Diseases » Adie syndrome » Diagnosis

Diagnosis of Adie syndrome

Adie syndrome Diagnosis: Book Excerpts

• Ask the Following Questions - HYPOACTIVE REFLEXES
• Approach to the Diagnosis - HYPOACTIVE REFLEXES
• History and physical examination - Deep tendon reflexes, hypoactive
• History and physical examination - Deep tendon reflexes, hyperactive
• History and physical examination - Doll's eye sign, absent [Negative oculocephalic reflex]
• History and physical examination - Deep tendon reflexes, hypoactive
• History and physical examination - Deep tendon reflexes, hyperactive
• Differential Overview - Deep Tendon Reflex Abnormalities
• History - Deep tendon reflexes, hypoactive
• History - Deep tendon reflexes, hyperactive
• History and physical examination - Doll's eye sign, absent [Negative oculocephalic reflex]
• History and physical examination - Deep tendon reflexes, hypoactive
• History and physical examination - Deep tendon reflexes, hyperactive
• Approach to the Diagnosis - HYPOACTIVE REFLEXES

Diagnostic Tests for Adie syndrome: Online Medical Books

16 MEDICAL BOOKS ONLINE! Review excerpts from medical books online, free, without registration, for more information about diagnostis of Adie syndrome.

HYPOACTIVE REFLEXES: Ask the Following Questions:
(Algorithmic Diagnosis of Symptoms and Signs)

1. Is it focal? Hypoactive reflexes limited to one extremity suggest a herniated disk, plexopathy, or early cauda equina or spinal cord tumor.
2. 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.
3. 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.
4. 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.

» READ BOOK EXCERPT ONLINE »

Source: Algorithmic Diagnosis of Symptoms and Signs, 2003

HYPOACTIVE REFLEXES: Approach to the Diagnosis
(Differential Diagnosis in Primary Care)

The differential diagnosis will depend on the presence or absence of other signs. If there is an acute onset of diffuse hypoactive reflexes and weakness, poliomyelitis Guillain–Barré syndrome, toxic peripheral neuropathy, and polymyositis must be considered in the differential. A gradual onset of diffuse weakness and hypoactive reflexes is more consistent with muscular atrophy, tabes dorsalis, pernicious anemia and muscular dystrophy. Abnormal sensory findings would point to pernicious anemia, tabes dorsalis and peripheral neuropathy while the absence of abnormal sensory findings would suggest muscular atrophy, muscular dystrophy or myasthenia gravis. Focal loss of reflexes suggests a herniated disc especially if there is associated radicular pain. Focal hypoactive reflexes of the lower extremities require plain films of the lumbosacral spine, EMG and NCV studies, and an MRI or CT scan of the lumbar spine. Isolated hypoactive reflexes in the upper extremity require an x-ray of the cervical spine, MRI of the cervical spine, and NCV and EMG of the upper extremities. Diffuse hypoactive reflexes merit an extensive laboratory workup including a CBC, urinalysis, chemistry panel, serum B12 and folic acid, ANA, glucose tolerance test, blood lead level, urine for porphobilinogen, HIV antibody titer, and serum protein electrophoresis. A spinal tap should be done if Guillain–Barré syndrome is suspected. An EMG and NCV study should also be done if peripheral neuropathy or muscular dystrophy is suspected. A muscle biopsy may be needed in muscular dystrophy and dermatomyositis.

» READ BOOK EXCERPT ONLINE »

Source: Differential Diagnosis in Primary Care, 2007

Deep tendon reflexes, hypoactive: History and physical examination
(Handbook of Signs & Symptoms (Third Edition))

After eliciting hypoactive DTRs, obtain a thorough history from the patient or a family member. Have him describe current signs and symptoms in detail. Then take a family and drug history.

