Impaired Reflex Research Articles

Fisher Syndrome with Taste Impairment

A 60-year-old woman was admitted to our hospital with a two day history of truncal ataxia and diplopia. Three days after admission, complete paresis of eye movements, left ptosis, taste impairment and absence of deep tendon reflexes appeared. The patient displayed normal facial movements; however, she reported decreased sensations of sweet and salty tastes. Anti-GQ1b antibodies were detected in the serum, and Fisher syndrome was therefore diagnosed. Intravenous immunoglobulin was administered starting five days after admission, with limitations of eye movements, areflexia and taste impairment showing improvements by 12 days after onset. Taste disturbance is rare in patients with Fisher syndrome. In this case, we hypothesize that autoantibodies may have targeted antigens in the chorda tympani, glossopharyngeal nerve or taste buds.

Bilateral Internal Superior Laryngeal Nerve Palsy of Traumatic Cervical Injury Patient Who Presented as Loss of Cough Reflex after Anterior Cervical Discectomy with Fusion

Injury to the bilateral internal branch of superior laryngeal nerve (ibSLN) brings on an impairment of the laryngeal cough reflex that could potentially result in aspiration pneumonia and other respiratory illnesses. We describe a patient with traumatic cervical injury who underwent bilateral ibSLN palsy after anterior cervical discectomy with fusion (ACDF). An 75-year-old man visited with cervical spine fracture and he underwent ACDF through a right side approach. During the post-operative days, he complained of high pitched tone defect, and occasional coughing during meals. With a suspicion of SLN injury and for the work up for the cause of aspiration, we performed several studies. According to the study results, he was diagnosed as right SLN and left ibSLN palsy. We managed him for protecting from silent aspiration. Swallowing study was repeated and no evidence of aspiration was found. The patient was discharged with incomplete recovery of a high pitched tone and improved state of neurologic status. The SLN is an important structure; therefore, spine surgeons need to be concerned and be cautious about SLN injury during high cervical neck dissection, especially around the level of C3-C4 and a suspicious condition of a contralateral nerve injury.

A prospective, open label, 24-week trial of methylcobalamin in the treatment of diabetic polyneuropathy

Introduction: Vitamin B complex has been used for peripheral neuropathy for a long time and continues to be part of current practice despite lack of strong evidence for its use and its non-inclusion in treatment guidelines. Objective: To determine the clinical and neurophysiological effects of 1500 μgm/day of oral methylcobalamin among subjects with diabetic polyneuropathy. Methodology: We conducted a prospective, open-label study on adult diabetic subjects with polyneuropathy who were given 1500 μgm/day of oral methylcobalamin over 24-weeks. The primary outcome measure was the Toronto Clinical Scoring System (CSS) and secondary measures were Subjective Impression of Change, Clinicians Impression of Change and neurophysiological parameters. Results: Out of forty eight subjects, thirty seven completed treatment and twenty one agreed to have repeat neurophysiologic study post-treatment. At the end of treatment, there was a significant decline in the Toronto CSS score (p < 0.0001) indicating improvement. This was observed across all stages of severity and in any duration of diabetes whether more or less than 10 years. The symptoms that improved compared to baseline and that did not emerge over the course of 24 weeks were tingling (p < 0.03), upper limb symptoms (p < 0.003), ataxia (p < 0.004), and signs of impaired position (P < 0.009) sense, vibration sense (p < 0.0001), pinprick sensation (p < 0.004) and knee reflex (p < 0.004). No significant improvement was seen in the secondary outcomes (both p=0.06) except for ulnar nerve amplitude and distal latency. Conclusion: This 24-week open label study demonstrated that symptoms of diabetic polyneuropathy significantly improved among subjects given methylcobalamin 1500 μgm/day and new symptoms did not emerge over the 24 week observation period. Larger controlled trials are needed to corroborate these findings.

Adolescent hyperactivity of offspring after maternal protein restriction during the second half of gestation and lactation periods in rats

To clarify the effect of systemic growth retardation on behavior, pregnant rats were fed a synthetic diet with either a normal (20% casein) or low (10% casein) protein concentration from gestational day 10 to postnatal day (PND) 21 at weaning. Offspring were examined for sensory and reflex functions, detailed clinical observations, manipulative test, grip strength, motor activity and water-filled multiple T-maze test. Lowering trend in the air righting reflex index during lactation period and a decrease in grip strength on PND 72 were observed in the low protein diet group showing suppression of systemic growth. However, they were simply the reflection of delayed systemic growth, because parameters on impaired reflex function, disturbance of motor function and paralysis were unaffected. On the other hand, low protein diet resulted in increased motor activity in female offspring. Thus, malnutrition due to maternal protein restriction may cause adolescent hyperactivity.

