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Jeffrey A Brinker, M.D.

Jeffrey A Brinker, M.D.

  • Professor of Medicine
  • Joint Appointment in Radiology and Radiological Science

https://www.hopkinsmedicine.org/profiles/results/directory/profile/0001297/jeffrey-brinker

Doctors discount 10 ml tobradex overnight delivery, nurses quality 10 ml tobradex, pharmacists and other healthcare workers can help you to purchase tobradex 10 ml on-line make decisions, connect you to other services and provide support. Someone has cirrhosis when serious and extensive injury or scarring has developed in the liver. The amount of time it takes for cirrhosis to develop depends on a few factors, including the cause of the cirrhosis, a person’s general health, lifestyle and genetics. The good news is that there are things you can do to manage cirrhosis and improve your health. This booklet has been written for people who have cirrhosis caused by viral hepatitis. Viral hepatitis is a disease in which the liver becomes damaged after getting infected by a really small germ called a virus. These viruses are also treated in different ways and some are easier to eliminate than others. For more information about hepatitis viruses, talk to a healthcare professional and check out. Blood from the stomach and intestines passes through your liver, where it is fltered and processed before heading to other parts of your body. When scar tissue begins to replace healthy tissue in the liver, it is harder for blood to fow normally through the liver and for the liver to work in its usual way. Cirrhosis is a silent disease, and people who have it sometimes don’t have symptoms until there’s been a lot of injury to the liver. The symptoms of early liver cirrhosis (sometimes called compensated cirrhosis) include: • fatigue and loss of energy • unexplained loss of appetite and weight loss • nausea • abdominal pain • pinhead-sized spots on the skin from which tiny blood vessels spread out in a circle (spider angiomas) • redness of the palms of the hand (palmar erythema) In some people, cirrhosis progresses over time and the liver’s ability to work normally decreases. How quickly this happens varies from person to person and depends on a few things, including the person’s general health, their gender, the cause of the cirrhosis, the stage of the disease when they were diagnosed, their diet and their alcohol intake. In a small number of people with cirrhosis, the liver gets so damaged it can no longer work properly. Bleeding varices are a very serious and potentially life-threatening medical problem. Some of the effects of cirrhosis on the body are directly related to the liver’s function. For example, jaundice develops because the liver can’t properly break down bilirubin. Bilirubin is a by-product of the breakdown of red blood cells; it is excreted into bile and changes the colour of stools. Bleeding gums, nosebleeds and bruising happen more easily than usual because the liver stops making enough platelets to help with blood clotting. Finally, brain fog and other serious mental changes linked to hepatic encephalopathy can happen when the injured liver cannot clear the toxin ammonia from the blood. Other symptoms develop because blood vessels in the scarred liver get narrower or become blocked. These blockages also cause blood and fuids to back up in the body, like water that cannot empty through a blocked drain. The backed-up blood increases pressure within the blood vessels that fow through the liver (called portal hypertension). Blockages also mean that blood is re-routed around the liver through smaller veins in the body. This causes the blood vessels in the food pipe and upper stomach to bulge (varices) and break more easily. Scarring in the liver that is caused by ongoing damage is talked about using F scores. These refer to the amount of fbrosis found in the liver, with F0 meaning no damage and F4 meaning cirrhosis. Your healthcare team look at your F scores, any symptoms you may be experiencing and blood test results to fgure out how severe your condition is and to determine possible treatment. Several different tests monitor your liver and help you and your healthcare provider understand how cirrhosis is affecting it. You may have some of the following types of tests: • Blood tests assess injury or infammation in the liver and how well your liver is working. Ultrasounds look at the shape and size of your liver, as well as checking for fuid in the liver and monitoring for cancer. There are two common tests: • FibroScan measures liver stiffness using sound waves—a scarred liver is stiffer than a healthy one. Talk to your healthcare provider about the tests you’ll need, how often you’ll need them, what to expect during each test and how to prepare for each one. For example, if your cirrhosis is caused by viral hepatitis, treatment of the infection will be an important part of your care. Treatments for hepatitis B do not cure the infection, but they can help to keep the virus under control. Another goal of treatment is to manage the symptoms and complications of cirrhosis. Medications taken by people with cirrhosis include the following: • Blood-pressure medications, such as beta-blockers, are used to lower pressure in blood vessels that carry blood through the liver. Talk to your healthcare provider about fguring out a way of taking it that works for you and doesn’t disrupt your day-to-day activities.

