HYPOACTIVE REFLEXES
HYPOACTIVE REFLEXES: Excerpt from Algorithmic Diagnosis of Symptoms and Signs
Ask the Following Questions:
- Is it focal? Hypoactive reflexes limited to one extremity suggest a herniated disk, plexopathy, or early cauda equina or spinal cord tumor.
- If focal, are the hypoactive reflexes involving both the upper and lower extremity? If the hypoactive reflexes are in both the upper and lower extremity on one side, this may be a normal phenomenon suggesting that the opposite side is pathologic. It may also be a finding in early cerebral vascular accident.
- If the hypoactive reflexes are diffuse, was there a sudden onset? Sudden onset of hypoactive reflexes would suggest acute spinal cord conditions, such as spinal fractures, transverse myelitis, Guillain-Barré syndrome, or poliomyelitis, or acute central nervous system disorders, such as toxic metabolic disease of the central nervous system, concussion, subdural hematoma, or acute increased intercranial pressure. Early basilar artery thrombosis may be associated with hypoactive reflexes also.
- Are there other neurologic signs? The presence of other neurologic signs, particularly cranial nerve involvement, would suggest an early basilar artery thrombosis, cerebral vascular accident, or subdural hematoma. If there are no other neurologic findings or there is simply a disordered state of consciousness, then a head injury or toxic metabolic disease of the central nervous system, increased intercranial pressure, or poliomyelitis might be suspected.
DIAGNOSTIC WORKUP
Focal hypoactive reflexes of the lower extremity require plane x-rays of the lumbosacral spine, a CT scan or MRI of the lumbosacral spine, and nerve conduction velocity and EMG studies. Dermatomal SSEP studies will occasionally show radiculopathy when EMGs are negative.
Hypoactive reflexes of one upper extremity can be worked up with x-rays of the cervical spine, MRI of the cervical spine, nerve conduction velocity studies, EMGs, and dermatomal SSEP studies. X-rays of the chest may be useful to rule out a Pancoast's tumor.
Diffuse hypoactive reflexes associated with other neurologic signs or symptoms require a neuropathy workup
. A serum B
12
and folic acid and possibly a Schilling test may need to be done to rule out pernicious anemia. An EMG and muscle biopsy may be done to rule out muscular dystrophy. A spinal tap will be helpful in cases of poliomyelitis and Guillain-Barré syndrome. If the hypoactive reflexes are part of a toxic metabolic or inflammatory disease of the nervous system, the workup will be similar to that of coma.
Book Source Details
- Book Title: Algorithmic Diagnosis of Symptoms and Signs
- Author(s): R. Douglas Collins
- Year of Publication: 2003
- Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.
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HYPOACTIVE REFLEXES (Differential Diagnosis in Primary Care)
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