Reactive oxygen species inactivate neuronal nicotinic acetylcholine receptors through a highly conserved cysteine near the intracellular mouth of the channel: implications for diseases that involve oxidative stress.

An intriguing feature of several nicotinic acetylcholine receptors (nAChRs) on neurons is that their subunits contain a highly conserved cysteine residue located near the intracellular mouth of the receptor pore. The work summarized in this review indicates that α3β4-containing and α4β2-containing neuronal nAChRs, and possibly other subtypes, are inactivated by elevations in intracellular reactive oxygen species (ROS). This review discusses a model for the molecular mechanisms that underlie this inactivation. In addition, we explore the implications of this mechanism in the context of complications that arise from diabetes. We review the evidence that diabetes elevates cytosolic ROS in sympathetic neurons and inactivates postsynaptic α3β4-containing nAChRs shortly after the onset of diabetes, leading to a depression of synaptic transmission in sympathetic ganglia, an impairment of sympathetic reflexes. These effects of ROS on nAChR function are due to the highly conserved Cys residues in the receptors: replacing the cysteine residues in α3 allow ganglionic transmission and sympathetic reflexes to function normally in diabetes. This example from diabetes suggests that other diseases involving oxidative stress, such as Parkinson's disease, could lead to the inactivation of nAChRs on neurons and disrupt cholinergic nicotinic signalling.

Evaluating discard mortality of summer flounder ( Paralichthys dentatus) in the commercial trawl fishery: Developing acoustic telemetry techniques

Fish bycatch discard mortality is one of the most significant issues influencing marine fisheries management worldwide. Discard mortality studies to date rely on potentially biased on-deck evaluation of immediate mortality or reflex impairment, and evaluation of delayed mortality through holding captured fish for varying lengths of time to determine survival. Telemetry of ultrasonically tagged fish provides a technique for evaluating fish bycatch discard mortality, and especially latent mortality, under natural conditions in the sea. For summer flounder ( Paralichthys dentatus), along the eastern United States, an 80% discard mortality is assumed but not verified. To determine the mortality of discarded fish, both live ( n = 41; excellent condition = 4, good condition = 16, poor condition = 21) and dead ( n = 16) summer flounder from commercial fishery-length tows were tagged and released in a fixed hydrophone array (mean depth of 8.8 m) on 15 September 2009 off Brigantine, NJ. We were able to re-detect both live and dead fish within the array and during mobile tracking for approximately 24 h before a storm. Fish of poor initial health and known dead fish were redetected after the storm in a concentrated area inshore of the release site and were presumed dead. Live fish exited the array offshore, as is typical in the fall migration. The final discard mortality estimate, combining on-deck mortality (32.7%) and latent mortality (49.0%), was 81.7% similar to current estimates. Latent mortality contributed at least as much to total discard mortality as on-deck mortality, confirming assumptions of earlier assessments. Several new telemetry metrics can lead to a better understanding of these important latent effects.

Toxoplasma gondii infection in workers occupationally exposed to unwashed raw fruits and vegetables: a case control seroprevalence study

BackgroundThrough a case control seroprevalence study, we sought to determine the association of Toxoplasma gondii infection with occupational exposure to unwashed raw fruits and vegetables.MethodsSubjects, numbering 200, who worked growing or selling fruits and vegetables, and 400 control subjects matched by age, gender, and residence were examined by enzyme immunoassays for the presence of anti-Toxoplasma IgG and IgM antibodies. Socio-demographic, clinical, and behavioral characteristics from the study subjects were obtained.ResultsOf the 200 fruit and vegetable workers, 15 (7.5%) of whom, and 31 (7.8%) of the 400 controls were positive for anti-Toxoplasma IgG antibodies (P = 0.96). Anti-Toxoplasma IgM antibodies were found in 2 (1%) of the fruit workers and in 11 (2.8%) of the control subjects (P = 0.23). Seroprevalence of Toxoplasma antibodies increased with age (P = 0.0004). In addition, seropositivity to Toxoplasma was associated with ill status (P = 0.04), chronic tonsillitis (P = 0.03), and reflex impairment (P = 0.03). Multivariate analysis showed that Toxoplasma infection was associated with consumption of raw meat (OR = 5.77; 95% CI: 1.15-28.79; P = 0.03), unwashed raw fruits (OR = 2.50; 95% CI: 1.11-5.63; P = 0.02), and living in a house with soil floors (OR = 3.10; 95% CI: 1.22-7.88; P = 0.01), whereas Toxoplasma infection was negatively associated with traveling abroad (OR = 0.28; 95% CI: 0.12-0.67; P = 0.005).ConclusionsThis is the first report of seroprevalence and contributing factors for Toxoplasma infection in workers occupationally exposed to unwashed raw fruits and vegetables, and the results may help in the design of optimal preventive measures against Toxoplasma infection especially in female workers at reproductive age.

