By X. Onatas. Schiller International University. 2018.
Journal of Neurology generic kamagra 50mg, Neurosurgery and Psychiatry 1988; 51: 635-642 Cross References Holmes-adie pupil buy 100 mg kamagra otc, Holmes-adie syndrome; Horner’s syndrome Head Droop, Head Drop - see DROPPED HEAD SYNDROME Head Impulse Test The head impulse test, also known as the head thrust test, assesses the vestibulo-ocular reflex. It consists of a rapid turning of the head to one side by about 15 degrees, sufficiently rapid to ensure that smooth pursuit eye movements do not compensate for head turning. The examiner observes the ability of the subject to maintain fixation on a distant target; if the vestibulo-ocular reflex is intact fixation is main- tained. If the vestibulo-ocular reflex is impaired, then an easily visible saccade back to the target occurs at the end of the movement. Tilting the head down by 20 degrees and moving the head unpredictably may optimize testing. This test is recommended in patients suffering a first attack of acute spontaneous vertigo. Sensitivity and specificity of around 80% for detecting a peripheral vestibular lesion, such as acute unilateral vestibular neuritis has been reported. Archives of Neurology 1988; 45: 737-739 Schubert MC, Das VE, Tusa RJ, Herdman SJ. Optimizing the sensi- tivity of the head thrust test for diagnosing vestibular hypofunction. Cross References Bielschowsky’s sign, Bielschowsky’s test; Diplopia; Laterocollis; Ocular tilt reaction Head Tremor Head tremor may be characterized as “yes-yes” (nodding, tremblement affirmatif) when predominantly in the vertical plane, or “no-no” (side- to-side, tremblement negatif) when predominantly in the horizontal plane. Head tremor may occur in isolation or with evidence of tremor else- where (e. In essential tremor the head movements are often intermittent, “yes-yes,” and of frequency about 7 Hz. Dystonic head tremor is often jerky and disorganized, with a frequency of less than 5 Hz. Cerebellum and brainstem disease, such as multiple sclerosis, can also produce head tremor (or titubation). It may also be seen as a consequence of aortic valve regurgitation (De Musset’s sign). Possible treatments, of variable efficacy, include: ● Essential tremor: propranolol, primidone, nicardipine, gabapentin, topiramate ● Dystonic tremor: anticholinergics, propranolol, botulinum toxin injections ● Cerebellar tremor: isoniazid, carbamazepine, ondansetron Cross References Dystonia; Tremor - 144 - Hemeralopia H “Head Turning Sign” It is often observed that patients who are cognitively impaired turn their head toward their spouse, partner, or caregiver to seek assistance when asked to give a history of their problems, or during tests of neuropsychological function. Cross References Dementia Heautoscopy This term was coined to denote seeing oneself, encountering ones alter ego or doppelgänger. Hence unlike the situation in autoscopy, there are two selves, a reduplicated body rather than a mirror image; egocentric and body-centered perspectives do not coincide. Cognitive Neuropsychiatry 2002; 7: 179-194 Cross References Autoscopy; Hallucination Heel-Knee-Shin Test, Heel-Shin Test A frequently used test of coordination in which the patient, sitting on the examination couch, is asked to lift the heel onto the contralateral knee, then run it smoothly down the shin bone toward the foot. Jerky performance, or a tendency for the heel to slide off the shin, may be seen in an ataxic limb. Cross References Ataxia; Cerebellar syndromes; Shin-tapping Heel-Toe Walking - see TANDEM WALKING Hemeralopia Hemeralopia, or day blindness, is worsening of vision in bright light (cf. This phenomenon may reflect severe impairment of blood flow to the eye, such that photostressing the macula by exposure to bright light is followed by only slow regeneration of the bleached photopigments. If due to retinal ischemia, hemeralopia may be accompanied by neovascularization of the retina. Impoverished perfusion pressure may be demonstrated by pressing on the eyeball (e. Hemeralopia may also occur in retinal diseases, such as cone dystrophies. Unilateral visual loss in bright light: an unusual symptom of carotid artery occlusive disease.