Ann continuous immunosuppressive therapy after beginning dialysis in Intern Med 2009; 150: 670–680 order 10ml tobradex otc. Intravenous immunoglobulins for resistance in antineutrophil cytoplasmic antibody-associated small relapses of systemic vasculitides associated with antineutrophil vessel vasculitis 10ml tobradex with amex. J Am Soc Nephrol 2007; 18: injury with accumulation of proximal tubular lysosomes due to cheap tobradex online master card 2180–2188. Nine patients with anti-neutrophil cytoplasmic antibody relapse in antineutrophil cytoplasmic autoantibody-associated positive vasculitis successfully treated with rituximab. Antiproteinase 3 comparing glucocorticoids and six or twelve cyclophosphamide pulses antineutrophil cytoplasmic antibodies and disease activity in Wegener in sixty-five patients. Am J Kidney associated small vessel vasculitis after transplantation: A pooled Dis 1992; 20: 261–269. Prognostic factors for hospital significance of clinical, pathologic and treatment factors. Mycophenolate mofetil for induction and patients with anti-glomerular basement membrane disease. Nephron maintenance of remission in microscopic polyangiitis with mild to Clin Pract 2005; 99: c49–c55. Incidence and outcome of antiglomerular mycophenolate mofetil in patients who cannot be treated with basement membrane disease in Chinese. Anti-glomerular basement azathioprine for remission maintenance in antineutrophil cytoplasmic membrane antibody disease in Japan: part of the nationwide rapidly antibody-associated vasculitis: a randomized controlled trial. Characteristics and outcomes of patients with sulfamethoxazole (co-trimoxazole) for the prevention of relapses of Goodpasture’s syndrome. Grading quality of evidence and strength A report of five cases and review of the literature. Rapid progressive glomerulonephritis: recommendations for clinical practice guidelines in nephrology. Development and validation of an international immunosuppressive treatment and plasma exchange. Clin Nephrol 1984; appraisal instrument for assessing the quality of clinical practice 21: 244–246. Case report and review of the clinical practice guidelines: a proposal from the Conference on literature. Further symptoms include cough, wheezing, important considerations of diagnosis and treatment in and a feeling of tightness in the chest. Asthmatic symp view of the current national and international asthma toms can often arise after physical exercise. The following discussion of bronchial asthma is large Methods: Selective literature review, with attention to the ly based on the German national care guidelines for current national and international guidelines. It is diagnosed on the basis of the clinical the learning objectives of this article are: history, physical examination, and pulmonary function > to become acquainted with the various conditions tests, including reversibility testing and measurement of that enter into the differential diagnosis of bronchial bronchial reactivity. The goal of treatment is to control the asthma, and symptoms of the disease effectively and in lasting fashion. This fact has been integrated into the definition of bronchial asthma, which is now defined Key words: bronchial asthma, bronchial hyperreactivity, as a chronic inflammatory disease of the airways char lung function, pharmacotherapy, inhaled corticosteroids acterized by bronchial hyperreactivity and a variable degree of airway obstruction (1–3). Airway obstruction in bronchial asthma is mainly caused by the following four mechanisms (2): > Contraction of bronchial smooth muscle > Edema of the airway walls > Mucous plugging of the bronchioles > Irreversible changes in the lungs ("remodeling"). Bronchial obstruction during exercise-induced asthma) an acute attack can progress, either slowly or rapidly, – in the setting of upper respiratory infection to life-threatening severity. Around the Symptoms world, however, there is little correlation between the Intermittent and variable (may also be absent. Normal > Orthopnea pulmonary function values do not rule out disease if > Chest constriction they have been obtained during a symptom-free interval. Non-allergic asthma in adults can arise, circadian variability greater than 20% is typical of for example, after a viral infection of the lower respi inadequately treated asthma (2, 5). Viral infections can, in turn, promote the Standards and individualized norms exist for both development of an allergic sensitization. Allergy and asthma History and physical examination About 10% of children suffer from asthma. Acute attacks of shortness of breath and cough Childhood asthma is usually due to allergy. An algorithm for (at least 200 mL) with respect to the initial value, and possibly also decrease the diagnostic assessment of asthma is shown in figure 1. In the current "Global Strategy for > Normal or nearly normal pulmonary function Asthma Management and Prevention" issued by the > No exacerbations. This includes, for example (1, 3) (evidence level D): > No limitation of physical, emotional, or intellectual development in childhood and adolescence > No symptoms and no asthma attacks > Normal, or the best possible, physical and social activities in everyday life > the best possible pulmonary function. The goals of pharmacotherapy are the suppression of the inflammation of asthma and the reduction of bron chial hyperreactivity and airway obstruction. The medi cations used for these purposes belong to two groups: > Relievers (medications taken for symptomatic relief as necessary) include mainly the inhaled, rapidly-acting beta2 sympathomimetic agents. Inhaled anticholinergic drugs and rapidly-acting theophylline (solution or drops) play a secondary role as relievers. Formoterol can be used as a reliever because of its rapid onset of action or as a controller in combination with corticosteroids. The undesired adverse effects that these medications can produce are listed in the e-box. The numbers attached to each panel indicate the hierarchical level (modified from 1,3) lergic rhinitis. The goal of treatment Pharmacotherapy is the best possible quality of life for the patient. Often, the treatment of Further options in step 3 – albeit with lesser clinical a previously untreated asthmatic is begun at step 2.

