RESUMO
This study estimated the frequency and assessed the clinical value of nine primitive reflexes (PR) in 78 AIDS cases, comparing them with 81 matched, seronegative controls. All subjects were evaluated with a standardized neurologic examination that included a Mini-Mental State Exam (MMSE). Fifty-six percent had cognitive impairment and PR. Overall, PR were 2-36 times more frequent in cases. Such association was univariately stronger for the glabellar, snout, and Rossolimo signs. Ninety-two percent of cases had > or = 2 PR vs. 8% of controls, who had up to 2 PR (p < 0.0001; 95 CI: 68% to 100%). We were able isolate or show opportunistic pathogens in CSF of 4 out of 43 cases. This study supports the association of PR to cognitive decline in patients with AIDS. Larger, long term follow-up studies with multivariate analysis in Latin America are needed to identify the PR that can serve as reliable indicators of human immunodeficiency virus type 1 (HIV-1)-associated cognitive/motor complex.
Assuntos
Síndrome da Imunodeficiência Adquirida/fisiopatologia , Transtornos Cognitivos/etiologia , Reflexo/fisiologia , Síndrome da Imunodeficiência Adquirida/complicações , Adolescente , Adulto , Estudos de Casos e Controles , Transtornos Cognitivos/diagnóstico , Interpretação Estatística de Dados , Feminino , Soropositividade para HIV , Humanos , Masculino , Entrevista Psiquiátrica Padronizada , Exame Neurológico , Reflexo Anormal/fisiologia , Reflexo de Babinski/fisiologiaRESUMO
In 1896 Joseph Francois Felix Babinski described for the first time the phenomenon of the toes. In his first paper he simply described extension of all toes with noxious stimulation of the sole of the foot. It was not until 1898 that he specifically described the extension of the hallux with stimulation of the lateral border of the sole. Babinski was probably not aware at the time that E. Remak, a German physician, had previously described the sign. In his third paper of 1903 Babinski concludes that if other authors had described the abnormal reflex before him, they found it fortuitously and did not realize its semiologic value. Babinski probably discovered it by a combination of chance, careful observation and intuition. He also had in mind practical applications of the sign particularly in the differential diagnosis with hysteria and in medico-legal areas. Several of his observations and the physiopathological mechanism proposed by him are still valid today. He realized since 1896 that the Babinski reflex was part of the flexor reflex synergy. He observed that several patients during the first hours of an acute cerebral or spinal insult had absent extensor reflexes. He realized that most patients with the abnormal reflex had weakness of the toes and ankles. He found a lack of correlation between hyperactive myotatic reflexes and the presence of an upgoing hallux. He discovered that not all patients with hemiplegia or paraplegia had the sign. He thought erroneously that some normal subjects could have an upgoing toe. His dream of a practical application of the sign has been fully achieved. The motto of Babinski was Observatio summa lex. Perhaps there is no better dictum in clinical neurology.
Assuntos
Neurologia/história , Reflexo de Babinski , Adulto , Transtornos Cerebrovasculares/fisiopatologia , Medicina Legal/história , História do Século XIX , História do Século XX , Humanos , Recém-Nascido , Neurônios Motores/fisiologia , Doenças do Sistema Nervoso/fisiopatologia , Tratos Piramidais/fisiopatologia , Reflexo de Babinski/fisiologia , Doenças da Medula Espinal/fisiopatologiaRESUMO
Las lesiones de la Médula Espinal pueden ser debidas a compresión (tumores, fracturas desplazamientos de vértebras), contunsión rotación o estiramiento. Las secciones o hemisecciones modulares provocadas por heridas por arma de fuego y arma blanca, son raras, según la literatura (1,2,3) o por efectos de la onda expansiva del proyectil. Los patrones neurológicos de lesión incompleta de Médula Espinal Cervical, se manifiesta como: Síndrome central, Síndrome Anterior y Síndrome de Brown-Sequard. Debido a su baja incidencia se presenta a propósito de un caso clínico el Síndrome de Brown-Sequard registrado en el Hospital Pérez de León secundario a herida por proyectil de arma de fuego a nivel cervical
Assuntos
Humanos , Masculino , Adulto , Laminectomia , Reflexo de Babinski/fisiologia , Síndrome de Brown-Séquard/patologiaRESUMO
El signo de Babinski es considerado el más importante de la neurología clínica. Sin embargo a pesar de que ya ha pasado casi un siglo desde su descripción original, desconocemos su verdadero valor diagnóstico. Estudiamos a 49 pacientes con evidencia de lesión de la vía piramidal y a 100 controles sanos. El signo de Babinski estuvo presente en 41/49 pacientes y en ninguno del grupo control; la sensibilidad fue de 84 por ciento y la especialidad del 100 por ciento, con un valor predictivo positivo casi perfecto (99 por ciento, negativo excelente (92 por ciento) y una eficacia global del 94.6 por ciento. La alta sensibilidad y especificidad del signo de Babinski permite al clínico afirmar que la vía piramidal está alterada cuando el signo está presente y confianza, para decir que la vía piramidal está sana, cuando el signo esta ausente. Dificilmente se puede pensar en una prueba clínica, con toda la tecnología moderna, que reúne estas características.