex flexion of the hips, with the patient lying supine. Other signs attributed to Brudzinski.
What is the pain on Kernig s neck?
Pathophysiology. The pain felt on Kernig’s sign is due to meningeal irritation caused by movement of the spinal cord within the meninges. In the Brudzinski’s neck sign, this movement with neck flexion is cancelled out by the flexion of the hip; much like two persons pulling on either side of a single rope.
What is Kernohan’s Notch Syndrome?
Raised intracranial pressure as a result of an expanding supratentorial lesion
(e.g. tumour, subdural haematoma) may cause herniation of brain tissue through
the tentorium into the sub tentorial space, putting pressure on the midbrain.
If the midbrain is shifted against the contralateral margin (free edge) of the
tentorium, the cerebral peduncle on that side may be compressed, resulting in a hemiparesis which is ipsilateral to the supratentorial lesion (and
hence may be considered ‘false-localizing’). There may also be an oculomotor nerve palsy ipsilateral to the lesion, which may be partial (unilateral pupil dilatation).
What is Kinesis Paradoxica?
Kinesis paradoxica is the brief but remarkably rapid and effective movement
sometimes observed in patients with Parkinson’s disease or postencephalitic
parkinsonism, despite the poverty and slowness of spontaneous movement (akinesia, hypokinesia; bradykinesia) seen in these conditions. It often occurs in response to alarm, excitement, or emotion (e.g. in response to a genuinely funny joke).
What is Klazomania?
Klazomania was the term applied to the motor and vocal tics seen as a sequel to
encephalitis lethargica (von Economo’s disease), along with parkinsonism and
oculogyric crises. This observation helped to promote the idea that tics were due
to neurological disease rather than being psychogenic, for example, in Tourette
syndrome.
What is a tic?
It is a sudden, repetitive, nonrhythmic motor movement or vocalization involving discrete muscle groups. Tics can be invisible to the observer, such as abdominal tensing or toe crunching. Common motor and phonic tics are, respectively, eye blinking and throat clearing.
What is the definition of echolalia?
Echolalia describes the precise repetition, or echoing, of words and sounds. Echolalia can be a symptom of various disorders including aphasia, dementia, traumatic brain injury, and schizophrenia, but it is most often associated with autism.
What is delayed echolalia?
A kind of echolalia is delayed echolalia, a baby’s imitation or repetition of sounds or words produced by others. It occurs normally in early childhood development. Also called echophrasia, or echo speech.
What does coprolalia mean?
Medical Definition of coprolalia. 1: obsessive or uncontrollable use of obscene language. 2: the use of obscene (as scatological) language as sexual gratification.
What is Kleptomania?
Kleptomania, a morbid impulse to steal, has been related to the obsessive–
compulsive spectrum of behaviours in patients with frontal lobe dysfunction.
Does coprolalia happen in Tourettes Syndrome?
Although coprolalia is the most widely known symptom of TS, it occurs in only a minority of patients with TS. It is most often expressed as a single word, but may involve complex phrases. There is no way to predict who will develop coprolalia. Copropraxia is a related complex motor tic symptom involving obscene gestures.
What is coprolalia in Tourettes?
Coprolalia is a typical symptom of Tourette syndrome, a condition that has its onset in childhood and is characterized by compulsive arm movements, facial tics, grunting, groaning and shouting. Aside from coprolalia, there is often echolalia, the involuntary parrot-like repetition (echoing) of a word or sentence just spoken by another person.
What is mirror movement?
The definition of mirror movement as involuntary, synkinetic mirror reversals of an intended movement of opposite side was coined by Cohen et al. in 1991.[1] These movements are soft, neurologic signs, seen uncommonly in clinical practice.
What are other names for mirror movement disorder?
The following are some additional synonyms for Congenital Mirror Movement Disorder: 1 Bimanual Synkinesis 2 Congenital Mirror Movements 3 Familial Congenital Mirror Movements 4 Hereditary Congenital Contralateral Synkinesia 5 Hereditary Congenital Mirror Movements 6 Isolated Congenital Mirror Movements
What is mirror hand syndrome?
Congenital mirror movement disorder is a condition in which intentional movements of one side of the body are mirrored by involuntary movements of the other side. For example, when an affected individual makes a fist with the right hand, the left hand makes a similar movement.
What is Klüver–Bucy Syndrome?
The Klüver–Bucy syndrome consists of a variety of neurobehavioral changes,
originally observed following bilateral temporal lobectomy (especially anterior
tip) in monkeys, but subsequently described in man. The characteristic features,
some or all of which may be present, are as follows:
• Visual agnosia (e.g. misrecognition of others)
• Hyperorality
• Hyperphagia, binge eating
• Hyper metamorphosis
• Hypersexuality
• Emotional changes: apathy; loss of fear, rage reactions
Clinical causes of the Klüver–Bucy syndrome include
• Sequel of bilateral temporal lobectomy
• Postictal phenomenon in a patient with a previous unilateral temporal
lobectomy
• Sequel to minor head trauma; subdural haematoma
• Tumour
• Meningoencephalitis
• Pick’s disease
• Alzheimer’s disease: especially hyperorality and hyperphagia, but it is rare to
have all features
What is Knee Tremor?