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Clinical effects of air filters in homes of asthmatic adults sensitized and exposed to buy 10 ml tobradex overnight delivery pet allergens cheap 10 ml tobradex free shipping. Outcomes for a comprehensive school-based asthma management program J School Health 2006 Aug;76(6):291-6 order tobradex 10ml otc. Self management education and regular practitioner review for adults with asthma. Pediatric biomarkers in asthma: exhaled nitric oxide, sputum eosinophils and leukotriene E4. Combination of inhaled long-acting beta2-agonists and inhaled steroids versus higher dose of inhaled steroids in children and adults with persistent asthma. Effect of mattress and pillow encasings on children with asthma and house dust mite allergy. Benefits of a school-based asthma treatment program in the absence of secondhand smoke exposure: results of a randomized clinical trial. Long-term safety study of levalbuterol administered via metered-dose inhaler in patients with asthma. Levalbuterol versus racemic albuterol in the treatment of acute exacerbation of asthma in children. The association between gastro-oesophageal reflux disease and asthma: a systematic review. House dust mite and cockroach exposure are strong risk factors for positive allergy skin test responses in the Childhood Asthma Management Program. Appendices Page 120 Clinical Practice Guideline for the Management of Asthma in Children and Adults Kavuru M, Melamed J, Gross G, Laforce C, House K, Prillaman B, Baitinger L, Woodring A, Shah T. Salmeterol and fluticasone propionate combined in a new powder inhalation device for the treatment of asthma: a randomized, double-blind, placebo-controlled trial. Gastroesophageal reflux in asthmatics: a double-blind, placebo controlled crossover study with omeprazole. Long-acting beta2-agonist monotherapy vs continued therapy with inhaled corticosteroids in patients with persistent asthma: a randomized controlled trial. Inhaled corticosteroid reduction and elimination in patients with persistent asthma receiving salmeterol: a randomized controlled trial. The link between allergic rhinitis and allergic asthma: a prospective population-based study. Effects of 24 weeks of lansoprazole therapy on asthma symptoms, exacerbations, quality of life, and pulmonary function in adult asthmatic patients with acid reflux symptoms. A randomized controlled trial of mite allergen-impermeable bed covers in adult mite-sensitized asthmatics. A comparison of two challenge tests for identifying exercise-induced bronchospasm in figure skaters. Moderate dose inhaled corticosteroids plus salmeterol versus higher doses of inhaled corticosteroids in symptomatic asthma. Results of a home-based environmental intervention among urban children with asthma. Evaluation of exertional dyspnea in the active duty patient: the diagnostic approach and the utility of clinical testing. Occupational asthma, rhinitis and urticaria due to piperacillin sodium in a pharmaceutical worker. Murray J, Rosenthal R, Somerville L, Blake K, House K, Baitinger L, VanderMeer A, Dorinsky P. Fluticasone propionate and salmeterol administered via Diskus compared with salmeterol or fluticasone propionate alone in patients suboptimally controlled with short-acting beta2-agonists. The influence of pulmonary function testing on the management of asthma in children. J Zafirlukast improves asthma symptoms and quality of life in patients with moderate reversible airflow obstruction. Efficacy and tolerability of fluticasone propionate/salmeterol administered twice daily via hydrofluoroalkane 134a metered-dose inhaler in adolescent and adult patients with persistent asthma: a randomized, double-blind, placebo-controlled, 12-week study. Clin Ther 2006;28:73-85 Nelson H, Kemp J, Berger W, Corren J, Casale T, Dube L, Walton-Bowen K, LaVallee N, Stepanians M. Efficacy of zileuton controlled-release tablets administered twice daily in the treatment of moderate persistent asthma: a 3 month randomized controlled study. Anti-leukotriene agents compared to inhaled corticosteroids in the management of recurrent and/or chronic asthma in adults and children. Evidence based guidelines for the prevention, identification, and management of occupational asthma. Efficacy and safety of budesonide and formoterol in one pressurised metered-dose inhaler in adults and adolescents with moderate to severe asthma: a randomised clinical trial. Montelukast, a potent leukotriene receptor antagonist, causes dose-related improvements in chronic asthma. A comparison of levalbuterol with racemic albuterol in the treatment of acute severe asthma exacerbations in adults. Onset and duration of protection against exercise-induced bronchoconstriction by a single oral dose of montelukast. Mite avoidance can reduce air trapping and airway inflammation in allergic asthmatic children. Tailored interventions based on exhaled nitric oxide versus clinical symptoms for asthma in children and adults. The role of intervention in established allergy: avoidance of indoor allergens in the treatment of chronic allergic disease.