Validation of reflex indicators for measuring vitality and predicting the delayed mortality of wild coho salmon bycatch released from fishing gears

Summary1. Effective management of fish and wildlife populations benefits from an understanding of the effects of stressors on individual physiology. While physiological knowledge can provide a mechanistic understanding of organismal responses, its applied utility is limited because it cannot easily be used by stakeholders.2. Reflex action mortality predictors (RAMP) is a method that involves checking for the presence or absence of natural animal reflexes to generate a condition (RAMP) score in response to stressors and to predict fate. The method has previously been validated with fishes in artificial laboratory‐ and field‐based holding studies as a responsive measure of fisheries capture stress and a predictor of delayed mortality, but has not been evaluated in the wild.3. We used radio telemetry to monitor migration success of 50 endangered coho salmon Oncorhynchus kisutch following incidental capture in an aboriginal beach seine fishery in the lower Fraser River (Canada). RAMP was used to measure the condition of fish at release and to predict migration success following capture. Biopsy of an additional 43 coho profiled physiological condition at time of release.4. Individuals with greater reflex impairment (higher RAMP scores) at release experienced significantly higher rates of migration failure. RAMP scores were also significantly correlated with fishery handling time. Plasma variables showed that captured coho had experienced physiological stress characteristic of exhaustive exercise and hypoxia, with significantly elevated cortisol and lactate values for fish entangled longer in fishing gear.5. Synthesis and applications. This is the first validation of RAMP in a wild setting. Based on our findings, fishers could use the method and make adjustments in fishing behaviour in real‐time to improve fish condition and reduce the mortality of bycatch, and conservation practitioners could monitor animal condition and identify problems that deserve management attention. RAMP is an easy, rapid and inexpensive approach to predicting mortality and measuring vitality and performed better than traditional physiological tools that cannot easily be used by stakeholders.

Effect of Aging on Cough and Swallowing Reflexes: Implications for Preventing Aspiration Pneumonia

The impairment of airway protective reflexes, i.e., swallowing and cough reflexes, is thought to be one of the major causes for aspiration pneumonia in older people. Restoration of cough and swallowing reflexes in the elderly is key to preventing aspiration pneumonia in the elderly. Although, the medical literature has asserted that cough and swallowing are controlled primarily by the brainstem, recent advances in human brain imaging has provided evidence that cortical and subcortical structures play critical roles in cough and swallowing control. Because of their nature, reflexive cough and swallowing activate both sensory and motor areas in the cortex. In both protective reflexes, the sensory component, including sensory cortex in reflexive circuits, seems to be more vulnerable to aging than the motor component, including the motor cortex. Therefore, the strategy to restore cough and swallowing reflexes should be focused on compensations of sensory components in these reflexive circuits. Remedies to enhance sensory nerve terminals and sensory cortical areas related to these reflexes might be useful to prevent aspiration pneumonia in the elderly.

A Classification of Postural Sway Patterns During Upright Stance in Healthy Adults and Patients with Parkinson’s Disease