Next, evaluate the patient's level of consciousness. Test motor function in his limbs, and palpate for muscle atrophy or increased mass. Test sensory function, including pain, touch, temperature, and vibration sense. Ask about paresthesia. To observe gait and coordination, have the patient take several steps. To check for Romberg's sign, ask him to stand with his feet together and his eyes closed. During conversation, evaluate speech. Check for signs of vision or hearing loss. Abrupt onset of hypoactive DTRs accompanied by muscle weakness may occur with life-threatening Guillain-Barré syndrome, botulism, or spinal cord lesions with spinal shock.

Look for autonomic nervous system effects by taking vital signs and monitoring for increased heart rate and blood pressure. Also, inspect the skin for pallor, dryness, flushing, or diaphoresis. Auscultate for hypoactive bowel sounds, and palpate for bladder distention. Ask about nausea, vomiting, constipation, and incontinence.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Signs & Symptoms (Third Edition), 2006

Deep tendon reflexes, hyperactive: History and physical examination
(Handbook of Signs & Symptoms (Third Edition))

After eliciting hyperactive DTRs, take the patient's history. Ask about spinal cord injury or other trauma and about prolonged exposure to cold, wind, or water. Could the patient be pregnant? A positive response to any of these questions requires prompt evaluation to rule out life-threatening autonomic hyperreflexia, tetanus, preeclampsia, or hypothermia. Ask about the onset and progression of associated signs and symptoms. Next, perform a neurologic examination. Evaluate the patient's level of consciousness, and test motor and sensory function in the limbs. Ask about paresthesia. Check for ataxia or tremors and for speech and visual deficits. Test for Chvostek's (an abnormal spasm of the facial muscles elicited by light taps on the facial nerve in a patient who has hypocalcemia) and Trousseau's (a carpal spasm induced by inflating a sphygmomanometer cuff on the upper arm to a pressure exceeding systolic blood pressure for 3 minutes in a patient who has hypocalcemia or hypomagnesemia) signs and for carpopedal spasm. Ask about vomiting or altered bladder habits. Make sure to take the patient's vital signs.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Signs & Symptoms (Third Edition), 2006

Doll's eye sign, absent [Negative oculocephalic reflex]: History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))

After detecting an absent doll’s eye sign, perform a neurologic examination. First, evaluate the patient’s level of consciousness (LOC), using the Glasgow Coma Scale. Note decerebrate or decorticate posture. Examine the pupils for size, equality, and response to light. Check for signs of increased ICP—increased systolic blood pressure, widening pulse pressure, and bradycardia.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

Deep tendon reflexes, hypoactive: History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))

After eliciting hypoactive DTRs, obtain a thorough history from the patient or a family member. Have him describe current signs and symptoms in detail. Then take a family and drug history.

Next, evaluate the patient’s level of consciousness. Test motor function in his limbs, and palpate for muscle atrophy or increased mass. Test sensory function, including pain, touch, temperature, and vibration sensation. Ask about paresthesia. To observe gait and coordination, have the patient take several steps. To check for Romberg’s sign, ask him to stand with his feet together and his eyes closed. During conversation, evaluate his speech. Check for signs of vision or hearing loss. Abrupt onset of hypoactive DTRs accompanied by muscle weakness may occur in life-threatening Guillain-Barré syndrome, botulism, or spinal cord lesions with spinal shock.

Look for autonomic nervous system effects by taking vital signs and monitoring for increased heart rate and blood pressure. Also, inspect the skin for pallor, dryness, flushing, or diaphoresis. Auscultate for hypoactive bowel sounds, and palpate for bladder distention. Ask about nausea, vomiting, constipation, and incontinence.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

Deep tendon reflexes, hyperactive: History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))