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Examine the area under the coverslip under low-power (10) and high-dry (40) lenses for cells generic tobradex 10ml with amex, casts discount tobradex 10 ml with mastercard, crystals order generic tobradex canada, and bacteria. Bacterial growth by certain organisms (eg, proteus) in a specimen may cause a marked alkaline shift (pH > 8), usually because of urea conversion to ammonia. Protein Negative 15–30 mg/dL False-positive readings can be caused by <15 mg/dL albumin highly buffered alkaline urine. A negative result does not ruleout the presence of globulins, hemoglobin,Bence Jones proteins, or mucoprotein. False <15 mg/dL negative results occur with urinary ascorbic acid concentrations 0 mg/dL and with ketone body levels 40 mg/dL. Trace = 100 mg/dL 1 = 1000 mg/dL = 250 mg/dL 2 = 2000 mg/dL = 500 mg/dL Ketone Negative 5–10 mg/dL Test does not react with acetone or acetoacetate -hydroxybutyric acid. False-negative readings can be or less) caused by ascorbic acid concentrations 25 mg/dL. Test sensitivity is reduced in urines with high speci c gravity, captopril, or heavy proteinuria. Test sensitivity is reduced in urines with elevated glucose concentrations 3 g/dL), or presence of cephalexin, cephalothin, tetracycline, or high concentrations of oxalate. Cells may be red cells, white cells, squamous cells, transitional (bladder) or tubular epithelial cells, or atypical (tumor) cells. Red cells suggest upper or lower urinary tract infections (cystitis, prostatitis, pyelonephritis), glomerulonephritis, collagen vascular disease, trauma, renal calculi, tumors, drug reactions, and structural abnormalities (polycystic kidneys). White cells suggest in ammatory processes such as urinary tract infection (most common), collagen vascular disease (eg, lupus), or inter stitial nephritis. Red cell casts are considered pathognomonic of glomerulonephritis; white cell casts, of pyelonephritis; and fatty (lipid) casts, of nephrotic syndrome. Comments See Table 8–28 for a guide to interpretation of urinalysis; and Figure 2–1 for a guide to microscopic ndings in urine. Note: Fully automated urinalysis systems (either image or ow cytometry-based) are now available in many clinical laboratories, so manual microscopy examination may not be performed routinely in a central laboratory. Vaginal Fluid Wet-Mount Preparation Preparation of Smear and Staining Technique a. Examine under the microscope, using the high-dry (40) lens and a low light source. Look for clue cells (vaginal epithelial cells with large numbers of organisms attached to them, obscuring cell borders), which are pathognomonic of Gardnerella vaginalis associated vaginosis. See Figure 2–2 for an example of a positive wet prep (trichomonads, clue cells) and Table 8–29 for the differential diagnosis of vaginal discharge. Obtain a skin specimen by using a scalpel blade to scrape scales from the skin lesion onto a glass slide or to transfer the top of a vesicle to the slide or, place a single drop of vaginal discharge on the slide. Point-of-Care Testing and Provider-Performed Microscopy 39 Microscopic Examination a. Examine the smear under low-power (10) and high-dry (40) lenses for mycelial forms. Branched, septate hyphae are typical of dermatophytosis (eg, trichophyton, epidermophyton, microsporum species); branched, septate pseudohyphae with or without budding yeast forms are seen with candidiasis (candida species); and short, curved hyphae plus clumps of spores ("spaghetti and meatballs") are seen with tinea versicolor (Malassezia furfur). Record and report any yeast, pseudohyphae, or hyphae, indicat ing budding and septation. Examine under a polarized light microscope with a red com pensator, using the high-dry lens and a moderately bright light source. Look for needle-shaped, negatively birefringent urate crystals (crystals parallel to the axis of the compensator appear yellow) in gout, or rhomboidal, positively birefringent calcium pyro phosphate crystals (crystals parallel to the axis of the compen sator appear blue) in pseudogout. Comments See Figure 2–4 for examples of positive synovial uid examinations for these two types of crystals. Fern Test of Amniotic Fluid the Fern test, in conjunction with pH determination using pH paper (Nitrazine test), detects the leakage of amniotic uid from the membrane