Hyperreflexia, Clonus and a Positive Hoffman's Sign
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- Опубликовано: 20 июн 2024
- In this video I talk about recognizing an upper motor neuron lesion while doing your clinical evaluation. This lady has hyperreflexia, clonus and a Positive Hoffman's sign. She is also presenting with leg weakness and incoordination. For more videos like this one, check out this playlist: • Hoffman's test and neu...
Thank you so much Carmen for letting your provider share your exam. Its such a great learning tool to see these presented in patients! You are a rockstar=)
Thank you for the video and to Carmen who allowed us, learners, to learn from her.
So kind to let us see this. Very useful now that I'm learning basic semiology. Thank you sooo muucch!!
Glad it is helping Martha! More to come. Spread the word.
@@OrthoEvalPalCheck this patient for Ehlers Danlos Syndrome. Babinski and Hoffman's sign are common with Cranio cervical instability due to Ehlers Danlos syndrome.
Wish all docs were as cool as this guy
This scares me because I have a lot of these signs. I've seen countless doctors including neurologists, surgeons, pain management, physical medicine and none of these providers have offered ways to improve my condition of frequent pain and lack of mobility. I was told I had MS and given injections for 10 years, but then told maybe not in 2017 and I stopped meds without changes on MRI's. I have been diagnosed and followed by annual MRI's which show cervical spinal cord compression due to herniated disks and lordosis of cervical spine. After years of being afraid of chiropractic care, I am now desperately seeking help to avoid worsening of my condition and mobility. My new chiropractor is apparently an expert in this problem, and has expertise in treatment and rehabilitation. Wish me luck!
Omg that clonus, well presented
Thanks. This lady is doing much better. She was diagnosed with hyperthyroidism.
Marquis, you are the man! Thank you for sharing these valuable tidbits and giving back to humanity.
OT student here! THIS VIDEO IS SO HELPFUL. Thank you!
Please thank your patient for allowing this video! It was a great example of clonus!
Will do Liberty! She was actually diagnosed with hypothyroidism. New meds helped significantly.
That's great! So glad to hear it wasn't serious!
Very informative. Exactly what I was looking for to help clarify what I was studying. Thank you
Glad to hear it was helpful. That's why I do it. This lady was later diagnosed with Hyperthyroidism. She is doing great now!
Thank you so much Carmen
As I recover from serotonin syndrome, it is interesting to see these examples of hyperreflexia and clonus. Thank you.
Serotonin syndrome? Oh dang. Which medications were you on? Was it necessary at the time for you to have been on all of them or was it overlooked?
Wait, I never heard of that! It makes perfect sense! Oh, God, themeds keeping me sane caused these fits and convulsions and focal seizures? Seriously?!
Thank you 🙏🏽 this is very helpful 👏🏼
He's more thorough than my neurologist
Thank you, Carmen for allowing this to be shown. I am a physician who does not see these signs very often, and this helps me to keep my skills current.
Glad it was helpful!
Thank you soo much! Very helpful!
This was really helpful. Thanks :)
Great job, Thanks
very well presented. hope you and the patient are in good health! this helped with my finals prep :)
Glad it was helpful Fatima!
I have no idea what my teacher was teaching, but it all gets clear in this video! Thank you!
Thank you, sir!
Very welcome!
Thanks doctor
I would probably get another MRI of the neck and spine if I were her. You don't want to miss any potential lesions, signs of MS or spinal cord injuries. Thanks for the awesome video.
she had hyperthyroidism. Did great with new meds. We had done all of the diagnositic testing. Thanks for the comment Anjuna!
Neck MRI ? Would CT scan be that ?
Nope CT is like a bunch of x-ray taken in a row like stop motion, where as MRI uses magnetic resonance and can allow you to see soft tissue pathology like in the brain or spinal cord much better than CT can!@@erickalvarado7676
@@OrthoEvalPal Thank you so much for this video! I have very similar symptoms and was recently diagnosed with elevated cortisol and hyperthyroid. I'm scheduled for an MRI but would rather wait and see how thyroid supplementation helps with my symptoms. Can you tell me how long it was before she started noticing an improvement with symptoms?? Are you able to share what type of meds helped her?
tx for sharing
doc
I really appreciate this video! It’s helpful to see positive signs on an exam. I’m very curious on any follow up on this patient.
Also, I am very curious what made this such an unusual presentation?
I know this video is older so I’m especially appreciative of any feedback.
I was diagnosed with Pott's Disease and underwent surgery. I remember my doctors do this to me and up until now i still have reactive reflexes like this. It is scaring me.
Thank you for sharing. Are there other ways to look for this? My neuro exam says I had none present, but my doc didn't do this test.
Hi, question.... Do you know if her labs prior to seeing you or a neurologist were normal? Did they not show elevated thyroid hormone? Or were they borderline high and the objective signs helped to clarify? I'm asking because I find it odd that any md would not have done standard blood work prior to her geeing that bad.
Hi Al, After I saw her, we recommended a full workup to discover she had hyperthyroidism. Good Question!
@@OrthoEvalPal same symptoms after spinal cord surgery lost a ton of weight, down to 100lbs but had developed severe hypothyroidism. Got to be the medications or all the radiation from procedures necessary for surgeries, that's what I'm betting on. We are being bombarded by poisons daily and a lot of times have a lot of unnecessary procedures, trying to find the one really necessary procedure if that makes any sense.
Would you run the same tests with myoclonic jerks, with the clonis, and voluntary movement? Is there a certain dr that a person should see? She is lucky to have such an insightful and talented dr such as yourself. Best Regards!
