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Journal of Clinical Medicine Research Dec 2011Assessment of primitive reflexes is one of the earliest, simplest, and most frequently used assessment tools among health care providers for newborns and young infants....
BACKGROUND
Assessment of primitive reflexes is one of the earliest, simplest, and most frequently used assessment tools among health care providers for newborns and young infants. However, very few data exist for high-risk infants in this topic. Among the various primitive reflexes, this study was undertaken particularly to describe the sucking, Babinski and Moro reflexes in high-risk newborns and to explore their relationships with clinical variables.
METHODS
This study is a cross-sectional descriptive study. Sixty seven high-risk newborns including full-term infants required intensive care as well as premature infants were recruited in a neonatal intensive care unit using convenient sampling method. The sucking, Babinski and Moro reflexes were assessed and classified by normal, abnormal and absence. To explore their relationships with clinical variables, birth-related variables, brain sonogram results, and behavioral state (the Anderson Behavioral State Scale, ABSS) and mental status (the Infant Coma Scale, ICS) were assessed.
RESULTS
The sucking reflex presented a normal response most frequently (63.5%), followed by Babinski reflex (58.7%) and Moro reflex (42.9%). Newborns who presented normal sucking and Babinski reflex responses were more likely to have older gestational age, heavier birth and current weight, higher Apgar scores, shorter length of hospitalization, better respiratory conditions, and better mental status assessed by ICS, but not with Moro reflex.
CONCLUSIONS
High risk newborns presented more frequent abnormal and absence responses of primitive reflex and the proportions of the responses varied by reflex. Further researches are necessary in exploring diverse aspects of primitive reflexes and revealing their clinical implication in the high-risk newborns that are unique and different to normal healthy newborns.
KEYWORDS
Primitive reflex; High risk infants; Korean; Moro reflex; Sucking reflex; Babinski reflex; The Anderson Behavioral State Scale; Infant Coma Scale.
PubMed: 22393339
DOI: 10.4021/jocmr706w -
World Journal of Clinical Cases Apr 2023Contrast-induced encephalopathy (CIE) is a rare transient, reversible abnormality in the structure or function of the nervous system caused by the intravascular use of...
BACKGROUND
Contrast-induced encephalopathy (CIE) is a rare transient, reversible abnormality in the structure or function of the nervous system caused by the intravascular use of contrast agents. CIE can present with a range of neurological manifestations, including focal neurological deficits (hemiplegia, hemianopia, cortical blindness, aphasia, and parkinsonism) and systemic symptoms (confusion, seizures, and coma). However, if not accurately diagnosed and treated in a timely manner, CIE can cause irreversible damage to patients, especially critically ill patients.
CASE SUMMARY
A male in his 50 s, 2 h after digital subtraction angiography, had a progressive disorder of consciousness, mixed aphasia, bilateral pupillary sluggish light reflex, and right limb weakness. Seven hours after the procedure, he developed unconsciousness, high fever (39.5 °C), seizures, hemiplegia, neck stiffness (+), and right Babinski signs (+). computed tomography (CT) findings 2 h postprocedure were very confusing and led us to misdiagnose the patient with subarachnoid hemorrhage. Brain CT was performed again 7 h after the procedure. Compared with the CT 2 h after the procedure, the CT 7 h after the procedure showed that the manifestations of subarachnoid hemorrhage in the left cerebral hemisphere had disappeared and were replaced by brain tissue swelling, and the cerebral sulci had disappeared. Combined with the clinical manifestations of the patient and after the exclusion of subarachnoid hemorrhage and cerebrovascular embolism, we diagnosed the patient with CIE, and intravenous fluids were given for adequate hydration, as well as mannitol, albumin dehydration, furosemide and the glucocorticoid methylprednisolone. After 17 d of active treatment, the patient was discharged with no sequelae.
CONCLUSION
CIE should be taken seriously, but it is easily misdiagnosed, and once CIE is diagnosed, rapid, accurate diagnosis and treatment are critical steps. Whether a follow-up examination using a contrast agent can be performed should be closely evaluated, and the patient should be fully informed of the associated risks.
PubMed: 37122519
DOI: 10.12998/wjcc.v11.i10.2260 -
Annals of Medicine and Surgery (2012) Feb 2024Acute disseminated encephalomyelitis (ADEM) is a rare neurological disorder characterized by inflammation in the brain and spinal cord. This systematic review aims to... (Review)
Review
INTRODUCTION
Acute disseminated encephalomyelitis (ADEM) is a rare neurological disorder characterized by inflammation in the brain and spinal cord. This systematic review aims to investigate the potential association between ADEM and influenza vaccination by analyzing relevant case reports. ADEM is traditionally thought to be a monophasic condition, predominantly affecting children, often following viral illnesses or immunizations. Recent attention has focused on a possible link between ADEM and influenza vaccination, prompting the need for a thorough investigation.
