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The babinski sign in Nigerian neonates and young infants.
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[Clinical studies on chaddock reflex].
One hundred neurological cases were evaluated for the positive rates of 6 pathological reflexes by the same examiner (author). Chaddock and Babinski reflexes were highly sensitive, their positive occurrence being 97.1% and 80.3% of the cases respectively, compared with other pathological reflexes. In patients with paresthesia on the soles, cold feet or foot grasping, Chaddock reflex was superior to Babinski, but in some cases Chaddock became definitely positive despite negative Babinski without attributable reasons, suggestive of the former is more sensitive than the latter. The original stimulation site in Chaddock reflex is the skin area just beneath the external malleolus, and within sural nerve distribution. The elicitation of Chaddock reflex was attempted by stimulating the dorsum of the foot from medial to lateral border, with definite positive responses from the areas of sural nerve distribution. To evaluate the sensitivity and receptive field of Chaddock reflex more objectively, the electromyographic method was employed in 13 cases. The needle electrode was inserted into the extensor hallucis longus (EHL) to monitor the up-going toe, as well as flexor hallucis brevis (FHB) for the plantar flexion of the toe, and the surface electric stimulator was applied to 7 different points of the foot and leg, including original Chaddock and Babinski zones. The results of electrical stimulations to 7 different sites revealed that definitely better responses of EHL in sural nerve distribution, compared with other nerve supply. The threshold strength to evoke the action potentials in EHL proved that Chaddock's area was significantly more sensitive than Babinski's area. The relationship of latencies between EHL and FHB on electrical stimulations to the Chaddock's and Babinski's areas showed that earlier and better responses in EHL than in FHB in Chaddock, which could be another reason that Chaddock reflex was more sensitive than Babinski. From the clinical and electromyographic evaluations mentioned above, Chaddock reflex is not just a variant of Babinski reflex, more sensitive and accurate, and its receptive field is considered to be in sural nerve distribution.
[Quantitative evaluation of muscular and periosteal reflexes].
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[Pathophysiology of spinal shock in man according to the results of stimulation electromyography].
Electromyography was made in 5 patients with a clinical picture of spinal shock. Within the first 4 days of the disease the disappearance of T potential of the soleus muscle was accompanied by the decreased amplitude of its H reflex, the enhancement of the phenomenon of H reflex depression upon low-frequency stimulation and predominance of the reflex component in the central response of the medial muscles of the foot sole. During weeks 4 and 8 of the spinal shock, there disappeared not only T potential but also H reflex of the soleus muscle and the central response of the foot muscles. It is concluded that during acute total disconnection of the descending control there is a successive loss of the functions of gamma-motoneurons, interneurones that mediate the segmental (probably, presynaptic) inhibition, and of alpha-motoneurons.
[Proximal spinal muscular atrophies].
The author observed 24 patients with proximal spinal muscular atrophies (PSMA) 15 of whom were suffering from Kugelberg-Welander's disease, and 9 from the intermediate form. In addition to the conventional neurological examinations carried out in all the patients, 11 patients were also examined electroneuromyographically. A genetic analysis of affected families was performed. The analysis showed that the disease forms being studied were inherited according to the autosomo-recessive type: this was in agreement with literary data. The age of the disease onset, the clinical manifestations of the disease, particularly, the character of the atrophies and their prevalent localization; the course and the degree of the disease progress, and the prognosis were also analyzed. The author discusses the character of the electroneuromyograms that showed a typical picture of motoneuron affection, while the conductivity of motor nerves remained normal, though showed signs of an increase of motor unit parameters with a decrease of the number of voluntarily-activated units, i.e. a diminution of mobilization. The degree of the EMG amplitude lowering during voluntary muscular contractions correlated with the disease gravity. The speed of the impulse conduction was normal. The data presented may be of a certain significance for medico-genetic consultations.
[Ross' syndrome (author's transl)].
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[Reflex reactions of the spinal cord in hypoparathyroidism].
Experiments were carried out on parathyroprival cats with varying degree of motor disorders. Disturbed reflex activity of the spinal cord was characterized by activation of motoneurons and the system of intercalary neurons, abatement of the phenomenon of posttetanic potentiation as well as by conductivity facilitation in the reflex arch. Marked tetany was accompanied by diminution and, in some cases, by complete absence of monosynaptic responses with enhancement of polysynaptic reflex discharges. After intravenous injection of calcium chloride the test animals showed a tendency to recovery of the reflexes recorded. It is concluded that the disordered functional state of the spinal cord segmental apparatus is mainly due to hypocalciemia and may be one of the causes of parathyroprival tetany.
