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The abnormal upper gastrointestinal vagovagal reflexes that affect the heart.

The clinically important upper gastrointestinal-cardiac vagovagal reflexes are mainly those initiated by swallowing and rapid gastric distention. Pre-existing-heart disease has little to do with determining susceptibility to upper gastrointestinal stimuli. The dangerous cardiac repercussions concern diminished coronary artery flow and the arrhythmias. The latter can be subcategorized as swallow tachycardia, pharyngeal disease with arrhythmia, glossopharyngeal neuralgia with swallow syncope, spontaneous swallow syncope and swallow bradycardia. Iatrogenic arrhythmias are particularly tragic potential hazards of all pharyngoesophagogastric manipulations.

Adolescent

Acute and chronic adaptations of muscle proprioceptors in response to increased use.

Acute adaptations to use have been shown to occur in both the muscle spindle and Golgi tendon organ pathways. This short term activation adaptation increases the excitability of the motoneuron pool, thereby potentially providing a nonvoluntary increase in the excitation of subsequent contractions. It is thought that the intrafusal muscle fibres reset to a higher gain after contraction and that the tendon organ pathway undergoes a brief desensitisation. These phenomena could be important clinically when trying to stretch muscles, i.e. a contraction before a stretch should make the stretch more difficult. Also, this could affect the amount of muscle force generated, thereby altering motor behaviours requiring fine accuracy. Research on the adaptations of proprioceptors during free movement, using locomotion as a model, has found that the hypothesis of consistent alpha-gamma coactivation during motor behaviours is much more complicated and adaptable, depending on the environmental circumstance and the specific motor task. These research findings support the use of selective training, i.e. training to the task, for optimal motor learning. The results of the relatively limited research on chronic adaptations of proprioceptors due to exercise has shown that on a microlevel, the intrafusal muscle fibres may show some metabolic changes but do not show any hypertrophy. However, on a more macro level, with extended training, the latency of the stretch reflex response is found to be decreased and the amplitude is found to be increased in both animals and humans. Through classical conditioning research, proprioceptors may also be necessary for motor learning. Lastly, both primates and humans have been shown to be able to up- or down-grade their stretch reflex responses using operant conditioning techniques and many practice sessions. These findings have important implications both for rehabilitation of persons with abnormal reflex activity and in the training of athletes. This review provides some consolidation of the recent research findings, but much more research needs to be done in order to fully understand the purpose and importance of the proprioceptive sensory system.

Humans

Are medium and long latency reflexes a screening tool for early Parkinson's disease?

We have studied whether assessment of medium latency (ML) and long latency (LL) reflex amplitudes may serve as a marker for early Parkinson's disease. Twenty-three patients with idiopathic Parkinson's disease (Hoehn and Yahr stage 1 to 4) and 24 controls received 20 4 degrees toe-up rotations of a platform upon which they were standing. All antiparkinsonian medication was withheld for at least 12 h before the study. ML reflexes in the stretched gastrocnemius muscle and LL reflexes in the shortened tibialis anterior muscle were recorded from both legs. ML responses were significantly enhanced in patients compared to controls. In contrast to previous studies which studied patients who continued their usual treatment, we observed that LL responses were significantly reduced in patients compared to controls. For the purpose of individual analysis, we subsequently determined the optimal specificity and sensitivity using various criteria for abnormality. The presence of either enhanced ML responses or reduced LL responses (or both) in at least one leg yielded a maximum sensitivity of 65.2% with a specificity of 75.0% (positive likelihood ratio 2.6; negative likelihood ratio 0.5). Abnormal reflexes were almost exclusively present in patients with advanced and long-standing Parkinson's disease. These results show abnormalities of ML and LL responses in advanced Parkinson's disease, but render it unlikely that these abnormalities are a suitable screening tool for early stages of the disease. The fact that LL responses were reduced in patients taken off antiparkinsonian medication raises the possibility that this reflex is under supraspinal dopaminergic control.

Aged

Vestibular system abnormalities in otosclerotic subjects.