surrounding the fetus during pregnancy. Examination of synovial uid for crystals using a compensated, polarized microscope. In gout, crystals are needle shaped, negatively birefringent, and composed of monosodium urate. In pseudogout, crystals are rhomboidal, positively birefringent, and composed of calcium pyrophosphate dihydrate. In both diseases, crystals can be found free oating or within polymorphonuclear cells. Point-of-Care Testing and Provider-Performed Microscopy 41 Preparation of Smear Technique a. If present, the amniotic uid crystallizes to form a fern-like pattern (ferning) (Figure 2–5). If the Fern test is positive but the Nitrazine test is negative, there is probable rupture of membrane. If the Fern test is negative but the Nitrazine test is positive, a second specimen should be collected and examined using both tests. Premature rupture of the membranes may lead to fetal infection and subsequent morbidity. Pinworm Tape Test this test is a method used to diagnose a pinworm infection by microscopic examination of specimens taken from the perianal region to identify Enterobius vermicularis eggs or adult female worms, if present. Firmly press the sticky side of a 1-inch strip of transparent adhesive (Cellophane) tape over the right and left perianal folds for a few seconds. Using a microscope, examine the entire tape for eggs or worms under the low-power (10) lens. The eggs are oval, elongated, and attened on one side, with a thick colorless shell. The adult female worms are tiny, white, and threadlike, with a long, pointed tail.

It is often dif cult to order tobradex once a day form a de nite judgment on the plantar response and reproducibility is also questionable discount tobradex 10 ml without prescription. A study of 24 experienced clinicians invited to effective 10ml tobradex examine plantar responses ‘blind’ found that the interobserver percentage agreement beyond chance was on average only 16. This may be likened to ‘echoes’ of the image, and eye movement may produce a trailing effect. Polyopia may occur as part of the visual aura of migraine and has also been associated with occipital and occipito-parietal lesions, bilateral or con ned to the non-dominant hemisphere, and with drug abuse. It has also been described in disease of the retina and optic nerve and occasionally in normal individuals. The pathophysiology is unknown; suggestions include a defect of visual xation or of visual integration; the latter may re ect pure occipital cortical dysfunction. Cross Reference Winging of the scapula Poriomania A name sometimes given to prolonged wandering as an epileptic automatism, or a fugue state of non-convulsive status epilepticus. However, abnormalities in these re exes are of relatively little diagnostic value except in infants. One exception is extrapyramidal disease (parkinsonism, Huntington’s dis ease, but not idiopathic dystonia) in which impairment or loss of postural re exes may be observed. Cross Reference Horner’s syndrome Pouting, Pout Re ex the pout re ex consists of a pouting movement of the lips elicited by lightly tapping orbicularis oris with a nger or tendon hammer, or by tapping a spatula placed over the lips. It differs from the snout re ex, which refers to the re ex elicited by constant pressure on the philtrum. Cross References Frontal release signs; Primitive re exes Prayer Sign An inability to fully oppose the palmar surfaces of the digits with the hands held in the praying position, recognized causes of which include ulnar neuropa thy (main en griffe), Dupuytren’s contracture, diabetic cheiroarthropathy, and camptodactyly. Presbycusis Presbycusis is a progressive sensorineural hearing loss, especially for high fre quencies, developing with increasing age, which may reduce speech discrimina tion. It is thought to be due to age-related attrition of hair cells in the organ of Corti and/or spiral ganglion neurones. Cross Reference Age-related signs Presbyopia Presbyopia is progressive far-sightedness which is increasingly common with increasing age, thought to be due to an age-related impairment of accommo dation. Cross References Flick sign; Phalen’s sign; Tinel’s sign Prevost’s Sign Also known as Vulpian’s sign, this refers to the acute and transient gaze palsy in a frontal lesion. The eyes can be brought to the other side with the oculocephalic manoeuvre or