After eliciting hyperactive DTRs, take the patient’s history. Ask about spinal cord injury or other trauma and about prolonged exposure to cold, wind, or water. Could the patient be pregnant? A positive response to any of these questions requires prompt evaluation to rule out life-threatening autonomic hyperreflexia, tetanus, preeclampsia, or hypothermia. Ask about the onset and progression of associated signs and symptoms. Next, perform a neurologic examination. Evaluate level of consciousness, and test motor and sensory function in the limbs. Ask about paresthesia. Check for ataxia or tremors and for speech and visual deficits. Test for Chvostek’s sign (an abnormal spasm of the facial muscles elicited by light taps on the facial nerve in patients who have hypocalcemia) and Trousseau’s sign (a carpal spasm induced by inflating a sphygmomanometer cuff on the upper arm to a pressure exceeding systolic blood pressure for 3 minutes in patients who have hypocalcemia or hypomagnesemia) and for carpopedal spasm. Ask about vomiting or altered urination habits. Be sure to take vital signs.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

Deep Tendon Reflex Abnormalities: Differential Overview
(Field Guide to Bedside Diagnosis)

Hyporeflexia

❑ Nerve root compression

❑ Hypothyroidism

❑ Acute stroke

❑ Diabetes

❑ Alcoholism

❑ Vitamin B₁₂ deficiency

❑ Uremia

❑ Myopathy

❑ Occult cancer

❑ Toxins

❑ Guillain-Barré syndrome

❑ Amyloidosis

❑ Spinal shock

❑ Adie syndrome

❑ Botulism

❑ Charcot-Marie-Tooth

Hyperreflexia

❑ Cervical spondylosis

❑ Spinal cord compression

❑ Multiple small strokes

❑ Multiple sclerosis

❑ Metabolic encephalopathy

❑ Amyotrophic lateral sclerosis

Diagnostic Approach

Symmetrically hyperactive or hypoactive reflexes in the presence of downgoing toes are usually normal. A positive Babinski sign (upgoing toe) is always abnormal, signifying an upper motor neuron lesion, and is usually associated with spastic weakness and hyperreflexia. Lower motor neuron lesions are marked by hyporeflexia, flaccid weakness, atrophy, and twitching.

» READ BOOK EXCERPT ONLINE »

Source: Field Guide to Bedside Diagnosis, 2007

Deep tendon reflexes, hypoactive: History
(Signs & Symptoms: A 2-in-1 Reference for Nurses)

After eliciting hypoactive DTRs, obtain a thorough history from the patient or a family member. Have him describe current signs and symptoms in detail. Then take a family and drug history.

» READ BOOK EXCERPT ONLINE »

Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007

Deep tendon reflexes, hyperactive: History
(Signs & Symptoms: A 2-in-1 Reference for Nurses)

After eliciting hyperactive DTRs, take the patient’s history. Ask about spinal cord injury or other trauma and about prolonged exposure to cold, wind, or water. Also find out if the patient could be pregnant. A positive response to any of these questions requires prompt evaluation to rule out life-threatening autonomic hyperreflexia, tetanus, preeclampsia, and hypothermia. Ask about the onset and progression of associated signs and symptoms. Also ask about paresthesia, vomiting, and altered bladder habits.

» READ BOOK EXCERPT ONLINE »

Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007

Doll's eye sign, absent [Negative oculocephalic reflex]: History and physical examination
(Nursing: Interpreting Signs and Symptoms)

After detecting an absent doll's eye sign, perform a neurologic examination. First, evaluate the patient's level of consciousness, using the Glasgow Coma Scale. Note decerebrate or decorticate posture. Examine the pupils for size, equality, and response to light. Check for signs of increased ICP—increased blood pressure, increasing pulse pressure, and bradycardia.

» READ BOOK EXCERPT ONLINE »

Source: Nursing: Interpreting Signs and Symptoms, 2007

Deep tendon reflexes, hypoactive: History and physical examination
(Nursing: Interpreting Signs and Symptoms)

After eliciting hypoactive DTRs, obtain a thorough history from the patient or a family member. Have him describe current signs and symptoms in detail. Then take a family and drug history.

