Positive Babinski Reflex Research Articles

Microsporidiosis generalizada por Encephalitozoon sp. en un paciente pediátrico con enfermedad de Bruton

We present the case of a four-year-old boy with a history of repeated upper respiratory tract infections and pyoderma. He presented fever, seizures, inability to talk, loss of swallowing, fine tremor in the upper extremities; positive bilateral Babinski reflex and quadriparesis. The diagnosis of Bruton's disease and generalized microporidiosis was based on immunologic analysis, smear tests with chromotrope R2 stain and indirect immunofluorescense with monoclonal 3B6 antibody for Encephalitozoon species in samples of spinal fluid, bronchial and paranasal sinus aspirates and stool, which were all positive. The patient was treated with albendazol during 72 days; he left the hospital in a good condition, walking, talking and able to swallow. His laboratory test controls were negative; he is followed up in the outpatient department.

Neurological phenomena during emergence from enflurane or isoflurane anaesthesia

During emergence from anaesthesia, transient neurological signs that would usually be considered pathological may appear. The objective of this randomized, patient (n = 30) and observer-blinded study was to compare prospectively the incidence and duration of post-anaesthetic neurological abnormalities in healthy patients undergoing minor elective procedures following thiopentone and succinylcholine induction, and enflurane-N2O or isoflurane-N2O anaesthesia. Patients were studied for 60 min after anaesthesia. Arousal state, muscle tone, deep tendon reflexes, plantar reflex, sustained clonus, shivering, intense muscular spasticity and temperature were assessed. Results of neurological examination were correlated with the patient's state of arousal. Transient emergent neurological abnormalities occurred more frequently following enflurane-N2O anaesthesia than isoflurane N2O anaesthesia. This was statistically significant (P less than 0.05) for quadriceps hyperreflexia, upgoing toes (positive Babinski reflex) and intense muscular spasticity. Neurological abnormalities occurred most commonly 5-20 min after anaesthesia and all abnormalities resolved within 60 min. Following enflurane anaesthesia, as patients became more alert the incidence of abnormalities declined, while the arousal state did not affect the incidence of abnormalities after isoflurane. There was no significant difference between axillary temperatures of those patients who shivered and those who did not. In conclusion, temporary emergent neurological abnormalities occurred more often following enflurane-N2O than after isoflurane-N2O anaesthesia.

頚髄圧迫疾患に合併する神経因性膀胱についての臨床的研究

Bladder and urethral functions were evaluated urodynamically in 62 patients with cervical cord compression disorder caused by either ossification of the posterior longitudinal ligament of the cervical spine (32 patients), cervical spondylosis (14 patients), prolapsed cervical intervertebral disc (14 patients) or cervical spinal canal stenosis (2 patients). The patients included 46 males and 16 females with average age of 57 years (range 39 to 73 years). Symptomatic organic infravesical obstruction was excluded by physical and radiographic examination. Cystometry revealed preoperative neurogenic bladder in 22 patients (35%) including overactive detrusor in 10 patients (45%) and underactive in 6 (27%). Twenty-one of them underwent electromyographic examination of external sphincter and 14 (67%) had overactive sphincter. Bladder and urethral functions appeared to be impaired in association with myelopathy of the pyramidal and spinothalamic tract of the cervical cord, because of high incidence of neurogenic bladder associated with positive Babinski's reflex and sensory disturbance at the perineal and lower extremity area. Furthermore, since many patients with deep sensory disturbance in the lower extremities had underactive detrusor, it appears likely that underactive detrusor was accompanied with myelopathy in the posterior funiculus of the cervical cord which mediates bladder proprioceptive sensation. Of twenty-two neurogenic bladder patients, seventeen underwent a cervical bone operation and eleven received postoperative urodynamic evaluation. The average interval from the operation to urodynamic evaluation was 1.6 months (range 1.1 to 2.3 months). Over half of the patients were found to be improved urodynamically as well as neurologically.(ABSTRACT TRUNCATED AT 250 WORDS)