Evidence ● Consider plasma expanders and prophylactic antibiotics suggests that aspirated fresh water is more likely than seawater to produce pulmonary oedema buy kamagra 50 mg without a prescription. Rewarming Extracorporeal membrane oxygenation with extracorporeal warming is the gold standard treatment for patients with profound hypothermia buy kamagra 50mg otc. The Swiss Mountain Rescue Service has recovered the bodies of 46 individuals over the years, all with deep hypothermia from burial in snow. Conscious patients can be placed in a bath maintained at a temperature of 42 C. Shadowing in the left Fluid and electrolyte balance lower zone Plasma electrolyte differences between patients who aspire and right mid-zone fresh water and seawater are seldom clinically important. In represents either situation, the patient is often hypovolaemic and in need aspirated of intravenous fluid replacement, preferably using a crystalloid. The Metabolic acidosis should be corrected by adequate patient is at the risk of oxygenation and plasma expansion; administration of sodium developing bicarbonate should be unnecessary. Water intoxication adult resulting in fits has been reported in infants after near respiratory distress drowning in backyard pools. Embolism of infected ● Chest compression alone for circulatory arrest ● No re-warming for deep hypothermia material from the lungs to the arterial tree may result in brain ● Intubate unconscious patients abscesses or death from systemic aspergillosis. A blood culture ● Defibrillation is unlikely to succeed should be undertaken in all instances in which aspiration has ● Associated trauma may include fracture of the cervical spine occurred. Leptospirosis has been reported after immersion in lakes or reservoirs, possibly due to ingestion of water contaminated with rats’ urine. Outpatient follow-up with a chest x ray taken two weeks later is advisable for all patients who have been immersed in water, irrespective of their clinical state on admission. Prognostic signs Resuscitation in hospital A pH of 7 or less indicates severe acidosis and is a poor ● Aspiration is an indication for admission prognostic sign. A low PaO2 provides an early indication that ● Facilities for extracorporeal blood re-warming should be water has been inhaled with the attendant risk of pulmonary available oedema. The presence of ventricular fibrillation is an adverse ● Correct arterial blood gas measurements for low core sign and responds poorly to defibrillation when the core temperature ● Pulmonary oedema seldom develops later than four hours temperature is below 28 C. The circulation must be supported after immersion by chest compression until further attempts can be made when ● Blood-born sepsis is a late complication the core temperature has been raised above this level. Effects of tonicities of Resuscitation from accidental hypothermia of 13. Circum-rescue collapse, ● Walpoth BH, Walpoth-Aslan BN, Mattle HP, Radanov BP, Schroth sometimes fatal, associated with rescue of immersion victims. Much of the experimental evidence on the role of route, but the intraosseous route is used drugs has been derived from animal work, but the results have occasionally, particularly in children. They include: Current resuscitation guidelines recommend that drugs ● Haemorrhage should be used when scientific evidence shows that drugs are of ● Arterial puncture value, rather than for historical or theoretical reasons, or on ● Extravascular drug administration regardless of the vein used the basis of anecdotal evidence alone. In many cases the ● Pneumothorax if cannulation of the subclavian vein is attempted strength of the evidence of benefit is inadequate to make a Central venous cannulation may be hazardous after the definite recommendation. In most cases, guidance represents administration of thrombolytic drugs, and, if required, in this a compromise between the available scientific evidence and a circumstance the femoral approach is recommended. The routes by which drugs may be administered in these circumstances are also described. Routes of Drug administration Intravenous routes Peripheral venous cannulation is safe, easily learned, and does not require interruption of CPR. A large vein, usually in the antecubital fossa, is the site of choice, and drugs injected here during CPR reach peak concentration in the major systemic arteries 1.
King’s ability enthusiastically to distil the truth and crystallize the facts of a clinical problem inspired his students to become orthopedic sur- geons buy 50mg kamagra free shipping. His residents worshiped him and remem- ber with appreciation the outstanding examples he set generic kamagra 50mg free shipping, both in the operating room and in the care of patients. King’s practice was considerable, and his approach to patients was friendly and direct. Many patients continued to seek his advice long after he ceased performing surgery. He served as president of both the Western Orthope- dic Association and the American Board of Ortho- 176 Who’s Who in Orthopedics pedic Surgery. He was a member of the American infancy in the large cities, Kite received many Orthopedic Association and the American neglected cases in older children for whom more Academy of Orthopedic Surgeons, as well as aggressive therapy was required. Lorenz had “broken” founded the Don King Orthopedic Library at the deformity over a pyramid, but the slower, Paciﬁc Presbyterian Medical Center in 1980. In gradual correction in plaster produced inﬁnitely his memory, the Don King Educational Fund has better results, if surgical intervention became been initiated for the education of orthopedic necessary; much less bone was involved in the residents at that institution. Following publication of Kite’s article, his December 1, 1987, at the age of 84. He was sur- method became standard practice for advanced vived by his wife Eva; sons, Donald and Douglas; deformed cases throughout the orthopedic world. Auguste Dejerine KLUMPKE 1859–1927 Joseph Hiram KITE 1891–1986 Auguste Dejerine-Klumpke was born in San Francisco in 1859 and educated in Switzerland Joseph Hiram Kite is generally associated with along with her three sisters. She