Medicowesome

Sunday, April 9, 2017

Toxic Ventral Horn Cell disease

Hey guys!

The only ventral horn cell disease famous in India is Polio which was successfully eradicated. During it's era, other diseases with similar clinical picture, such as Kugelberg-Welander syndrome, Cerebral palsy, Friedreich's Ataxia, Spina Bifida etc were rampantly misdiagnosed as Polio.
Hence after it's eradication the incidence of these rare disorders has increased!

The disease is also known as "Infantile paralysis" and this moniker can't be more inaccurate. The commonest manifestation of this disease is Aseptic meningitis presenting with headache, photophobia, etc. And only 1% cases develop into paralytic poliomyelitis. And another point is that adults are 15 times more likely to become paralysed and are more likely to die.

Sorry for going off topic above; couldn't help it. Fortunately there are no drugs that are known to cause ventral horn cell disease. But there is one chemical called- TriocP, full form is tri-ortho-cresyl phosphate. It is illicitly used as a component of country liquor especially in USA; and in Mediterranean countries it was used as an adulterant in cooking oil.

Another toxic cause is Tick paralysis. The ixodes tick secretes a toxin that can cause Ataxia, flaccid asending paralysis, bulbar palsy etc closely mimicking Guillian barre's syndrome.

That's all!

-VM

Saturday, April 8, 2017

Lasegue's Test

Hey guys here's another clinical sign!

Lasegue’s sign is another name for the modified straight leg maneuver used in the diagnosis of lumbosacral radiculopathy.

To perform the straight leg test, the clinician lifts the extended leg of a patient in a supine position. A positive response occurs when the pain pattern of the lumbar radiculopathy is reproduced. The test should be stopped when the pain is reproduced or maximum flexion is achieved.

But this sign is difficult to evaluate clinically especially for students. The reason being as simple as that it has been performed many a times before and patient already knows that he is going to suffer pain. So it was modified a bit by Lasague, he proposed that the leg should be raised while the knee is flexed by flexing the thigh at the hip joint. And then the knee is slowly extended until the patient complains of pain. In severe cases patient will complain of pain even during the flexion of hip.

More useful than the straight leg maneuver is the crossed straight leg test. This test has a lower sensitivity but a higher specificity. The crossed straight leg maneuver is performed by raising the unaffected leg in a similar manner to the straight leg test. The examiner looks for the reproduction of radicular pain with elevation of the opposite leg.

A supplement to this straight leg raising test is Braggard's test. First we have to start raising the leg of the patient while his knee is extended until he complains of pain and then dorsiflex his foot, if the pain worsens, it's a positive Braggard's test.

But as given in most books, these signs are not only positive in case of lower lumbar vertebral disc lesions but also in a no of other conditions. The differential diagnosis of a positive straight leg test includes:
1. disc protrusion with impingement of nerve roots below L4;
2. meningismus;
3. any intraspinal lesion such as tumor below L4;
4. malignant disease or
5. osteomyelitis of the ilium or upper femur;
6. ankylosing spondylitis;
7. fractured sacrum and more.

That's all!

-VM

Tinel's Test

Heyy guys!!

Tinel's sign is the sign that a nerve is irritated. Tinel's sign is positive when lightly banging or percussing over the nerve elicits a sensation of tingling, or 'pins and needles,' in the distribution of the nerve.

For example, in carpal tunnel syndrome, where the median nerve is compressed at the wrist, the test for Tinel's sign is often positive, eliciting tingling in the thumb, index, and middle fingers.

Procedure: First you have to hyperextend the wrist to get the median nerve in the carpal tunnel more juxtaposed to the flexor retinaculum. Then tap the skin over the flexor retinaculum midway between pisciform bone and hook of hamate and then observe the patient's response.

This test can also be useful in the diagnosis of Tarsal tunnel syndrome where the tibial nerve is entrapped.

Another test in Carpal tunnel syndrome is Phallen's test.

-VM