Next, evaluate the patient's level of consciousness. Test motor function in his limbs, and palpate for muscle atrophy or increased mass. Test sensory function, including pain, touch, temperature, and vibration sense. Ask about paresthesia. To observe gait and coordination, have the patient take several steps. To check for Romberg's sign, ask him to stand with his feet together and his eyes closed. During conversation, evaluate speech. Check for signs of vision or hearing loss. Abrupt onset of hypoactive DTRs accompanied by muscle weakness may occur with life-threatening Guillain-Barré syndrome, botulism, or spinal cord lesions with spinal shock.

Look for autonomic nervous system effects by taking vital signs and monitoring for increased heart rate and blood pressure. Also, inspect the skin for pallor, dryness, flushing, or diaphoresis. Auscultate for hypoactive bowel sounds, and palpate for bladder distention. Ask about nausea, vomiting, constipation, and incontinence.

» READ BOOK EXCERPT ONLINE »

Source: Nursing: Interpreting Signs and Symptoms, 2007

Deep tendon reflexes, hyperactive: History and physical examination
(Nursing: Interpreting Signs and Symptoms)

After eliciting hyperactive DTRs, take the patient's history. Ask about spinal cord injury or other trauma and about prolonged exposure to cold, wind, or water. Could the patient be pregnant? A positive response to any of these questions requires prompt evaluation to rule out life-threatening autonomic hyperreflexia, tetanus, preeclampsia, or hypothermia. Ask about the onset and progression of associated signs and symptoms. Next, perform a neurologic examination. Evaluate the patient's level of consciousness, and test motor and sensory function in the limbs. Ask about paresthesia. Check for ataxia or tremors and for speech and visual deficits. Test for Chvostek's (an abnormal spasm of the facial muscles elicited by light taps on the facial nerve in a patient who has hypocalcemia) and Trousseau's (a carpal spasm induced by inflating a sphygmomanometer cuff on the upper arm to a pressure exceeding systolic blood pressure for 3 minutes in a patient who has hypocalcemia or hypomagnesemia) signs and for carpopedal spasm. Ask about vomiting or altered bladder habits. Be sure to take the patient's vital signs.

» READ BOOK EXCERPT ONLINE »

Source: Nursing: Interpreting Signs and Symptoms, 2007

HYPOACTIVE REFLEXES: Approach to the Diagnosis
(Differential Diagnosis in Primary Care)

The differential diagnosis will depend on the presence or absence of other signs. If there is an acute onset of diffuse hypoactive reflexes and weakness, poliomyelitis Guillain–Barré syndrome, toxic peripheral neuropathy, and polymyositis must be considered in the differential. A gradual onset of diffuse weakness and hypoactive reflexes is more consistent with muscular atrophy, tabes dorsalis, pernicious anemia, and muscular dystrophy. Abnormal sensory findings would point to pernicious anemia, tabes dorsalis, and peripheral neuropathy whereas the absence of abnormal sensory findings would suggest muscular atrophy, muscular dystrophy, or myasthenia gravis. Focal loss of reflexes suggests a herniated disc, especially if there is associated radicular pain. Focal hypoactive reflexes of the lower extremities require plain films of the lumbosacral spine, EMG and NCV studies, and an MRI or CT scan of the lumbar spine. Isolated hypoactive reflexes in the upper extremities require an x-ray of the cervical spine, MRI of the cervical spine, and NCV and EMG of the upper extremities. Diffuse hypoactive reflexes merit an extensive laboratory workup including a CBC, urinalysis, chemistry panel, serum B₁₂ and folic acid, ANA, glucose tolerance test, blood lead level, urine for porphobilinogen, human immunodeficiency virus (HIV) antibody titer, and serum protein electrophoresis. A spinal tap should be done if Guillain–Barré syndrome is suspected. An EMG and NCV study should also be done if peripheral neuropathy or muscular dystrophy is suspected. A muscle biopsy may be needed in muscular dystrophy and dermatomyositis.

» READ BOOK EXCERPT ONLINE »

Source: Differential Diagnosis in Primary Care, 2007

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