A technique to quantify the tandem Romberg test (posturography) was used to study ten patients with otosclerosis before (series 1), 48 hours after (series 2), and between two to four months after (series 3) a stapedectomy. The results were analyzed by power spectrum analysis and then compared to findings from electronystagmographic testing performed with series 1 and 3. There was no significant change in the electronystagmography (ENG) test findings between series 1 and 3. Posturography, however, demonstrated an uncompensated vestibular pattern in the immediate postoperative period which, after two months, converted to a compensated vestibular pattern. Posturography serves as a useful quantitative test for the study of patients with balance disorders because the procedure supplements rather than complements the ENG. In addition, posturography detects vestibular reflex abnormalities in stapedectomized patients two months afterwards. Other testing modalities have not consistently demonstrated this postoperative vestibular system instability.

Adult

Phencyclidine. Nine cases of poisoning.

In nine cases of phencyclidine hydrochloride poisoning, early signs of overdose included drowsiness, nystagmus, miotic pupils, blood pressure elevation, increased deep tendon reflexes, ataxia, anxiety, and agitation. In more severe cases, seizures, spasticity, and opisthotonos were seen in addition to deep coma and respiratory depression. Treatment included removal by emetics or lavage, hydration, and a quiet, reassuring environment. Spasticity, agitation, and ocular manifestions responded to diazepam. Psychiatric intervention was instituted after the patients were stable and no longer agitated.

Adolescent

Tonic pupils with acute ophthalmoplegic polyneuritis.

Two patients with the symmetrical ophthalmoplegic variant of acute idiopathic polyneuritis (Fisher's syndrome) developed bilateral dilated pupils with cholinergic supersensitivity and light-near dissociation (tonic pupils), indicating involvement of the postganglionic parasympathetic neuron within the orbit. Supranuclear eye movement dysfunction also was present, indicated by relative levator sparing in both patients and by preservation of Bell's phenomenon in 1 patient despite paralysis of voluntary upward gaze. The lesions that produce the eye signs of ophthalmoplegic polyneuritis are not necessarily restricted to the cranial nerve trunks. The present cases support a relationship between the ophthalmoplegic variant of the Guillain-Barré syndrome and acute postinfectious encephalomyelitis (brainstem encephalitis) on the one hand, and idiopathic autonomic neuropathies such as the Holmes-Adie syndrome and pandysautonomia on the other.

Adult

Attenuated dynamic responses of primary endings of muscle spindles: a basis for depressed tendon responses in acrylamide neuropathy.

Depressed or lost tendon reflexes commonly observed in patients with peripheral neuropathies may result partly from attenuation of the dynamic discharge from the primary endings of muscle spindles. This possibility was investigated in cats with an experimental neuropathy induced with acrylamide (30 mg/kg/day intramuscularly). Achilles tendon reflexes and the dynamic discharge from primary muscle spindles were evaluated after five or ten injections of acrylamide. After five injections the animals were moderately impaired neurologically, the Achilles tendon reflex was difficult to elicit in 2 of 5 animals, and the dynamic responses of primary endings of soleus muscle spindles to stretch were depressed. Following ten injections of acrylamide the cats were severely impaired neurologically; tendon responses were either absent or difficult to elicit, and the dynamic responses of their muscle spindles to stretch were reduced by 50% (p less than 0.01). Additionally, the spindels responded to stretch with only 20 to 30% the normal number of afferent impulses. These data suggest that lost tendon responses in acrylamide neuropathy result in part from inadequate activation of motoneurons by spindle afferent discharge.

Acrylamides

Primary aberrant third nerve regeneration.

The clinical and neuroradiological features in 4 patients with the syndrome of aberrant regeneration of the third nerve are presented. In contrast to what is commonly seen, the syndrome was not preceded by third nerve palsy. A petrous apex-cavernous sinus meningioma was the underlying lesion in all 4 patients. Surgical and pathological confirmation of the diagnosis was obtained in 3. Regardless of whether the other ocular motor nerves are spared (as in our patients) or involved (as in other cases reported in the literature), primary aberrant regeneration of the oculomotor nerve appears to be characteristic of a cavernous sinus meningioma.

Adult

Cutaneous reflexes in Parkinson's disease.

