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PubMed2000

Achalasia presenting as acute airway obstruction.

Achalasia presenting as acute airway obstruction is an uncommon complication. We report the case of an elderly woman with previously undiagnosed achalasia who presented with acute respiratory distress due to megaesophagus. Emergency endotracheal intubation and insertion of a catheter into the esophagus, with continuous aspiration was required. Upon introduction of the esophageal catheter an abruptand audible air decompression occurred, with marked improvement of the clinical picture. Endoscopic injection of botulinum toxin was chosen as the definitive treatment with good clinical result. The pathophysiology of the phenomenon of esophageal blowing in achalasia is unclear, but different hypothetical mechanisms have been suggested. One postulated mechanism is an increase in upper esophageal sphincter (UES) residual pressure or abnormal UES relaxation with swallowing in achalasia patients. We reviewed the UES manometric findings in 50 achalasia patients and compared it with measurement performed in 45 healthy controls. We did not find any abnormalities in UES function in any of our achalasia patients group, or in the case under study. An alternative hypothesis postulates that airway compromise in patients with achalasia results from the loss UES belch reflex (abnormal UES relaxation during esophageal air distension), and in fact, an abnormal UES belch reflex was evidenced in our case.

Aged↗
PubMed2000

Isolated superior oblique palsies with electrophysiologically documented brainstem lesions.

Over a 13.5-year period, we observed 10 patients with isolated superior oblique palsies in whom electrophysiological abnormalities indicated brainstem lesions. In 7 patients unilateral masseter reflex abnormalities were seen, and were located on the side of the superior oblique palsy in 2 patients and on the opposite side in 5 patients. Two patients had slowed gain of following eye movements to the side contralateral to the superior oblique palsy. Slowed adduction saccades in the eye contralateral to the superior oblique palsy were seen in 1 patient. Clinical improvement was frequently (in 7 of 10 patients) associated with improvement or normalization of electrophysiologic findings. Magnetic resonance imaging (MRI) was normal, showing no evidence of brainstem lesions in 6 patients. Unilateral superior oblique palsy may be the only clinical sign of a brainstem lesion. Although such a cause may be underdiagnosed if based on MRI-documented lesions only, it remains a rare condition.

Adult↗
PubMed1982

Abnormalities in postural reflexes and voluntarily induced automatic movements in Parkinson patients.

Postural abnormalities were systematically studied in 41 Parkinson patients in relation with the other Parkinson symptomatology. Evidence was collected that kinetic postural mechanisms, including turning in recumbant position, rising from the floor and walking, to be considered as volitional automatic movements, reacted differently on Levodopa therapy compared with static postural reflexes and the classical Parkinson symptoms. This suggests that the neuro-biochemical substrate of these postural movements may involve other than dopaminergic pathways as well.

Basal Ganglia↗
PubMed1991

A quantitative analysis of pendular motion of the lower leg in spastic human subjects.

The purpose of this study was to examine gravity-induced oscillations of the lower leg in normal and spastic subjects, with a view towards evaluating a clinical test of spasticity called the "pendulum" test. Motivations for studying the pendulum test were to determine if realistic aspects of spasticity and neuromuscular control could be incorporated into a description of the motion, and to better understand the underlying neurophysiological disturbances in spasticity. For passive limb motion (in which no reflex excitation occurred), a second-order linear model did not provide an adequate description of the motion for either spastic or normal legs. Instead, system equations including nonlinear mechanical properties simulating asymmetries in the swing and amplitude dependent variations in stiffness and damping provided a more accurate description. For spastic limb motion (in which reflex excitation did occur), accurate simulation required components accounting for abnormal reflex activation, coinciding with the time course of EMG activation. These included increased stiffness and damping with their gains related to reflex EMG magnitude, and changes in the rest length of the stiffness. Comparison of numerical solutions of the equations with experimental data showed our nonlinear model simulated the motion accurately, with the variance accounted for usually exceeding 90%.

Aged↗
PubMed1985

Jaw, blink and corneal reflex latencies in multiple sclerosis.