METHODS
The systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the AMSTAR2 (A MeaSurement Tool to Assess systematic Reviews 2) guidelines. Electronic searches were conducted on PubMed, Cochrane Library, and clinicaltrials.gov databases, spanning up to August 2023. Inclusion criteria encompassed full-text articles in English, observational studies, case reports, and case series providing comprehensive details for confirming clinical diagnoses of ADEM following influenza vaccination. Data were extracted, including demographic information, vaccination details, clinical symptoms, diagnostic evaluations, treatment modalities, and outcomes. Quality assessment was performed using the Joanna Briggs Institute (JBI) Critical Appraisal tool.
RESULTS
A total of 23 cases of ADEM following influenza vaccination were identified from 19 included articles. The mean age of affected individuals was 40.2 years (±25.7) with 60.8% being male. Common presenting symptoms included muscle weakness (52.1%), urinary abnormalities (30.4%), altered consciousness (26%), and sensory disturbances (26%). Neurological examination revealed findings such as extensor plantar reflex (positive Babinski sign) in 26%, hyperreflexia in 30.4%, and generalized hyporeflexia in 13% of the cases. Diagnostic evaluations involved MRI, showing multiple hyperintense lesions in cerebral hemispheres (43.4%), subcortex (60.8%), and spinal cord (39.1%). Cerebrospinal fluid analysis indicated elevated white blood cell count in 69.5% of cases, with lymphocytic pleocytosis in 52.1%. Oligoclonal bands were reported positively in 8.6% of cases. Treatment approaches varied, with intravenous methylprednisolone being the most common (39.1%). Out of the 23 cases, two (8.6%) patients had a fatal outcome, while the rest showed clinical improvement with complete or partial resolution of symptoms. Persisting symptoms included numbness in the lower extremities (8.6%) and impaired ability to walk after 10 months (4.3%).
CONCLUSION
While the association between ADEM and influenza vaccination is rare, healthcare professionals should remain vigilant and consider patients' vaccination history, particularly following an influenza immunization. This systematic review highlights the clinical manifestations, diagnostic tools, treatment approaches, and outcomes of ADEM cases post-influenza vaccination. Further research is essential to understand this association and improve clinical decision-making, ensuring the safety and efficacy of immunization programs.
PubMed: 38333316
DOI: 10.1097/MS9.0000000000001656 -
Journal of Alzheimer's Disease : JAD 2016Sophisticated and expensive biomarkers are proposed for the diagnostic of Alzheimer's disease (AD). The amyloid process seems to be early in AD, and brain amyloid load...
BACKGROUND
Sophisticated and expensive biomarkers are proposed for the diagnostic of Alzheimer's disease (AD). The amyloid process seems to be early in AD, and brain amyloid load affects the frontal lobe.
OBJECTIVE
To determine if certain simple clinical signs, especially frontal-related signs, could help reach an earlier and better diagnosis.
METHODS
In the frame of the 3-City cohort, we conducted a nested case-control study comparing incident cases of AD to controls matched for age, gender, and education. The standardized neurological exam included extrapyramidal signs (akinesia, rigidity, rest tremor), pyramidal symptoms (spastic rigidity, Babinski reflex), primitive reflexes (snout, palmomental reflex grasping), and tremor (essential, intentional, head) at the time of diagnosis and two years before.
RESULTS
We compared 106 incident AD subjects (mean age at diagnosis 82.2 (SD = 5.9); median MMSE at diagnosis = 23) to 208 matched controls. In patients younger than 80, palmomental reflexes were more frequent in AD than controls, two years before diagnosis (25.0 versus 7.0% , p = 0.03) and at time of diagnosis (30.3 versus 12.3% , p = 0.02). No difference was observed for other signs two years before diagnosis or for patients older than 80.
CONCLUSION
Before diagnosis, the clinical examination of AD patients is not strictly normal; the primitive reflexes appear to be pathological. It might be in connection with the frontal amyloid load at an early stage of the disease. Clinical examination can reveal simple and interesting signs that deserve consideration as well as the other more invasive and expensive biomarkers.