The physiology of rigidity in Parkinson's disease (PD) can be investigated by the study of reflexes. Cutaneous reflexes (CR) were measured in 10 patients with PD and in 10 age- and sex-matched normal volunteers. EMG activity was recorded from the first dorsal interosseous muscle with surface electrodes, rectified and averaged. The index finger was stimulated with an intensity four times the sensory threshold. The subjects abducted the index finger with 20% of maximal force. While the latencies of the different reflex components and the amplitudes of the excitatory peaks were not different in the two groups, the first inhibitory component was less pronounced in patients with PD as compared with normals. This effect is partially reversed with dopaminergic drug treatment. The results are compatible with the loss of an inhibitory spinal mechanism elicited by cutaneous afferents, and can be a partial explanation for increased tone in PD.

Electromyography

[Paradoxical pupillary reaction to light -- a pupillographic study (author's transl)].

A report given of a 32-year-old female patient who exhibited a unilateral paradoxical pupillary reaction to light, but was obviously healthy in all other respects. All of the neuroophthalmological findings, including the infrared reflex-pupillographic results registered, are indicated and discussed in detail in the report. An analysis of the findings leads to the conclusion that this disturbance has a central, prenuclear location. Apart from a stenosis at the junction of the arteria vertebralis, which was determined angiographically, further examination did not reveal any pathological findings.

Adult

Neuropsychiatric symptomatology with chronic renal insufficiency in the stage of compensated and decompensated retention. II. Peripheral nerve disturbances.

80 strictly selected patients with chronic renal insufficiency with plasma creatinine values of 1.4-14.5 mg% were examined for clinical and electrophysiological signs of nephrogenic polyneuropathy. The motor symptoms complained of were cramps in 43.8% of the patients, "restless leggs" in 18.7%, muscular twitchings in 12.5%. It was emphasized that the first two symptoms do not always indicate the presence of polyneuropathy. 30% complained of paresthesias, 5% of "burning feet". The most frequent clinical finding was the impairment of vibration sense in the feet in 37.5% followed by diminshed appreciation of passive movement of the toes in 30%, weakening or absence of the ankle jerk in 23.8% and finally, weakening of the patellar reflex in 5%...

Adult

Subclinical organic psychosyndromes on intrathecal injection of metrizamide for lumbar myelography.

Eighteen patients with symptoms and signs of possible lumbar disc herniation, who had no evidence of a preexisting organic psychosyndrome were included in the study. An organic psychosyndrome was found in six of them 10 h after lumbar myelography with metrizamide. The psychosyndrome, which was characterized by impaired memory and depression, could be demonstrated only by psychometric methods. In these patients metrizamide could be demonstrated within the basal cisterns by computed tomography 8 h after lumbar injection of the contrast medium. The organic psychosyndrome was completely reversible; five days after myelography it could not be detected any more by psychometric means. The development of an organic psychosyndrome in six of the 18 patients suggests a neurotoxic effect of metrizamide. This assumption is supported by hypo- and areflexia in four patients after intrathecal metrizamide as well as by EEG changes seen in three patients after myelography. There was no correlation between the EEG changes or reflex abnormalities and the organic psychosyndrome.

Adult

Periodic nocturnal myoclonus in a patient with hyperexplexia (startle disease).

The periodic nocturnal myoclonus of a patient with hyperexplexia has been studied. Evidence has been given that the jerks are spontaneous arousal reactions. The temporal characteristics of the jerks have been analysed. The jerks appear to be correlated with the respiratory rhythm and the data suggest a correlation of the jerks with circulatory and respiratory higher order waves. The results are discussed with relation to the literature concerning spontaneous sleep jerks.

Arousal

The oral toxicity of clioquinol (5-chloro-7-iodo-8-hydroxyquinoline) in beagle dogs.

When clioquinol was administered to Beagle dogs, disturbances in gait which were associated with abnormal reflexes and reactions, were seen in animals receiving 250 and 400 mg/kg body weight per day. Histopathological examination of the central nervous system (CNS) showed pathological change in the posterior columns of the spinal cord.

Animals