Jaw, blink and corneal reflexes, which all involve the trigeminal system, were recorded in 54 patients with multiple sclerosis; thirty-seven of these patients were classified as having definite multiple sclerosis and 17 as indefinite multiple sclerosis, according to Schumacher's criteria. The jaw reflex was abnormal less frequently than either of the other two reflexes, but in four cases it was the only abnormal reflex found. Testing a combination of two or three trigeminal reflexes did not yield a higher incidence of abnormalities than testing the blink or corneal reflex alone. Nine patients showed abnormal reflexes which were unexpected on the basis of clinical symptoms. The combined recordings demonstrate at least one abnormal reflex in 74% of the patients. The various types of reflex abnormalities reflect major damage to different parts of the trigeminal system and may therefore make an important contribution to the diagnosis of multiple sclerosis.

Adult↗
PubMed1991

The effect of posture on the normal and pathological auditory startle reflex.

The effect of posture on the EMG pattern of the normal auditory startle reflex was investigated. The startle response to an unexpected auditory tone was studied in eleven normal subjects when standing, and in six normal subjects when sitting relaxed or tonically plantar flexing both feet. Reflex EMG activity was recorded in the tibialis anterior and soleus about twice as frequently when standing, than when sitting relaxed. In addition, the median latencies to onset of reflex EMG activity in the tibialis anterior and soleus were about 40 and 60 ms shorter during standing, than when sitting relaxed. No short latency EMG activity was recorded in the calf muscles during tonic plantar flexion of the feet, while sitting. The effect of posture on the EMG pattern of the pathological auditory startle reflex was studied in five patients with hyperekplexia. In three patients the latency to onset of reflex EMG activity in the tibialis anterior was shorter when standing, than when sitting relaxed. The EMG pattern of the reflex response to sound was studied in detail in two of these patients and consisted of up to three successive components. The expression of each EMG component depended on the postural set of the limbs. In particular, a distinct short latency component was found in posturally important muscles following auditory stimulation. This short latency component was not recorded when sitting relaxed. It is concluded that the EMG pattern of the physiological and pathological auditory startle response is not fixed, but may change with the postural stance of the body. This finding supports the theory that the normal startle reflex and the abnormal startle reflex in hyperekplexia have a common brainstem origin.

Adolescent↗
PubMed2002

Autonomic neuropathy is associated with increased cardiovascular risk factors: the EURODIAB IDDM Complications Study.

AIMS: To assess the prevalence of and risk factors for autonomic neuropathy in the EURODIAB IDDM Complications Study. METHODS: The study involved the examination of randomly selected Type I (insulin-dependent) diabetic patients from 31 centres in 16 European countries. Neuropathic symptoms and two tests of autonomic function (changes in heart rate and blood pressure from lying to standing) were assessed and data from 3007 patients were available for the present analysis. Autonomic neuropathy was defined as an abnormality of at least one of the tests. RESULTS: The prevalence of autonomic neuropathy was 36% with no sex differences. The frequency of one and two abnormal reflex tests was 30% and 6%, respectively. The R-R ratio was abnormal in 24% of patients while 18% had orthostatic hypotension defined as a fall in systolic blood pressure > 20 mmHg on standing. Significant correlations were observed between autonomic neuropathy and age (P < 0.01), duration of diabetes (P < 0.0001), HbA1c (P < 0.0001), diastolic blood pressure (P < 0.05), lower HDL-cholesterol (P < 0.01), the presence of retinopathy (P < 0.0001) and albuminuria (P < 0.0001). New associations have been identified from the study: the strong relationship of autonomic neuropathy to cigarette smoking (P < 0.01), total cholesterol/HDL-cholesterol ratio (P < 0.05) and fasting triglyceride (P < 0.0001). As a key finding, autonomic neuropathy was related to the presence of cardiovascular disease (P < 0.0001). All analyses were adjusted for age, duration of diabetes and HbA1c. However, data have been only partly confirmed by logistic regression analyses. Frequency of dizziness on standing up was 18%, while only 4% of patients had nocturnal diarrhoea and 5% had problems with bladder control. CONCLUSION: Cardiovascular reflex tests, even in the form of the two tests applied, rather than a questionnaire, seem to be appropriate for the diagnosis of autonomic neuropathy. The study has identified previously known and new potential risk factors for the development of autonomic neuropathy, which may be important for the development of risk reduction strategies. Our results may support the role of vascular factors in the pathogenesis of autonomic neuropathy.

Adolescent↗
PubMed2000

Masseter reflex latencies and amplitudes are not influenced by supratentorial and cerebellar lesions.