[The value of the study of brain stem reflexes in coma (author's transl)].
A better clinical assessment of the comatose state is obtained by the study of brain stem reflexes. Systematic research of the fronto orbicular, pupillar, corneal, masseteric, vestibulo-ocular, oculo-cardiac, palmo-mental and cornéo mandibular reflexes has enabled characterization of functional levels. Degree of comatose stade and other usual physical symptoms have been correlated. Hence brain stem injury and course is followed in acute coma. Six functional levels permit assessment of cranio-caudal disintegration of brain stem functions. According to our opinion, diencéphalo-mesencephalic level is of bad prognosis in the course of follow-up.
[Isolated tonic ambulatory flexion of the foot (author's transl)].
A tonic ambulatory foot response developed one year after clamping of an aneurysm of the contralateral carotid artery in a young adult. No motor deficiency was noted during the postoperative period, but spasm of the carotid bifurcation branches were present on arteriograms. Clinical examination and deep reflexes tests excluded pyramidal lesions. Cortical somatesthetic evoked potential recordings confirmed the absence of sensory disturbances. CT scan suggested the presence of an infarct in the territory of the anterior choroidal artery. The present findings are compared with previous reports. The etiological data and CT scan results in the present case allow reconsideration of the physiopathology of tonic ambulatory foot response in the light of current knowledge of locomotor function in animals. The tonic flexion, an "extension" dystonia of the toes, electively provoked by walking, occurring one year after the neurological accident without any pyramidal signs, could arise from a coordination synkinesis due to lesions limited to the efferent extrapyramidal system.
[Possibilities and limitations of the method of studying the H-reflex in the diagnosis of nervous system diseases].
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Hemiplegic spasticity: neurophysiologic studies.
The excitability of segmental reflex pathways in normal subjects and in patients with hemiplegia has been examined by conditioning the monosynaptic H reflex with a 200 msec burst of vibration applied to the tendo Achilles. In 6 normal subjects, the burst of vibration produced a short-latency facilitation of soleus motoneurons (attributed to monosynaptic excitation) which was followed by a longer-latency inhibition. A similar response was observed in 8 patients with hemiplegia, but the late inhibition was significantly less. The loss of an inhibitory mechanism may contribute to the exaggerated reflexes observed in patients with hemiplegia.
[Ophthalmoneurology. IV. Pupillary motility and disturbances. Lesions of pupillary motility].
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[Functional nature of the spinal center of the hand muscles in normal subjects and in certain neurologic diseases (according to the results of stimulation electromyography)].
The parameters of the motor and the central responses of the thenar muscles to stimulation of the median nerve in 28 healthy subjects and 85 neurological patients were examined. It was shown that the infracervical alpha-motoneurons responded only to antidromic stimulation (the F-wave was registered). In cerebral pareses monosynaptic transmission from the 1a afferents becomes possible (the central response is similar to the H-reflex): this points to a disturbance of the segmented inhibition. In processes involving the anterior corticospinal tract the F-wave is depressed down to its complete disappearance, i.e. the motoneurons lose their capacity to respond to antidromic stimulation.
[Classification of the light reflexes of the fundus oculi].
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[Neuro-ophthalmological signs in coma. II. Palpebral and pupillary functions].
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[Reflex-motor asymmetries in clinical neurology (mechanisms, differentiation, and clinical evaluation)].
The neurological status of almost 7,000 patients aged 18 to 20 years, as well as of normal subjects under the conditions of long-time stay in bed was examined. In a considerable number of observations, reflector motor asymmetries pointing to prevailing insufficiently of the left hemisphere were revealed. A classification of the asymmetries is suggested and cliniconeurological characteristics of the variants of genital and acquired asymmetries are presented. Criteria for differentiating residual and actual, functional, morphological, and mixed asymmetries are offered, and the role of the reflector motor asymmetries in diagnosing diseases and evaluating the patients' working capacity is determined.
[Startle disease: growing rigid with fear].
Hyperekplexia or startle disease was diagnosed in four patients, a girl of 14 months, two men of 45 and 61 years old, and a woman of 56 years old. This is an autosomal dominant inherited disorder, characterized by excessive startle reactions, notably to auditory stimuli. The four patients belong to a Dutch family in which two forms of the disorder occur. The first one is the major form, in which the startle reaction is followed by a temporary generalized stiffening of the body. These patients experience continuous generalized stiffness from birth to about the second year of life. They fall down frequently. The other is the minor form, characterized by an excessive startle reaction only.