The intermittent control during human quiet upright stance is a new hypothesis which claims that the active neural feedback control generating the ankle muscle torque is switched off and on intermittently at appropriate timings. The intermittent strategy is capable of providing compliant posture while ensuring robust stability. Contrastingly, impairment of postural reflexes in patients with Parkinson’s disease (PD) causes postural instability. Here we hypothesize that the instability in PD patients might be due to a loss of appropriate intermittent activations in the feedback muscle torque during stance. In order to provide evidence for this hypothesis, we characterized stochastic postural sway patterns measured as changes in center of pressure (CoP) and activities of ankle muscles during quiet stance in healthy young and elderly subjects as well as PD patients. To this end, sway patterns and associated ankle muscle activities were quantified by several indices including the CoP sway area, scaling factors of double-power-law power spectra of the sway, as well as levels and patterns of the muscle activations. Hierarchical cluster analysis was performed to suggest that the sway patterns could be classified into two major types. The first type consisted mainly of sway and muscle activation patterns from healthy subjects and some PD patients with the mild level of severity, and they showed features indicating the intermittent control. The second type, consisting mainly of PD patients with relatively severe levels of motor symptoms, was accompanied with non-intermittent but tonic muscle activities and sway areas either smaller or larger than those in the first type. Moreover, the major two types were further classified into several subtypes with distinguishable characteristics. Results suggested that a loss of the intermittent activations in the ankle muscles could be a cause of the postural instability for a population of PD patients.

Prevention of Chronic Obstructive Pulmonary Disease Exacerbation by Angiotensin‐Converting Enzyme Inhibitors in Individuals with Impaired Swallowing

Prevention of Chronic Obstructive Pulmonary Disease Exacerbation by Angiotensin‐Converting Enzyme Inhibitors in Individuals with Impaired Swallowing

Pontine hemorrhage at a microbleed site in a patient with central pontine myelinolysis

Central pontine myelinolysis (CPM) is an uncommon disorder, characterized by non-inflammatory demyelination, which may be caused by an abrupt change of serum osmolarity, especially of sodium concentration [1]. Although rapid correction of chronic hyponatremia leads to the disruption of the blood–brain-barrier (BBB) [2], CPM associated with intracerebral hemorrhage (ICH) has rarely been reported [3, 4]. Cerebral microbleed (CMB) is a 2–5-mm sized small hypointense lesion that is generally detected by gradient echo (GRE) magnetic resonance imaging (MRI), which is thought to be associated with advanced microangiopathy, focal breakdown of the BBB and risk of bleeding [5]. In view of the possible effects of CPM and CMB on the BBB, we can postulate that the affected region is in a hemorrhagic-prone state. We describe a patient who suffered CPM and subsequent ICH at the site of pontine microbleeds. An 89-year-old female attended the emergency room (ER) with stuporous mentality. In the past, she had suffered from hypertension and chronic kidney disease with antihypertensives and diuretics without dialysis. Seven days before visiting the ER, her general condition had worsened after fall down and oral intake was poor. It had not been possible to wake her for the last 5 h before she appeared in the ER. Neurological examination revealed stupor mentality with decreased corneal, vestibulo-ocular and gag reflexes. Her withdrawal response to painful stimuli on all extremities was reduced especially on her left side. Laboratory findings revealed mild anemia (hemoglobin 9.3 g/dL) and elevated renal function values (blood urea nitrogen 42 mg/dL, creatinine 3.2 mg/dL) and normal range electrolyte values. Total protein (4.9 g/dL) and albumin (2.6 g/dL) levels were low, suggesting malnutrition. Brain fluid attenuated inversion recovery (FLAIR) MRI revealed diffuse high signal areas in the basis pontis (Fig. 1a). In addition, multiple microbleed signals were detected in the whole brain area as well as the lower pons within FLAIR high signal area on GRE imaging (Fig. 1b). Her diagnosis was CPM without any hyponatremia correction and we initiated general and nutritional care. Three days after admission, she became alert and motor power was partially recovered. However, on the 8th day, her mental functioning deteriorated abruptly to stupor. Neurological examination showed pin-pointed pupils with impaired light reflex. Brainstem reflexes were also completely absent. Brain MRI revealed pontine hemorrhage in two different foci that coincided with microbleed sites on the previous MRI (Fig. 1c, d). The patient died from respiratory and renal failure 3 weeks after admission. CPM is an osmotic demyelination syndrome (ODS) which is a well-known disease caused by rapid correction of hyponatremia, alcoholism, liver transplantation and malnutrition [1]. Although the exact mechanism of ODS is not clear, it has been suggested that any rapid change in serum osmolality with resulting changes in brain cell volume may lead to stereotyped injury to myelin sheaths [2]. Therefore, ICH, which is due to rupture of intracerebral arteries, is an unusual complication and has been rarely reported [3, 4]. However, these previous reports differ from Y. S. Kim and J. Lee equally contributed to this work.