The aim of this study was to investigate possible influences of suprasegmental lesions on the masseter reflex. The masseter reflex was elicited in 54 patients with supratentorial (37 patients) or cerebellar (17 patients) lesions 3-11 days after the acute onset of clinical disease. Patients showing lesions within the pons and midbrain on thin-slice magnetic resonance imaging were excluded from evaluation. The testing procedure included an additional facilitating maneuver (opening and closing the jaw before tapping). Masseter reflex latencies, interside differences, and amplitudes were within the normal range in all patients. Latencies were not different with and without the facilitating maneuver. Amplitudes were significantly higher with the maneuver, but interside differences of amplitudes were unchanged. Masseter reflex abnormality can be taken as a reliable measure of direct involvement of the reflex arc.

Adult↗
PubMed1994

Autonomic nervous system function in narcolepsy.

A disturbance of the autonomic nervous system (ANS) in narcolepsy has been suggested, based on abnormalities on pupillometry, ejaculatory and cardiovascular function. The ANS function was studied by measuring the variation in the heart rate and blood pressure during provocations, using the following tests: deep breathing test, Valsalva test and Orthostatic test for heart rate reactivity measurements, and Orthostatic test for blood pressure control. Each test session gave seven variables, and these were compared to age-adjusted reference values in healthy normals. In 22 unmedicated narcoleptics (median age 50.5 y, range 18-70 y) the results did not differ from these. Seventeen of the patients were included in a controlled stimulant medication trial (selegiline 10-40 mg daily), and they showed no significant changes in the ANS variables except for a dose-dependent rise in heart ratio (placebo 1.32+/-1-0.13 and 40 mg 1.14+/-0.05; mean+/-SD) and a decrease in systolic blood pressure (placebo 5.8+/-9.7 and 40 mg 30.1+/-21.5 mmHg) on Orthostatic test. Although blood pressure decreases >/=30 mmHg (maximally 72 mmHg) occurred in 9 patients, they were asymptomatic. These changes are considered primarily to reflect the known characteristic of monoamine oxidase inhibitors to cause postural hypotonia. Abnormalities using these methods were not found, thus supporting the view that cardiovascular reflex abnormalities would be characteristic of narcolepsy.

Journal Article↗
PubMed2006

[The clinical manifestations and assessment of post stroke dysphagia].

OBJECTIVE: To find the relationship between the clinical manifestations of dysphagia resulting from stroke and dysfunction of swallowing organs. It is helpful to understand the mechanism of dysphagia so as to guide its diagnosis and therapy. METHODS: Oral facial examination experimental swallowing methods were used to identify the abnormal manifestations of dysphagia. Spearman correlation analysis was used as statistic method. Sensitivity (SN), specificity (SP), predictive values (PV+/-) were calculated. RESULTS: There were about 20 or so abnormal manifestations after stroke and swallowing organs dysfunction include abnormal lip closure, decreased tongue motility, weakness of palate, decreased or disappeared gag reflex, abnormal lift of larynx and insufficient opening of cricopharyngeal muscle. The sensitivity and negative predictive values were high in all the dysfunction organs with the highest sensitivity, specificity, positive and negative predictive value in abnormal lip closure (84.62%), decreased tongue motility (67.75%), insufficient opening of cricopharyngeal muscle (80.96%) and abnormal lip closure (90.91%). CONCLUSIONS: It is comparatively accurate for clinical evaluation to judge dysfunction in lip closure, lingual movement and larynx elevation.

Adult↗
PubMed2004

Iron status and neurobehavioral development of premature infants.

OBJECTIVE: This study was conducted to examine the relation between iron status and neurobehavioral development in premature infants. STUDY DESIGN: Infants born before 34 weeks postmenstrual age and who were medically stable were studied. Anemia was defined as hemoglobin < or =10 g/Dl and low iron stores as a serum ferritin concentration < or =75 microg/l. The infants were classified as anemic with low ferritin (Group 1; n=18), anemic with normal ferritin (Group 2; n=14), and nonanemic with normal ferritin (Group 3; n=21). A total of 18 reflexes were behaviorally evaluated at 37 weeks postmenstrual age and "reflex scores" were compared between the groups. Higher scores reflect a greater percentage of abnormal reflexes. RESULTS: Infants in group 1 (anemia/low ferritin) had a significantly higher reflex score (51.45+/-18.32%) than infants in Group 3 (38.32+/-17.75%). Group 2 had an intermediate score (45.40+/-21.70%), but not different from the other two groups. CONCLUSION: These data indicate that low iron status, both measured by anemia and ferritin levels, is related to poorer neurobehavioral status in premature infants.

Birth Weight↗