Dr Pratyush Chaudhuri

Supported by Nirmal ClinicsScience comes first

Neuro Clinics 57

Hyper reflexia – Deep tendon reflexes

• Renal Syndrome• Parkinson disease• Portal hypertension

• Malaria• Acute pesticide poisoning – xylene• hypernatremia

Case 2

• 34 yrs old male• Had complained of headache during the

last 2 years• Recent c/o confusion at work• Loss of recent memory

• Profession - painter

• Higher function – unable to perform simple graphic copying

• Ataxia• Cerebellar signs• hyperreflexia

Laboratory findings

• Hb – 7gm%• Na/K/Cl/Ca = 150/4.9/111/3.0

• Sr Creat = 1.6• Urinary methylhippuric acid - elevated

• Whats your diagnosis?

• This is Xylene poisoning.

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Case 2

• 76 years old• Presented with c/o confusional state with

incontinence of urine since last 2 days• He has been diagnosed as a case of

parkinsons disease on syncapone during the last 6 months

• HT & Diabetic

• Clinical examination reveals • Parkinson disease findings• Dementia on psychometric testing• Hyper-reflexia

• Lab reports • Hypernatremia• Rest within normal limits

• CT scan brain revealed diffuse cerebral atrophy

• What is your diagnosis?

• Here the diagnosis for the exaggerated reflexes is hypernatremia.

• Cause for hypernatremia may be DI or dehydration.

Case 3

• 17 yrs old male presented with c/o high grade fever with headache since last 2 days.

• He had severe chills with rigors during the fever.

• Fever 103 F• Exagerated reflexes• Rest normal

• Peripheral smear – MP- Falciform

• Remember falciform malaria causes endotoxic cerebral oedema

Thank You!

• Next clinic- Examples of hypo-natremia