Autonomic Dysfunction Secondary to Focal Central Nervous System Disease

The autonomic nervous system syndrome may also be classified anatomically into telencephalic, diencephalic, brain stem, and spinal cord disorders ( Ia.b e., 21-5 ). Telencephalon Syndromes. Temporolimbic seizures may induce changes in heart rate, heart rhythm, and blood pressure. Cardiovascular manifestations of seizures include sinus tachycardia or bradyarrhythmias (including sinus arrest) with syncope. Seizure-induced ventricular tachycardia and fibrillation have been implicated in sudden...

Combined Upper and Lower Motor Neuron Syndromes

Motor neuron disease refers to a group of disorders in which selective degeneration of both upper and lower motor neurons occurs. y Amyotrophic lateral sclerosis (ALS, Lou Gehrig's disease) is the prototypical motor neuron disease. Several varieties or subtypes are recognized based on the sites at which the motor neurons are first and most prominently involved. The spinal form most commonly TABLE 15-12 -- EXAMPLES OF COMMON NEUROPATHIES CAUSING WEAKNESS Patterns of Muscle Weakness and Reflex...

Painful Legs Moving Toes Syndrome

Painful legs-moving toes syndrome (PLMTS) is a movement disorder associated with significant sensory symptoms. The condition is idiopathic in origin but usually develops in association with back pain and often in the context of prior back injury or surgery. No specific pathophysiological mechanisms have been elucidated, and although a spinal cord or peripheral nervous system origin has been proposed, electrophysiological studies are often normal. y Because the condition sometimes follows herpes...

Sensory Gait Syndrome

The adaptation of spinal and brain stem synergies to an individual's goals and limitations (i.e., context) requires a knowledge of the relations of the body segments to each other, the situation of the body in space and the gravitational field, and the presence of environmental hazards and aids to balance and locomotion. This information is largely derived from the somatosensory, vestibular, and visual senses. Generally, one sensory system is adequate to orient a person and permit normal...

Pupillary Syndromes Anisocoria

It is commonly written that 20 percent of the population has anisocoria of at least 0.4 mm in dim light, although published series cite highly variable percentages from 2 to 60 percent. The most common sort of variable anisocoria among healthy people has been called see-saw anisocoria or simple central anisocoria whereas the mechanism is indeterminate, this benign condition may vary from one examination to the next or even reverse sides. Light stimulation of one or both eyes decreases the...

Osteosclerotic Myeloma

Osteosclerotic myeloma may be considered a rare variant of multiple myeloma, comprising only 3 percent of all patients with myeloma. Many of the typical features of multiple myeloma, including anemia, hypercalcemia, chronic renal failure, fatigue, weakness, and bone pain, are rare or at least uncommon in osteosclerotic myeloma. Furthermore, the level of M-protein is lower, and there are fewer plasma cells in the bone marrow. In contrast to multiple myeloma,...

Alcoholism and Movement Disorders

In addition to the classic postural tremor associated with alcohol withdrawal, other movement disorders can occur in the setting of alcohol abuse and withdrawal. '104' A rare, slow tremor of the lower extremities can also occur in alcoholics and is produced by the synchronous flexion- extension of the muscles of the hip girdle. yj This 3-Hz tremor is associated with alcoholic cerebellar degeneration affecting the anterior superior vermis and cerebellar hemispheres. '106' When they are supine,...

Mixed Connective Tissue Disease

In 1971, Sharp described patients in whom a new type of antibody to ribonuclease-sensitive extractable nuclear antigen was accompanied by clinical features of more than one connective tissue disease. He called the syndrome mixed connective tissue disease (MCTD), and described several serologic characteristics (1) high titers of hemagglutinating antibody to saline-extractable nuclear antigen (2) marked sensitivity of this antibody to ribonuclease with moderate...