Analgesia for joint punctures in children - experiences with a nitrous oxide / oxygen mixture (LIVOPAN®)

Background Joint punctures in children require adequate analgesia, sedation or both. Suitable for this are intravenous sedatives (eg propofol, midazolam) and analgetics (eg, ketamine and fentanyl). The use of these substances is safe, but requires an intravenous line, monitoring and followup. Nitrous oxide/oxygen (N2O/O2) sedation has a long-standing history of safety and success. N2O/O2 has analgic and hypnotic quality characteristics. The mask inhalation of a fixed combination of nitrous oxide with 50% oxygen causes a mean analgesia without loss of consciousness or impairment of protective reflexes for the period of inhalation.

Toxoplasma gondii infection and liver disease: a case-control study in a Northern Mexican population

BackgroundInfection with the protozoan parasite Toxoplasma gondii may cause liver disease. However, the impact of the infection in patients suffering from liver disease is unknown. Therefore, through a case-control study design, 75 adult liver disease patients attending a public hospital in Durango City, Mexico, and 150 controls from the general population of the same region matched by gender, age, and residence were examined with enzyme-linked immunoassays for the presence of anti-Toxoplasma IgG and anti-Toxoplasma IgM antibodies. Socio-demographic, clinical and behavioral characteristics from the study subjects were obtained.ResultsSeroprevalence of anti-Toxoplasma IgG antibodies and IgG titers did not differ significantly in patients (10/75; 13.3%) and controls (16/150; 10.7%). Two (2.7%) patients and 5 (3.3%) controls had anti-Toxoplasma IgM antibodies (P = 0.57). Seropositivity to Toxoplasma did not show any association with the diagnosis of liver disease. In contrast, seropositivity to Toxoplasma in patients was associated with consumption of venison and quail meat. Toxoplasma seropositivity was more frequent in patients with reflex impairment (27.8%) than in patients without this impairment (8.8%) (P = 0.05). Multivariate analysis showed that Toxoplasma seropositivity in patients was associated with consumption of sheep meat (OR = 8.69; 95% CI: 1.02-73.71; P = 0.04) and rabbit meat (OR = 4.61; 95% CI: 1.06-19.98; P = 0.04).ConclusionsSeropositivity to Toxoplasma was comparable among liver disease patients and controls. Further studies with larger sample sizes are needed to elucidate the association of Toxoplasma with liver disease. Consumption of venison, and rabbit, sheep, and quail meats may warrant further investigation.

Acute ischaemic hemispheric stroke is associated with impairment of reflex in addition to voluntary cough

Acute ischaemic hemispheric stroke is associated with impairment of reflex in addition to voluntary cough

A case of late-onset aqueductal membranous occlusion and a successful treatment with neuro-endoscopic surgery

A 57 year-old man developed broad-based unsteady gait and memory loss over a period of one year. On admission, bradykinesia and impairment of postural reflex were evident. Mini-mental state examination scored 27/ 30. Urinary control was normal. MRI revealed symmetric dilatation of lateral and 3rd ventricles, but the 4th ventricle appeared normal. Partial obstruction of the aqueduct with a membranous structure was disclosed by fast imaging employing steady state acquisition (FIESTA), and the diagnosis of late-onset aqueductal membranous occlusion (LAMO) was made. The symptoms were ameliorated shortly after endoscopic aqueductoplasty (EAP) and endoscopic third ventriculostomy (ETV). Membranous occlusion of the aqueduct can be detected by FIESTA and it can be cured by neuro-endoscopic measures.

Postoperative impairment of airway reflexes reversed by ventricular CSF diversion in a patient with a trigeminal schwannomma

Postoperative impairment of airway reflexes reversed by ventricular CSF diversion in a patient with a trigeminal schwannomma