caloric testing. There are also non neurological causes, such as haematological conditions (sickle cell anaemia, polycythaemia rubra vera) which may cause intrapenile thromboses. Developmental re exes: the reappearance of foetal and neonatal re exes in aged patients. Cross References Babinski’s sign (1); Corneomandibular re ex; Frontal release signs; Grasp re ex; Palmomental re ex; Pout re ex; Rooting re ex Procerus Sign A focal dystonia of the procerus muscle, denoted the procerus sign, has been suggested to contribute to the ‘astonished’, ‘worried’, or ‘reptile-like’ facial expression typical of progressive supranuclear palsy, which may also be char acterized by reduced blinking, lid retraction, and gaze palsy. It suggests a contralateral corti cospinal tract lesion and may be accompanied by downward drift of the arm and exion of the ngers and/or elbow. Proprioceptive information is carried within the dorsal columns of the spinal cord (more reliably so than vibration sensation, though not necessarily exclu sively). Cross References Ataxia; Dissociated sensory loss; Myelopathy; Pseudoathetosis; Pseudochoreoathetosis; Rombergism, Romberg’s sign; Useless hand of Oppenheim; Vibration Proptosis Proptosis is forward displacement of the eyeball, an exaggerated degree of exoph thalmos. Once established, it is crucial to determine whether the proptosis is axial or non-axial. Axial proptosis re ects increased pressure within or transmitted through the cone of extraocular muscles. Familiar individuals may be recognized by their voices or clothing or hair; hence, the defect may be one of visually triggered episodic memory. Prosopagnosia is often found in association with a visual eld defect, most often a left superior quadrantanopia or even hemianopia, although for the diag nosis of prosopagnosia to be made this should not be suf cient to produce a perceptual de cit. Anatomically, prosopagnosia occurs most often in association with bilateral occipito-temporal lesions involving the inferior and mesial visual association cortices in the lingual and fusiform gyri, sometimes with subjacent white mat ter. Unilateral non-dominant (right) hemisphere lesions have occasionally been associated with prosopagnosia, and a syndrome of progressive prosopagnosia associated with selective focal atrophy of the right temporal lobe has been reported. Involvement of the periventricular region on the left side may explain accompanying alexia, and disconnection of the inferior visual association cortex (area V4) may explain achromatopsia. Pathological causes of prosopagnosia include • Cerebrovascular disease: by far the most common cause; • Tumour. Progressive prosopagnosia associ ated with selective right temporal lobe atrophy. Odour-evoked autobiographical memories: psychological investigations of Proustian phenomena. Cross Reference Amnesia Proximal Limb Weakness Weakness affecting predominantly the proximal musculature (shoulder abduc tors and hip exors) is a pattern frequently observed in myopathic and dystrophic muscle disorders and neuromuscular junction transmission disorders, much more so than predominantly distal weakness (the differential diagnosis of which encompasses myotonic dystrophy, distal myopathy of Miyoshi type, desmin myopathy, and, rarely, myasthenia gravis). Age of onset and other clinical features may help to narrow the differential diagnosis: painful muscles may suggest an in ammatory cause (polymyositis, dermatomyositis); fatiguability may suggest myasthenia gravis (although lesser degrees of fatigue may be seen in myopathic disorders); weakness elsewhere may suggest a speci c diagnosis. Investigations (blood creatine kinase, neurophysiology, and muscle biopsy) may be required to determine exact diagnosis. Causes include any interruption to the anatomical pathway mediating proprioception, most often lesions in the dorsal cervical cord. Cross References Athetosis; Chorea, Choreoathetosis; Proprioception; Pseudochoreoathetosis Pseudo-Babinski Sign Pseudo-Babinski sign is the name given to dystonic extension of the great toe on stroking the sole of the foot, as when trying to elicit Babinski’s sign, with which this may be confused, although pseudo-Babinski responses persist for longer, and spontaneous extension of the toe, striatal toe, may also be present.

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