Medicine Hack

This type of gait can be seen in cases of cerebellar or sensory ataxia. Cerebellar ataxia and gait: The problem here lies with the coordinating mechanisms in the cerebellum and its connecting systems. The gait is a clumsy, staggering, unsteady, irregular, lurching, titubating and wide-based. The patient may sway to either side, back or forward. Leg movements are erratic, and step length varies unpredictably. The patient is unable to follow a straight line on the floor (to walk tandem). With a lesion of the cerebellar vermis, the patient will exhibit a lurching, staggering gait but without laterality, the ataxia will be as marked toward one side as the other. Cerebellar ataxia is present with eyes both open and closed; it may increase slightly with eyes closed but not so markedly as in sensory ataxia. A gait resembling cerebellar ataxia is seen in acute alcohol intoxication. With a hemispheric lesion the patient will stagger and deviate toward the involved side. In disease l

This test was first described by Bors and Blinn in 1957. The authors did this test to check if there are any temperature receptors in the bladder, how they work and whether the test can have a diagnostic purpose. Procedure: (originally done by Bors and Blinn) 60 mL of ice cold water is instilled in the bladder in 30 seconds and patient is requested to try to retain the fluid. Results: If water is expelled in less than 1 minute, the test is said to be positive. Interpretation: The rapid evacuation of the fluid is due to the reflex contraction of the detrusor muscle. The authors also found that this test was positive in patients having an upper motor neuron lesion. The physiology behind is that there are cold receptors in the bladder wall. From there, the impulses travel through the afferent C fibers to the spinal cord and return via the motor nerves to the detrusor muscle thereby completing the reflex arc. This reflex is normally present in children up to the age of 4. After

 INTRODUCTION  Romberg's test is done to assess the integrity of the dorsal columns of the spinal cord. It is not a test to assess the cerebellar function. The test was first described by Moritz Heinrich von Romberg who found that patients with tabes dorsalis (neurosyphilis) often complained of increased unsteadiness in the dark. The test should be performed in all patients who complain of dizziness, imbalance or falls to rule out sensory ataxia.  HOW TO DO THE TEST?  The test is done by requesting the patient to keep his feet firmly together, arms by the side and the eyes open at first. The balance of the patient is noted. Now the patient is asked to close both eyes and the balance is now noted for around 1 minute. The physician should stand in front of the patient with his arms extended on either side of the patient but not touching him. This is done as the latter may fall.  INTERPRETATION  1) If with the eyes open, the balance is not good then there may be a probl