subsequently the Scottish Rite Hospital for Crippled Children went to Paris for her medical education, which in Decatur, Georgia. He was trained at Johns was obtained only by surmounting all of the bar- Hopkins Hospital and practiced in Atlanta. His riers placed in the way of women who wished to greatest work, however, was done at the hospital pursue a medical career in those days. Dejerine- in Decatur, an institution that primarily served the Klumpke was the ﬁrst woman extern and intern children of the Kentucky–Tennessee mountain in the Paris hospital system. Early in her career, country, where little medical care was available she described a form of brachial plexus palsy during and before the 1930s. At a time when con- affecting the lowest branches, which is still genital club foot was already being treated in known as Klumpke’s paralysis. Jules Dejerine, a young neu- where he graduated from the college of medicine rologist, while she was still a student and they in 1920. Following this he went to Chicago and tigations that resulted in her husband rising to the took a residency at St. Knowles’inventiveness extended into other neurology at the Salpetriere Hospital in Paris. He designed a fascinating home on the Dejerine-Klumpke was highly respected as a banks of the Des Moines River in the outskirts neurologist in her own right. His inter- est in art continued during his medical career and he carried on with his painting and was involved with several local art groups. Knowles was active in the American Academy of Orthopedic Surgeons since its founding in 1933. He was a past president of the Iowa Orthopedic Society, and a member of the Mid-Central States Ortho- pedic Society, the International College of Sur- geons, and national, state, and local medical societies. Knowles’ productive life can serve as an excellent model for those of us who ﬁnd our intel- lectual pursuits hurried in the turmoil of private orthopedic practice. Knowles practiced orthopedics pri- vately in the small and academically isolated community of Fort Dodge, Iowa, for over 40 years, he remained a remarkable innovator in the mechanical aspects of orthopedic surgery.
For instance generic 50 mg kamagra, Hanna explained her own experience to me: I’m a yoga therapist and a reflexologist discount kamagra 50 mg free shipping. The brochures were offering a yoga course that was on four different levels and it took eighteen months to complete. In the course I also got taught a little 84 | Using Alternative Therapies: A Qualitative Analysis reflexology so that kind of stayed on the back burner until I got everything working with the yoga. I went for my reflexology, which was a six months course, a certified course. Similarly, after using the Feldenkrais method informally, Roger described how he sought formal training: “So I was using it also with handicapped people, just in a very informal way, and then I decided to get trained in it and did the second North American training that existed. For example, Natalie told me that she practised alternative healing independently out of her home: “I would try to heal people with my mind from a distance, or with my hands from a distance, and I was finding it was working. For these people, a key encounter with an alternative practitioner reinforced their commitment to these therapies (Deierlein 1994). For example, Scott and Natalie told me about meetings with alternative practitioners that launched them on the road to becoming healers themselves. She was really inspiring, she was amazing, she was full of life and joy and she had her own health and she had her practice room and she had her own world and she travelled all over the world and did this and that and met all these amazing healers, and I had never really thought about healing up until this time. But I realized as I was getting to know this woman, it was like: ‘Oh my god! We talked about nutrition and everything else and then he said, ‘Natalie, you’re a healer. For instance, after experiencing successful acupuncture treatments, Simon made the decision to leave medical school and train to become an acupuncturist: I was on every kind of muscle relaxant, painkiller, sleep aid, everything. My chiropractor also does acupuncture so we tried acupuncture and within two weeks I was off all the medications and I said: ‘You know, I’m going into this field’ and that’s what I did. Said goodbye to formal education and mainstream medicine and went into the alternative. These key encounters and experiences are important because it is through them that alternative ideology is more deeply internalized by the individual. In other words, an individual’s “commitment to a healer/client relationship,” in particular, is instrumental in the adoption of alternative belief systems (Deierlein 1994:180). Deepening commitment to alternative ideology is, in turn, what propels people along the continuum of identity change. For example, it was the intensity of Marie’s belief in alternative therapies that inspired her to become an alternative practitioner: “I became a certified reflexologist because I believe in those things so much” (emphasis mine). CHANGES IN SELF-PERCEPTION Adopting a healer identity was one type of self-change experienced by the people who took part in this study; however, it was not the only one. For many informants, participation in alternative therapies, and adoption of alternative health and healing ideologies, led to changes in their subjective perceptions of self. In particular, it allowed them to re-define aspects of personal identity, that “unique collection of life history items that comes to be attached to the individual” (Goffman 1963:57). That participation in alternative approaches to health care can have this effect has been observed in other research on the users of alternative therapies (Csordas 1983; Easthope 1993; Glik 1988 1990; McGuire 1983, 1987; Pawluch et al. For instance, in describing the use of creative visualization among participants in a metaphysical healing group (MHG), Glik (1988:1201) reports that “In MHGs images of light emanating from and surrounding the self protected from dark forces and to some degree transformed self and others” (emphasis mine).
