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American Family Physician Jan 2020Although the prevalence of muscle weakness in the general population is uncertain, it occurs in about 5% of U.S. adults 60 years and older. Determining the cause of... (Review)
Review
Although the prevalence of muscle weakness in the general population is uncertain, it occurs in about 5% of U.S. adults 60 years and older. Determining the cause of muscle weakness can be challenging. True muscle weakness must first be differentiated from subjective fatigue or pain-related motor impairment with normal motor strength. Muscle weakness should then be graded objectively using a formal tool such as the Medical Research Council Manual Muscle Testing scale. The differential diagnosis of true muscle weakness is extensive, including neurologic, rheumatologic, endocrine, genetic, medication- or toxin-related, and infectious etiologies. A stepwise approach to narrowing this differential diagnosis relies on the history and physical examination combined with knowledge of the potential etiologies. Frailty and sarcopenia are clinical syndromes occurring in older people that can present with generalized weakness. Asymmetric weakness is more common in neurologic conditions, whereas pain is more common in neuropathies or radiculopathies. Identifying abnormal findings, such as Chvostek sign, Babinski reflex, hoarse voice, and muscle atrophy, will narrow the possible diagnoses. Laboratory testing, including electrolyte, thyroid-stimulating hormone, and creatine kinase measurements, may also be helpful. Magnetic resonance imaging is indicated if there is concern for acute neurologic conditions, such as stroke or cauda equina syndrome, and may also guide muscle biopsy. Electromyography is indicated when certain diagnoses are being considered, such as amyotrophic lateral sclerosis, myasthenia gravis, neuropathy, and radiculopathy, and may also guide biopsy. If the etiology remains unclear, specialist consultation or muscle biopsy may be necessary to reach a diagnosis.
Topics: Adult; Aged; Aged, 80 and over; Diagnosis, Differential; Humans; Muscle Weakness; Muscles; Muscular Diseases; Neurologic Examination; Neurology
PubMed: 31939642
DOI: No ID Found -
Arquivos de Neuro-psiquiatria Apr 2023Percussion is an important part of the neurological examination and reflex hammers are necessary to obtain it properly. (Review)
Review
BACKGROUND
Percussion is an important part of the neurological examination and reflex hammers are necessary to obtain it properly.
OBJECTIVE
We aimed to review the historical aspects of the main reflex hammers and to define the favorite one of Brazilian neurologists.
METHODS
We searched original and review articles about historical aspects of the reflex hammers in Scielo and Pubmed and conducted an online survey to investigate the favorite reflex hammer of Brazilian neurologists.
RESULTS
In the first part, we describe the major milestones in the creation of the reflex hammers. Following, we exhibit the results of the online survey: Babinski-Rabiner was the most voted.
CONCLUSIONS
The origins of the reflex hammers goes back long before their creation, from a basic clinical examination method: percussion. Since the description of deep tendon reflexes and the creation of percussion hammers, much has been improved in this technique. Among all the hammers surveyed, the Babinski-Rabiner was the chosen one by a significant portion of Brazilian neurologists.
Topics: Humans; Brazil; Neurologic Examination; Neurologists; Reflex
PubMed: 37160138
DOI: 10.1055/s-0043-1768697 -
Postgraduate Medical Journal Nov 1995The plantar response is a reflex that involves not only the toes, but all muscles that shorten the leg. In the newborn the synergy is brisk, involving all flexor muscles...
The plantar response is a reflex that involves not only the toes, but all muscles that shorten the leg. In the newborn the synergy is brisk, involving all flexor muscles of the leg; these include the toe 'extensors', which also shorten the leg on contraction and therefore are flexors in a physiological sense. As the nervous system matures and the pyramidal tract gains more control over spinal motoneurones the flexion synergy becomes less brisk, and the toe 'extensors' are no longer part of it. The toes then often go down instead of up, as a result of a segmental reflex involving the small foot muscles and the overlying skin, comparable to the abdominal reflexes. With lesions of the pyramidal system, structural or functional, this segmental, downward response of the toes disappears, the flexion synergy may become disinhibited and the extensor hallucis longus muscle is again recruited into the flexion reflex of the leg: the sign of Babinski. A true Babinski sign denotes dysfunction of the pyramidal tract, and should be clearly distinguished from upgoing toes that do not belong to the flexion synergy of the leg. Correct interpretation of the plantar response depends only to a minor degree on the method or site of stimulation of the foot. It is therefore most important to assess the response in the entire leg.
Topics: Humans; Muscle Contraction; Physical Stimulation; Pyramidal Tracts; Reflex, Babinski; Spinal Cord Diseases
PubMed: 7494766
DOI: 10.1136/pgmj.71.841.645 -
Journal of Neurology, Neurosurgery, and... Oct 2002Babinski's life and the story of the Babinski sign are summarised. The physiological basis of the sign is discussed.
Babinski's life and the story of the Babinski sign are summarised. The physiological basis of the sign is discussed.
Topics: Eponyms; France; History, 19th Century; History, 20th Century; Humans; Myelitis, Transverse; Neurology; Pyramidal Tracts; Reflex, Babinski
PubMed: 12235300
DOI: 10.1136/jnnp.73.4.360