Academic literature on the topic 'Patellar tendon reflex'

Abstract Amuscle Stretch Reflex (aka myotatic reflex or deep tendon reflex) is a simple circuit that requires the following: muscle spindle cells, large sensory afferent fibers, spinal cord interneurons, motor neurons, motor efferent fibers, and a paired agonist–antagonist muscle group. In this chapter,we will use the patellar reflex (aka knee extensor reflex) as a prototypical muscle stretch reflex to learn about spinal reflexes. The common muscle stretch reflexes we test are at the biceps (C5, C6), triceps (C7, C8), patella (L3, L4), and achilles (S1). Also, in this chapter, we will discuss the related anatomy of muscle tone.

A 33-year-old woman with systemic lupus erythematosus, diagnosed 2 years prior and treated with hydroxychloroquine, sought care for a 4-week history of pain and paresthesias in her low back and lower extremities. She described a bandlike sensation of numbness starting in her midback which descended to both legs. Her symptoms progressed to constipation and inability to urinate adequately. She reported difficulty with ambulation. Over the course of 1 week of hospitalization, urinary and fecal incontinence developed. On examination, she was alert and appropriately oriented. She had a malar rash and swelling of the metacarpophalangeal joints consistent with bilateral hand synovitis. Neurologic examination indicated hyperreflexia with brisk patellar and Achilles tendon reflexes bilaterally. She had trace motor weakness of the hip flexors, quadriceps, and hamstrings. She had loss of pinprick and temperature sensation in the lower extremities, extending beyond the saddle area to the T12 dermatome. Vibration perception and proprioception were preserved. She had a positive Babinski sign in the left foot. Her cerebellar examination showed slowing of rapid alternating movements in the left hand. Magnetic resonance imaging of the lumbosacral spine indicated subtle T2 signal change of the intramedullary conus and enhancement of the cauda equina nerve roots. Cerebrospinal fluid analysis showed an increased protein concentration. Two white blood cells/µL were found in the cerebrospinal fluid. The serum antinuclear antibody was strongly positive, and the anti–double-stranded DNA antibody level was greater than 1,000 IU/mL. The serum complement levels were low. Lupus anticoagulant, beta-2 glycoprotein antibodies, and antiphospholipid antibodies were increased, at greater than twice the upper limits of normal. Electromyography indicated multiple sacral radiculopathies. The patient was diagnosed with autoimmune myeloradiculitis as a neuropsychiatric manifestation of systemic lupus erythematosus (neuropsychiatric systemic lupus erythematosus). The patient received methylprednisolone followed by prednisone, with a gradual taper. Her hospital course was complicated by the development of deep venous thromboses in the bilateral lower extremities. She was started on heparin and transitioned to warfarin therapy. She started mycophenolate mofetil. Hydroxychloroquine was continued. At a 24-month follow-up visit, the patient remained in neurologic remission. Neuropsychiatric systemic lupus erythematosus events consist of a heterogeneous array of neurologic and psychiatric disorders including intractable headaches, cognitive dysfunction, psychosis, seizure disorders, transverse myelitis, aseptic meningitis, cranial neuropathies, and acute inflammatory demyelinating polyneuropathy.

Context: areflexia and hyporeflexia are mandatory clinical criteria for the diagnosis of Guillain-Barré Syndrome (GBS). However there are case reports in literature of GBS that exhibit hyperreflexia. Case report: Male patient, 38 years old, after weakness and pain in lower limbs, after exercise, for 4 days, without alteration of balance and sphincter. A week earlier, he had diarrhea and fever. Previous bariatric surgery. On examination: For both upper limbs, the grade of power was 5/5 in the proximal muscle group and 4/5 in the distal muscle group. For the lower limbs, the grade of power was 4

Context: The Spinal Muscular Atrophy (SMA) is a genetic disease responsible for degeneration of the motor neurons of the spinal cord and the motor nucleus of the cranial nerves. Case report: Male patient, 32 years old, 6 years ago presented proximal weakness in lower limbs and distal weakness in upper limbs with progressive worsening and episodes of dyspnea on physical exercise, without dysphagia and dysarthria. The lower limbs showed grade of power of 3/5 in the proximal muscle group and 4/5 in the distal muscle group. On the upper limbs the grade of power was 4/5 in both proximal and distal

Introduction: Miller-Fisher syndrome (MFS) is recognized as a variant of Guillain-Barré syndrome, composed of the clinical triad of ataxia, areflexia and ophtalmoplegia. The association between MFS and pregnancy/postpartum has been described in few cases previously. Case presentation: Woman, 28-year-old, nine days after normal partum present paresthesia and weakness in arms, a day later presenting with abnormal gate and diplopia. No recent infections or vaccination was described. The examination showed gait ataxia, right sixty nerve palsy, muscle strength in legs MRC grade 4 and hypotonia. The