Brain 2000; 123: 244-253 - 46 - Automatism A Lüders H buy kamagra 50mg, Acharya J kamagra 50 mg lowest price, Baumgartner C et al. Neurology 1992; 42: 801-808 Cross References “Alice in Wonderland” syndrome; Déjà vu; Fortification spectra; Hallucination; Illusion; Jamais vu; Parosmia; Seizure; “Tunnel vision” Automatic Obedience Automatic obedience may be seen in startle syndromes, such as the jumping Frenchmen of Maine, latah, and myriachit, when a sud- den shout of, for example, “jump” is followed by a jump. Although initially classified (by Gilles de la Tourette) with tic syndromes, there are clear clinical and pathophysiological differences. Archives of Neurology 1996; 53: 567-574 Cross References Tic Automatic Writing Behavior Automatic writing behavior is a form of increased writing activity. It has been suggested that it should refer specifically to a permanently present or elicitable, compulsive, iterative and not necessarily com- plete, written reproduction of visually or orally perceived messages (cf. This is characterized as a particular, sometimes iso- lated, form of utilization behavior in which the inhibitory functions of the frontal lobes are suppressed. Increased writing activity in neurological conditions: a review and clinical study. Journal of Neurology, Neurosurgery and Psychiatry 1996; 61: 510-514 Cross References Hypergraphia; Utilization behavior Automatism Automatisms are complex motor movements occurring in complex motor seizures, which resemble natural movements but occur in an inappropriate setting. These may occur during a state of impaired con- sciousness during or shortly after an epileptic seizure. Automatisms occur in about one-third of patients with complex partial seizures, most commonly those of temporal or frontal lobe ori- gin. Although there are qualitative differences between the automa- tisms seen in seizures arising from these sites, they are not of sufficient specificity to be of reliable diagnostic value; bizarre automatisms are more likely to be frontal. Automatic behavior and fugue-like states may also occur in the context of narcolepsy, and must be differentiated from the automatisms of com- plex partial seizures, on the basis of history, examination and EEG. Complex partial seizures on closed circuit television and EEGs: a study of 691 attacks in 79 patients. Annals of Neurology 1982; 11: 292-300 Lüders H, Acharya J, Baumgartner C et al. Epilepsia 1998; 39: 1006-1013 Cross References Absence; Aura; Pelvic thrusting; Poriomania; Seizure Autophony The perception of the reverberation of ones own voice, which occurs with external or middle, but not inner, ear disease. Autoscopy Autoscopy (literally “seeing oneself”) is a visual hallucination of ones own face, sometimes with upper body or entire body, likened to seeing oneself in a mirror (hence mirror hallucination). Unlike heautoscopy, there is a coincidence of egocentric and body-centered perspectives. Autoscopy may be associated with parieto-occipital space-occupying lesions, epilepsy, and migraine. Cognitive Neuropsychiatry 2002; 7: 179-194 - 48 - Autotopagnosia A Maillard L, Vignal JP, Anxionnat R, Taillandier Vespignani L. Epilepsia 2004; 45: 391-394 Cross References Hallucination; Heautoscopy Autotopagnosia Autotopagnosia, or somatotopagnosia, is a rare disorder of body schema characterized by inability to identify parts of the body, either to verbal command or by imitation; this is sometimes localized but at worst involves all parts of the body. This may be a form of category-specific anomia with maximum difficulty for naming body parts, or one feature of anosognosia. Finger agnosia and right-left disorientation are partial forms of autotopag- nosia, all of which are most often seen following cerebrovascular events involving the left parietal area. Cross References Agnosia; Anosognosia; Finger agnosia; Gerstmann syndrome; Right- left disorientation; Somatoparaphrenia - 49 - B Babinski’s Sign (1) Babinski’s sign is a polysynaptic cutaneous reflex consisting of an extensor movement (dorsiflexion) of the big toe on eliciting the plan- tar response, due to contraction of extensor hallucis longus. There may be in addition fanning (abduction) of the other toes (fan sign; signe de l’éventail) but this is neither necessary nor sufficient for Babinski’s sign to be present. There may be simultaneous contraction of other limb flexor muscles, consistent with the notion that Babinski’s sign forms part of a flexion synergy (withdrawal) of the leg. The use of the term “negative Babinski sign” to indicate the normal finding of a downgoing (flexor; plantar flexion) big toe is incorrect, “flexor plantar response” being the appropriate description. The plantar response is most commonly performed by stroking the sole of the foot, although many other variants are described (e.