A characteristic tremor of the patellae, sometimes known as knee bobbing, juddering, or quivering, may be seen in primary orthostatic tremor (POT; ‘shaky legs
syndrome’, ‘White rabbit syndrome’). It is due to rapid rhythmic contractions
of the leg muscles on standing, which dampen or subside on walking, leaning
against a wall, or being lifted off the ground, with disappearance of the knee
tremor; hence this is a task-specific tremor. Auscultation with the diaphragm of
a stethoscope over the lower limb muscles reveals a regular thumping sound,
likened to the sound of a distant helicopter. EMG studies show pathognomonic
synchronous activity in the leg muscles with a frequency of 14–18 Hz, thought
to be generated by a central oscillator (peripheral loading does not alter tremor
frequency).
A number of drugs have anecdotally been reported to be helpful in POT,
including phenobarbitone, primidone, clonazepam, pramipexole, and levodopa,
although the only blinded placebo-controlled study suggesting efficacy is with
gabapentin. Unlike the situation in essential tremor, propranolol is not helpful.
What is Körber– Salus–Elschnig Syndrome?
This describes convergence–retraction nystagmus, in which adducting saccades
(medial rectus contraction) occur spontaneously or on attempted upgaze, often
accompanied by retraction of the eyes into the orbits. This is associated with
mesencephalic lesions of the pretectal region (e.g. pinealoma). The term may be
used interchangeably with Parinaud’s syndrome or pretectal syndrome.
What is Parinaud’s syndrome?
It refers to the group of abnormalities of eye movement and pupil dysfunction. There is an inability to move the eyes up or down due to compression of the vertical gaze center at the rostral insterstitial nucleus of medial longitudinal fasciculus. Loss of blood supply resulting in damage to the mesencephalic tectum
What is Kyphoscoliosis?
Kyphoscoliosis is twisting of the spinal column in both the anteroposterior
(kyphosis) and lateral (scoliosis) planes. Although such deformity is often primary or idiopathic, thus falling within the orthopaedic field of expertise, it
may also be a consequence of neurological disease which causes weakness of
paraspinal muscles. Recognized neurological associations of kyphoscoliosis and
scoliosis includes
• Chiari I malformation, syringomyelia
• Myelopathy (cause or effect? Skeletal disease such as achondroplasia is more
likely to be associated with myelopathy than idiopathic scoliosis)
• Cerebral palsy
• Friedreich’s ataxia
• Neurofibromatosis
• Hereditary motor and sensory neuropathies
• Spinal muscular atrophies
• Myopathies, e.g. Duchenne muscular dystrophy
Stiff person syndrome may produce a characteristic hyperlordotic spine.
Some degree of scoliosis occurs in virtually all patients who suffer from paralytic
poliomyelitis before the pubertal growth spurt.
What is neural facilitation?
Neural facilitation, also known as paired pulse facilitation (PPF), is a phenomenon in neuroscience in which postsynaptic potentials (PSPs) (EPPs, EPSPs or IPSPs) evoked by an impulse are increased when that impulse closely follows a prior impulse. PPF is thus a form of short-term synaptic plasticity.
What is Lagophthalmos?
Lagophthalmos is an inability to close the eyelid in a peripheral facial (VII)
nerve palsy, with partial opening of the palpebral fissure. A similar phenomenon
may be observed with aberrant regeneration of the oculomotor nerve, thought to
be due to cocontraction of the levator palpebrae superioris and superior rectus
muscles during Bell’s phenomenon.
What is Lambert’s Sign?
Lambert’s sign is a gradual increase in force over a few seconds when a patient
with Lambert–Eaton myasthenic syndrome is asked to squeeze the examiner’s
hand as hard as possible, reflecting increased power with sustained exercise. This
may also be known as augmentation.
What is the mechanism of Bell’s phenomenon?
Bell’s phenomenon (also known as the palpebral oculogyric reflex) is a medical sign that allows observers to notice an upward and outward movement of the eye, when an attempt is made to close the eyes. The upward movement of the eye is present in the majority of the population, and is a defensive mechanism.
What is Lasègue’s Sign?
Lasègue’s sign is pain along the course of the sciatic nerve induced by stretching
of the nerve, achieved by flexing the thigh at the hip while the leg is extended at
the knee (‘straight leg raising’). This is similar to the manoeuvre used in Kernig’s
sign (gradual extension of knee with thigh flexed at hip). Both indicate irritation
of the lower lumbosacral nerve roots and/or meninges. The test may be positive
with disc protrusion, intraspinal tumour, or inflammatory radiculopathy. Pain
may be aggravated or elicited sooner using Bragard’s test, dorsiflexing the foot
while raising the leg thus increasing sciatic nerve stretch, or Neri’s test, flexing
the neck to bring the head on to the chest, indicating dural irritation.
What is Kernig’s sign?
It is present if, with the patient supine and the hip and knee flexed, extension of the knee causes pain in the back and neck. Brudzinski’s sign is positive if passive flexion of the neck causes knee and hip flexion. Both signs have low sensitivity but high specificity for meningitis. Meningitis is inflammation of the meninges.
What is the femoral nerve stretch test?
The femoral nerve stretch test or the prone knee bending test is done for testing the motor function of the femoral nerve and to stress the lumbar (L2-L4) nerve roots. This is one of the most reliable techniques for assessment of the mid-lumbar (L2, L3, and L4) nerve root impingement.