Pharmacotherapeutic Approaches for Swallowing Disorders

Recently, swallowing disorders have increasingly become a critical clinical issue. The aims of treatment for dysphagic patients are focused on the recovery of oral alimentation and prevention of aspiration pneumonia. Rehabilitation and surgical interventions have been the basic treatment strategies. In addition, pharmacologic treatment options have been developed over the last two decades. Substance P plays an important role as a neurotransmitter for inducing the swallowing or cough reflex. Angiotensin converting enzyme inhibitors, dopamine agonists, and capsaicin facilitate local accumulation of substance P, therefore, they upregulate the impaired swallowing reflex. Many recent reports have described that these pharmacotherapeutic approaches could reduce the risk of pneumonia. Our clinical study showed that capsaicin administration for a month improved decreased pharyngeal contraction and upper esophageal sphincter function. Also, anti-platelet therapy with cilostazol, traditional Chinese medicine (Hange-Koboku To), and olfactory stimulation with black pepper oil and menthol were reported to prevent pneumonia, especially in the elderly. However, many of these reports lack sufficient evidence, and additional studies are warranted. Botulinum toxin injection into the cricopharyngeal muscle has a direct effect on various types of dysphagia by blocking sustained contraction of the upper esophageal sphincter. It can be an alternative treatment instead of cricopharyngeal myotomy. Influenza or pneumococcal vaccination were reported to be beneficial and recommended for elderly disabled patients at high-risk for pneumonia, but its efficacy is still the subject of discussion. In conclusion, although pharmacologic treatment for dysphagia is a novel research topic, it has a great possibility as an efficient therapeutic option for numerous patients with swallowing disorders. Further studies are necessary.

Cough in the elderly: A novel strategy for preventing aspiration pneumonia

Management of cough in the elderly with a deteriorated physical and mental status has received little focus. Since an aged population is rapidly increasing in developed countries, the research in this population are warranted. Cough reflex sensitivity in the elderly was shown to be hypersensitive, normosensitive and hyposensitive. The hypersensitive cough reflex is mostly due to gastro-esophageal reflux in nursing home patients. Impaired cough reflex sensitivity is assumed to play a crucial role in the development of pneumonia in the elderly. A marked depression of cough reflex sensitivity is reported in elderly patients with aspiration pneumonia. The impairment of the cough reflex in patients with aspiration pneumonia can involve both cortical facilitatory pathways for cough and medullary reflex pathways. We found the urge-to-cough in patients with aspiration pneumonia was also down-regulated, suggesting the involvement of supramedullary dysfunction in the etiology of aspiration pneumonia in the elderly. In order to prevent aspiration pneumonia in the elderly, restoration of cough reflex sensitivity is essential. We found several methods to restore cough reflex sensitivity in the elderly. They also improved the swallowing reflex, another important airway protective reflex, in the elderly. In the treatment of aspiration pneumonia, one of the most challenging steps is the start of eating for patients who usually fast at the time of hospitalization. By combining the methods to restore the cough reflex sensitivity and swallowing reflex, we developed a protocol to start eating in the elderly patients with aspiration pneumonia. Using the protocol, we reduced the incidence of re-aspiration due to start of eating in patients with aspiration pneumonia to one third of the patients without the protocol.

Seroepidemiology of Toxoplasma gondii Infection in Patients with Vision and Hearing Impairments, Cancer, HIV, or Undergoing Hemodialysis in Durango, Mexico

Toxoplasma gondii infection may cause a variety of symptoms involving virtually all organs. Little is known of the epidemiology of T. gondii infection in different patient groups in Mexico. We sought to determine the prevalence of T. gondii infection and associated epidemiological characteristics in 472 patients in Durango, Mexico. Participants were tested for T. gondii IgG and IgM antibodies. In addition, sociodemographic, clinical, and behavioral characteristics from each participant were obtained. Seroprevalences of T. gondii IgG antibodies were found in 7 (8.2%) of 85 patients with hearing impairment, 5 (10.0%) of 50 patients with hemodialysis, 28 (12.0%) of 234 patients with visual impairment, and 7 (6.8%) of 103 at risk of immunosuppression. In total, 47 (10%) of 472 subjects had IgG T. gondii antibodies; 6 (1.3%) of them also had IgM anti- T. gondii antibodies. Patients born in Durango State had a significantly lower prevalence of T. gondii infection than patients born in other Mexican states (9.0% vs. 21.4%, respectively; P < 0.05). Multivariate analysis showed that T. gondii infection was significantly associated with consumption of undercooked meat (adjusted odds ratio [OR] = 2.95; 95% confidence interval [CI]: 1.18-7.35) or raw cow's milk (adjusted OR = 2.52; 95% CI: 1.28-4.96), presence of cats at home (adjusted OR = 2.01; 95% CI: 1.06-3.78), raising animals (adjusted OR = 2.44; 95% CI: 1.06-5.63), or eating away from home (adjusted OR = 2.70; 95% CI: 1.03-7.11). In the group of patients with visual impairment, those with reflex impairment had a significantly higher frequency of T. gondii infection than those with normal reflexes (19% vs. 9.4%, respectively: P = 0.04). Results of the present study are the first step in the design of prevention programs to avoid the sequelae of toxoplasmosis.