Unusual Case of Head Injury Presented with Brain Gliomas

Seven years female child came with parents who gave us history that 1month back, child during playing had fall on face and lost consciousness which remained for 30 min followed by convulsion. On examination patient was conscious, responds to command, vitals were stable, aphasia was present, pupils were equal and reactive to light bilaterally and horizontal gaze was restricted. There was no facial weakness, Tone increase more in left upper and lower limb .Deep tendon reflexes (DTR) increase in left side. Plantar reflex were extensors. MRI was done which shows intra axial space occupying lesion in brainstem with expansion of brainstem with hydrocephalus. Pt was inoperable and ventriculoperitoneal shunt was done for hydrocephalus. Post operatively patient was kept on assisted ventilation. Conclusion: Unusual presentation of brainstem gliomas as head injury.

The essential neurological examination in telemedicine consultations in the context of COVID 19/ O exame neurológico essencial nas consultas de telemedicina no contexto da COVID 19

Introduction: In clinical evaluation, the neurological area is one of the most complex and extensive to be analyzed, besides that, when added with Neurophobia it becomes even more difficult. With the COVID-19 Pandemic, there was an accelerated process of migration from outpatient clinics to digital platforms, requiring doctors to update their way of examining patients. The essential neurological examination, the tool that collaborates in this updated assessment, demonstrates greater objectivity in confirming the normality of the neurological system. The practice of checklists is a tool that helps these doctors to better evaluate their patients, optimizing their time and exams, contributing to its clinical diagnosis. Methodology: Review study integrative process that culminated in the elaboration and adaptation of new measures for essential neurological therapy in patients in the context of COVID-19 through Telemedicine. Results and Discussion: When comparing the essential neurological exam with the knowledge experienced by the authors of this article and the global pandemic context, were recommendations on the application of telemedicine were made. In addition to the need for doctor-patient communication to be audible and visible, without external interference so as not to impair the exams, the participation of a patient's companion is important to assist the doctor in exams. With that done, we identified that some of the exams essential neurological conditions become difficult to perform digitally, being: Indirect fundoscopy and reflexes (Biceps, Brachioradialis, Triceps, Patellar, Aquileu). However, exams such as direct fundoscopy, pupillary reflex, eye chase, mimic facial, gait, and plantar reflex can be examined via digital platforms as long as always the patient is accompanied. Conclusion: It is concluded that, amid pandemic, essential neurological examination becomes outdated, but useful in several areas, helping the doctor to take more informed measures.

Assessment of Different Technique of Eliciting the Planter Reflex in Term Neonates

Background: Planter reflex is still an essential part of the neurological examination. The usual plantar reflex involved bending of the big toe or no response. There is a positive Babinski signal with corticospinal dysfunction, which involves big toe dorsal flexion and the accompanying fanning of the other toes. It’s one of the infant reflexes that disappers as the infant nervous system grows. The plantar reaction is primarily extensive in stable, term neonates. Many have researched this reflex's accuracy but very few studies have analyzed the various techniques of the planting reflex. Objective: To assess the five different technique of eliciting the plantar reflex in newborn babies. Materials and Methods: In this cross-sectional study, the eligible healthy newborn will be given the different methods for the elicitation of the plantar reflex i.e. Oppenheim sign, Gordon sign, Gonda’s sign, Chaddock sign, and Schaefer sign. During this procedure, we will record the baseline RR, HR, and SpO2 before, and after the procedure. Three pediatric residents of the different years will be selected for examining the newborn reflexes throughout the study period. Results: After completion of the study, we will come to know the negative likelihood ratio, negative predictive value, positive predictive, specificity, positive likelihood ratio, and sensitivity of the Oppenheim sign, Gordon sign, Gonda’s sign, Chaddock sign, and Schaefer sign. Conclusion: The study will probably give us information about the sensitivity and specificity of the Oppenheim sign, Gordon sign, Gonda’s sign, Chaddock sign, and Schaefer sign for the elicitation of the plantar reflex in the neonates.

A New Method of Eliciting Pyramidal Tract Impairment in Adults

Background: To suggest a new way of eliciting pyramidal tract dysfunction in adults since the most widely utilized plantar reflex, which is the Babinski reflex, has limitations with different reliability and consistency among different examiners.    Materials and methods: 168 adult subjects were examined for the new sign in addition. It consists of just an observation of the patient’s feet and toes in a conscious patient looking for the extension of the great toe along with fanning, spreading and plantar flexion of the small toes either at rest or when patient elevates one leg up at a time.   Results: We were able to observe the extension of the great toe along with fanning, spreading and plantar flexion of the small toes in patients with impairment of pyramidal tract. The specificity was 94% while the sensitivity was 96%.   Conclusion: Pyramidal tract lesion in adults can be elicited by this new test that observes the extension of the great toe along with fanning, spreading and plantar flexion of the small toes in patients. We suggest this sign as a complement to established signs like Babinski reflex.

The Crossed Flexor Plantar Response in Patients with Klippel-Feil Syndrome

The plantar reflex is one of most important and widely tested components of the neurological examination. We describe 3 subjects with Klippel-Feil syndrome and mirror movements where unilateral cutaneous stimulation of the foot leads to flexor plantar responses in both feet. We discuss the evidence which suggests that this “crossed flexor” plantar response reveals a transcortical pathway for the flexor plantar response.

Posterior reversible leukoencephalopathy syndrome (PRES) as a complication of ozone injections for chronic pain

A 57-year-old female presented with encephalopathy, focal neurological findings, and possible seizure immediately after receivingan intramuscular injection of liquefied ozone to the posterior skull base. Ozone injections were being used to treat chronic neckpain and headaches. On presentation the patient was found to have a Glasgow Coma Scale score of 6. Her blood pressure washigh at 220/93 and she had a temperature of 39.5℃. Neurological exam revealed increased muscle tone in the left leg as well asan extension plantar reflex. Lab work, including lumbar puncture results, were unremarkable. Magnetic resonance imaging (MRI) showed findings consistent with Posterior Reversible Leukoencephalopathy Syndrome (PRES). The patient’s hypertension wastreated and she significantly recovered after five days. Follow up MRI three weeks later showed interval resolution of the previousfindings, and the patient had complete return to functional baseline thereby making the diagnosis of PRES most likely. No othercases of ozone induced PRES have been reported in the literature.