Topics: Aged; Aged, 80 and over; Alzheimer Disease; Cohort Studies; Early Diagnosis; Female; Follow-Up Studies; France; Humans; Longitudinal Studies; Male; Neuropsychological Tests; Reflex
PubMed: 26639955
DOI: 10.3233/JAD-150436 -
BMJ (Clinical Research Ed.) Dec 2020To investigate systematically the presence of the Babinski sign in paintings of the Christ Child by the greatest painters of the Renaissance. (Observational Study)
Observational Study
OBJECTIVE
To investigate systematically the presence of the Babinski sign in paintings of the Christ Child by the greatest painters of the Renaissance.
DESIGN
Observational analysis.
SETTING
Large collection of paintings depicting the Christ Child from Flemish, Rhenish, and Italian schools between 1400 and 1550 CE, searched using published catalogues and Google.
STUDY SAMPLE
302 Renaissance paintings (by 19 painters) depicting the Christ Child.
MAIN OUTCOME MEASURE
Babinski sign, defined as a hallux extension with an amplitude greater than 30°. The presence of foot sole stimulation was also noted.
RESULTS
An unquestionable upgoing toe was apparent in 90 (30%) of the 302 paintings. The Babinski sign was present in more than 60% of Christ Child paintings by Rogier van der Weyden, Hans Memling, Martin Schongauer, and Matthias Grünewald. A bilateral Babinski sign was observed in three paintings. Stimulation of the sole was noted in 48/90 (53%) paintings and was always present in paintings by Andrea del Verrocchio, Leonardo da Vinci, and Giorgione. No association existed between the presence of the Babinski sign and the period during which the painter was active.
CONCLUSIONS
Four main factors were noted in relation to the representation of the Babinski sign in paintings of the Christ Child: the physiological toe phenomenon in infants, the representation of the nudity of the Christ by painters during the 15th century to demonstrate the incarnation, Renaissance painters' need for precise observation of anatomy, and the desire of some Rhenish and Flemish painters to depict very realistic details. Italian Renaissance painters, whether Mannerist or not, tended to idealise the beauty of human body, and they often did not reproduce the Babinski sign.
Topics: Christianity; Female; History, 15th Century; History, Medieval; Humans; Infant; Infant, Newborn; Male; Medicine in the Arts; Paintings; Reflex, Babinski; Toes
PubMed: 33303424
DOI: 10.1136/bmj.m4556 -
Arquivos de Neuro-psiquiatria Aug 2010In addition to the famous sign described by Joseph Babinski, which is also known as Babinski's reflex, there are references in the literature to various other signs...
In addition to the famous sign described by Joseph Babinski, which is also known as Babinski's reflex, there are references in the literature to various other signs described by this famous disciple of J-M Charcot. This article reviews all the neurological signs described by Babinski.
Topics: France; History, 19th Century; History, 20th Century; Neurology; Poland; Reflex, Babinski
PubMed: 20730331
DOI: 10.1590/s0004-282x2010000400037 -
European Spine Journal : Official... Oct 2010A retrospective study was performed to determine the sensitivities of the pyramidal signs in patients with cervical myelopathy, focusing on those with increased signal... (Comparative Study)
Comparative Study
A retrospective study was performed to determine the sensitivities of the pyramidal signs in patients with cervical myelopathy, focusing on those with increased signal intensity (ISI) in T2-weighted magnetic resonance imaging (MRI). The relationship between prevalence of the pyramidal signs and the severity of myelopathy was investigated. We reviewed the records of 275 patients with cervical myelopathy who underwent surgery. Of these, 143 patients were excluded from this study due to comorbidities that might complicate neurological findings. The MR images of the remaining 132 patients were evaluated in a blinded fashion. The neurological findings of 120 patients with ISI (90 men and 30 women; mean age 61 years) were reviewed for hyperreflexia (patellar tendon reflex), ankle clonus, Hoffmann reflex, and Babinski sign. To assess the severity of myelopathy, the motor function scores of the upper and lower extremities for cervical myelopathy set by the Japanese Orthopaedic Association (m-JOA score) were used. The most prevalent signs were hyperreflexia (94%), Hoffmann reflex (81%), Babinski sign (53%), and ankle clonus (35%). Babinski sign (P < 0.001), ankle clonus, and Hoffmann reflex showed significant association with the lower m-JOA score. Conversely, no association was found with the upper m-JOA score. In patients with cervical myelopathy, hyperreflexia showed the highest sensitivity followed by Hoffmann reflex, Babinski sign, and ankle clonus. The prevalence of the pyramidal signs correlated with increasing severity of myelopathy. Considering their low sensitivity in patients with mild disability, the pyramidal signs may have limited utility in early diagnosis of cervical myelopathy.