Thank you but I am not a Dr. Been a PT for over 28 yrs. These folks should see a neurologist and/or a physiatrist. To answer your question, Yes. Doesn't take long to do
My father had a stroke 3 years ago and he is showing signs of clonus
My legs do that. And they bounce all over the place. I used to wonder about why when I was younger. Now I know it is Multiple Sclerosis
Yes Jessica, you can see this with MS. Head up and push forward. Best, Paul
Hi doc
I saw in the comments she was diagnosed with hyperthyroidism.
Would that not of showed up in previous blood tests?
Or is there a specific test for that?
Thanks
I noticed when you checked C7 on the right, her RLE was triggered. What could be the causation?
how the stimulus and stretch occur in one side and the clonus occur in the opposite side ??🤔
Did she have any saddle numbness, I have the same symptoms along with some clavicle swelling but no diagnosis yet, I've had 2 brain MRIs that were unremarkable and 2 full Spine MRIs, I have bulging discs at L4-S1, T11-12, and T7-9 the MRIs don't show any stenosis tho
You need to get checked for syringomyelia and/or chiari malformation. Both these conditions have these symptoms.
If that is hyperreflexia then how do we know if it is normal reflexia
I think most likely Syringomyelia, usually has a knock on affect with hormones and other body processes. It affects almost every system, particularly if it's a syrinx sitting in the upper cervical area. Hyperreflexia typical presentation, many patients have cardiac, airway, thyroid, gastrointestinal, bladder/bowel, mobility issues with this condition.
She had hyperthyroidism. Meds corrected it
I had Grave's Disease. Later on developed papillary thyroid cancer but it was minor.
So glad she had a treatable disease. I was really worried for her.😯
Have all these issues (hyperreflexia, ankle clonus, bilateral Hoffman's sign), thyroid is fine and nothing is pinched in my spine...all the shmptoms outside of this point to MS but the MRIs keep coming back clear. Im convinced the lesions are too small to be seen, but we wont know until i get a spinal tap. Wish it could just be a simple solution like her!
I have similar issues of MRI not showing anything. It is great! But at the same time very frustrating. Now they say that my whole left side weakness (a line drawn with a ruler in the middle of my face/body) is caused by a narrowing in nerve pathways in my neck. I have positive Hoffman sign on both sides too and that would be consistant with neck injury.
However, I suffer from severe heat sensitivity, fatigue and wide range of other symptoms and they do not agree with neck injury (which I have no other explanation than maybe holding it in the wrong position in the work for 5 years).
It is frustrating in this limboland of not having any diagnosis.
Same here. I did have a syrinx years ago that hasn't been mentioned since. My current (and 3rd neuro) says I present as someone who still has a syrinx and will be getting an updated MRI from the place I went to years ago. He just said I have hyperreflexia and positive Hoffman. Apparently, syringomyelia presents very similarly to MS though. I've been dealing with all this since at least 2015 and still have no real answers. It is truly frustrating but hopefully, we all get answers soon.
What caused her drastic weight loss?
Any answers for this woman's diagnosis? Interesting as well that a patellar reflex is incited at 1:23 with assessment of the upper limb.
Hi Natasha, This lady had hyperthyroidism! Meds took care of most all of these symptoms. She is doing very well.
1:22 right leg also responds.
Plz let me know clonus is bad sign or good ?
Hi Nikul, Clonus is not good. Ususally a sign of a upper motor neuron problem
Did she ever get a diagnosis?
still waiting. Thanks for asking.
Any update on this diagnosis?
Yess!! Just found out she had a severe case of hyperthyroidism. Doing much better on meds. Thanks for asking.
Ortho EVAL Pal With Paul Marquis Did you also suspect of als?
She had a patellar reflex when testing the biceps reflex
Knowing that this lady was later diagnosed with hyperthiroidism is surprising. How can such a disease cause so many ms-like symptoms?
IKR! I thought the same thing when I first saw her
There's a hypereflexia presents on the R quad concurrent with triceps reflex test-very unusual and concerning
I also noticed, any specific name for it
WHAT IS THE DIAGNOSIS?
She has yet to see the Neurologist. I will post once I find out.
she don`t have the diagnosis yet?
Hyperthyroidism
Hm possible Multiple Sclerosis?
Why do my knees do this. I’m only 22
Hi Tori, If your knees do this you should ask your Dr. to evaluate you.
Don't freak out it can be as something as simple as anxiety. I have twitching and brisk reflexes going on 2 years that is attributable to general anxiety. Get checked and trust your doctor
Angela Adkins I do have anxiety so maybe that’s it!
MS
Actually, Hyperthyroidism! Doing much better with medication
She defenetly have ALS because of upper motor neuron symptoms and mild hand atrophy seen on video...
She actually had Hyperthyroidism. Once treated, this all went away.
Ortho EVAL Pal With Paul Marquis oh wow, I have Graves too. 31 years old. In remission now. I had no idea it could cause all this tho. I thought only things like ALS could
@@OrthoEvalPal One note: Hoffman's is positive if the thumb flexes (and at least one other finger), that is called the true Hoffman's sign. Without the thumb, some call it incomplete or just negative. Flexion of the index finger can be elicited in most people, some studies indicated as much as 30% (which I find a bit too high). However, my point is that such an incomplete sign is of no clinical value, as stated by various sources.
In Encyclopedia of the Neurological Sciences, see page 603, it is available on Google Books too.
@@MrBliznicka He did say that it was very clear earlier when she was relaxed
At 1:22 watch her right leg.
This was caused by hyperthyroidism