Following surgery, the patient's anterior fontanelle is concave and the head circumference shows a progressive decrease over time. The patient’s dehydration is treated and a ventriculoperitoneal shunt procedure is performed by a neurosurgeon. Imaging studies demonstrate hydrocephalus and aqueductal stenosis. Her grasp and glabellar reflexes are present. Her startle response is minimally present. Her lower extremities show increased muscle tone with brisk reflexes bilaterally.
#Brisk reflexes full#
Her upper extremities show good muscle tone and full range of motion with slightly brisk reflexes. Her spine is straight without protrusions or apparent defects. Her heart examination reveals tachycardia with a regular rhythm without murmur. Lung fields are clear to auscultation bilaterally. There is mild tachypnea with slight intercostal retractions. Extraocular movements (EOM) are clearly dysconjugate. Eyes show pupils which are equal and round, but are sluggishly reactive to light. Her scalp veins are prominent, and the anterior fontanelle is tense and bulging. Her head large and oddly shaped (like an inverted pear). In general, this is a lethargic infant with a weak, high-pitched cry. Weight 4.20 kg (5th percentile), length 57 cm (10th to 25th percentile), HC 42.6 cm (95th percentile). The infant weighed 2900 grams at birth (25th percentile), measured 47.8 cm in length (10th to 25th percentile), and had a head circumference of 34 cm (25th percentile).Įxam: VS: T 36.5 C, P 165, R 45, BP 98/65. There was poor prenatal care, but the labor and delivery were unremarkable.
From the previous medical records, it is confirmed that the infant was born at term. The infant was released after a 48 hour stay in the regular newborn nursery, and had follow-up initially with her pediatrician about one week after discharge. She reports that the infant was born on time and that there were no prenatal or perinatal complications. She has had fewer wet diapers and no bowel movements today. She thinks that the infant has felt warm, but she has not measured the temperature with a thermometer. Her mother is concerned because she thinks her infant's head has grown, and the fontanelle appears to be bulging. She has been less interactive, and her cry has become more high-pitched and weak. Her mother reports that she has been increasingly irritable in the last week and does not appear to be herself.
#Brisk reflexes update#
This current third edition chapter is a revision and update of the original authors’ work.Ī 12 week old female infant presents to the emergency department with progressive vomiting, lethargy, and difficulty feeding over the past two days. Bouterie, and the 2014 second edition, Dr. Since that first neuro my reflexes have been tested normal three times (including today).Ĭan any of you provide any guidance? Do "pathological reflexes" get better? My knee reflexes were a little brisk today but that was her only finding and it was symmetrical and I was nervous.The editors and current author would like to thank and acknowledge the significant contribution of the previous authors of this chapter from the 2004 first edition, Dr. I do have some twitching and discomfort in my arm, but no weakness. She said my exam was normal, but she was concerned about my previous exam that found "clinical pathological reflexes" and wants to do an EMG and MRI, apparently looking for "myelopathic process." Now I'm actually concerned, and I asked her if she thought it was ALS and she said she does not think it's that based on my symptoms. I had myself worried about bulbar onset ALS (mild swallowing issues) and went to see a different neuro today. Of my own volition, I will admit I am a hypochondriac. He didn't seem too concerned, but ordered an MRI that my insurance denied. He found asymmetrical reflexes on the left (affected) side. (Aware these aren't ALS.) I was diagnosed at an ER with cervical radiculopathy, and I saw my neurologist a few weeks later. Symptoms started in December 2016 - tingling, pain, discomfort in arm.
First and foremost, I respect you all above all else and I hate to waste your time.
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