被殻出血および視床出血の予後に関する研究 予後規定因子等の比較検討

The prognosis and factors affecting prognosis of 66 putaminal hemorrhage (PH) and 48 thalamic hemorrhage (TH) cases were compared. All patients were diagnosed by CT scan and treated palliatively. They were studied for six months. Functional prognosis was classified into four groups as follows according to activities of daly living (ADL): ADL1 almost full recovery, ADL2 partially dependent, ADL3 almost completely dependent, ADL4 bedridden.The results were as follows:1) The mortality rate for PH sufferers, 44.5%, was almost the same as for TH sufferers, 46.8%. 21 (58%) out of PH survivors were classified as ADL1 which was significantly higher than the percentage of ADL1 (23%) in the TH group (p<0.05).2) Age was one of the major factors affecting prognosis in both the PH and TH groups. For patients in their forties and fifties functional prognosis was favourable. For those in their sixties and seventies ADL was generally poor. Patients in their eighties had an extremely poor prognosis.3) Deterioration or improvement in consciousness level from admission to the third day of illness occurred more frequently in the PH group than in the TH group. A deterioration in consciousness level indicated a poor prognosis.4) Anisocoria with a dilated pupil on the same side as hematoma was the worst prognostic ocular sign in both groups. The second worst sign was a non-reactive pupil.5) None of the TH patients with a severe motor inability on admission advanced to the ADL1 category.6) In both the PH and TH groups, the patients with bilaterally positive Babinski reflexes had a poor prognosis.7) A close correlation between CT classification and prognosis was found in both the PH and TH groups. P1 and T1 showed a good prognosis. In patients of P2a and T2a, prognosis depended on their age. However no T2a cases advanced to the ADL1 category. In P2b, T2b, P3 and T3, prognosis was poor.8) The estimated hematoma volume on CT had a close correlation with the prognosis in PH and TH. The maximum hematoma volume of ADL1 in the PH group was 18 ml and 3 ml in the TH group. Over 80ml was fatal in the PH group, and over 10 ml in the TH group resulted in ADL4 or death.9) Hematoma rupture into the ventricular system occurred in cases of PH when the hematoma volume was over 25 ml, 4 ml in cases of TH. PH and TH cases with a ventricular rupture generally had a poor prognosis. None of rupture cases in PH became ADL1. A rupture into the 3rd and /or 4th ventricle resulted in an extremely poor prognosis in both the PH and TH groups. However the prognosis of rupture cases was considered to depend more on the degree of brain damage than the ventricular rupture itself.10) The mean survival time of fatal TH cases was shorter than that of PH (5.4 days vs 9.8 days).

Mediastinal and Extrapleural Masses in a Young Adult

‘J his 21-year-old man was admitted to the hospital with the complaint of increasing ataxia of three months’ duration. Two weeks after falling from a skateboard, he noted leg weakness. One month later, he noted stiffness of his arms in the morning. Physical examination revealed diffuse weakness. The cranial nerves were intact as was sensation. Positive Babinski reflex and diffuse hyperreflexia were noted bilaterally. Laboratory data were noncontributory. Some pertinent information is being withheld. Admission chest films are shown in Figures 1 and 2.

PELLAGRA-LIKE SKIN LESIONS APPEARING IN THE COURSE OF A KETOGENIC DIET

The case here reported illustrates a relatively new complication—a dietary deficiency syndrome—due to poorly supervised ketogenic diet. B. R., a woman, aged 20, single, the only child of living and healthy parents, was reared in comfortable circumstances. Her early development was uneventful except for whooping cough at 1½ years, and measles at 8 years. There was nothing relevant in the family history. Nocturnal convulsions were first observed at 14. Various methods of treatment were tried in her case. At 16 she was given glandular therapy in the form of whole gland pituitary substance and thyroid extract because her basal metabolic rate was —24 per cent and she was slightly overweight. At that time she presented some vaguely described neurologic signs; i. e., some cranial nerve involvement and positive Babinski reflex on the left. About this time her tonsils were removed. The convulsions gradually became more frequent, both nocturnal and diurnal.

REPORT OF A CASE OF ANAPHYLACTIC SHOCK, WITH FAILURE TO DESENSITIZE BY INTRASPINAL ADMINISTRATION OF SERUM

This case of anaphylactic shock in cerebrospinal meningitis is reported in order to record the failure of serum administered intraspinally to desensitize the patient to its intravenous administration. The patient, a woman, aged 40, first seen by me one week after the onset of her illness, had had severe headache, with moderate temperature, at first declining and then rising, on the day when first seen, April 13. No focal meningeal symptoms had been observed. On the date of admission, April 13, her temperature was 104, pulse 90, and respiration 20. Physical examination revealed only a moderately rigid neck, absent patellar reflexes, and positive Babinski and Oppenheim reflexes on the right side. Kernig's sign was present. Lumbar puncture at 5 p. m. on the same day revealed a spinal fluid under pressure, moderately turbid, containing 810 cells per cubic millimeter, a + + + butyric acid test, and the intracellular and extracellular presence of