Topics: Adult; Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Pyramidal Tracts; Radiculopathy; Reflex, Abnormal; Retrospective Studies; Severity of Illness Index; Spinal Cord Compression
PubMed: 20229121
DOI: 10.1007/s00586-010-1364-3 -
Annals of Indian Academy of Neurology 2018Approximately 5%-11% of neurologically normal population has extensor plantar response (EPR).
INTRODUCTION
Approximately 5%-11% of neurologically normal population has extensor plantar response (EPR).
METHOD
This study is aimed to identify differentiating features of EPR between physiological and pathological population.
RESULTS
A total of 43 patients with pyramidal lesions and 113 normal controls were recruited for this study. The pathological EPRs were more reproducible, with 89.4% having at least two positive Babinski responses and 91.5% having two positive Chaddock responses (vs. 14.3% and 4.8% in controls, < 0.001). The pathological EPR was more sensitive to stimulation, in which 89.1% were elicited when the stimulation reached mid-lateral sole (vs. 11.9% in controls, < 0.001). Most (93.6%) pathological cases had sustained big toe extension throughout stimulation (vs. 73.8% in controls, < 0.001). As compared to those with brain lesion, the plantar responses in those with spinal lesion are less likely to have ankle dorsiflexion (5.3% vs. 25%, < 0.05) more likely to have sustained extensor response with Babinski (94.7% vs. 71.4%, < 0.05), Chaddock (89.5% vs. 64.3%, < 0.05), and Schaefer (26.3% vs. 3.6%, < 0.05) methods. A scoring system was computed using four variables, i.e., two consecutive positive Babinski or Chaddock responses, extensor response at mid-lateral sole, and sustained extension throughout stimulation. A score ≥3 is predictive of pathological origin, with sensitivity and specificity of 78.7% and 95.2%, respectively.
CONCLUSION
The pathological EPR is more reproducible, sensitive to stimulation, and sustainable compared to physiological extensor response.
PubMed: 30122841
DOI: 10.4103/aian.AIAN_254_17 -
Anesthesiology Feb 1981Transient hyperreflexia, the Babinski reflex, and other transient neurologic signs may follow anesthesia in healthy persons. The authors describe the appearance and...
Transient hyperreflexia, the Babinski reflex, and other transient neurologic signs may follow anesthesia in healthy persons. The authors describe the appearance and durations of these signs and relate them to anesthetic agent, time following cessation of anesthesia, and state of arousal. Twenty-nine neurologically normal male patients undergoing superficial operations were anesthetized with halothane-nitrous oxide, enflurane-nitrous oxide, or nitrous oxide-narcotic. During awakening, patients experienced transient hyperreflexia and shivering following all anesthetic techniques. Quadriceps hyperreflexia occurred in three of eight patients after halothane-N2O, seven of 12 patients after enflurane-N2O, and no patient after n2O-narcotic anesthesia. Sustained ankle clonus and upgoing plantar responses were observed most frequently following enflurane-N2O (50 percent of patients). Following halothane-N2O, ankle clonus was observed in 12.5 per cent of patients and upgoing plantar responses in 25 per cent of patients. Neither sign occurred after N2O-narcotic anesthesia. Shivering, too, was observed most frequently following enflurane anesthesia (66 per cent of patients). There were equal reductions of body temperature in shivering and nonshivering patients. In every patient, regardless of the anesthetic used, the lash reflex and the pupillary response to light returned to normal with the return of consciousness as measured by the response to verbal commands. It is concluded that the neurologic profile during awakening from general anesthesia is most abnormal following enflurane-N2O, compared with halothane-N2O and N2O-narcotic anesthesia. Abnormalities are found most frequently when patients are poorly responsive to verbal commands. Although their incidence diminishes with time, abnormal responses to neurologic examination may persist for 40 min or more after cessation of anesthesia.
Topics: Adult; Anesthetics; Arousal; Blinking; Body Temperature; Enflurane; Fentanyl; Halothane; Humans; Injections, Intravenous; Male; Middle Aged; Morphine; Nervous System; Nitrous Oxide; Reflex, Pupillary; Reflex, Stretch; Shivering; Time Factors
PubMed: 7469090
DOI: 10.1097/00000542-198102000-00005 -
Neurology India 2018
Topics: Fingers; Humans; Neurologic Examination; Pyramidal Tracts; Reflex, Babinski; Sensitivity and Specificity
PubMed: 30233008
DOI: 10.4103/0028-3886.241383