Also either absent or diminished. Mickle groups with the absent and exaggerated knee-jerks certain definite symptoms: 'With absent knee-jerk a relatively larger share of pain, wet habits, hallucinations (and slightly, of epileptiform seizures and ataxiform gait); and lessened feeling of, and motor reaction to, pinches and tickling of the feet. And, on the other hand, with exaggerated knee-jerks a large, almost exclusive, share of quasi-syncopal seizures, and much jerk and spasm in movement.' Pickett,^ in a clinical study of one hundred and forty-nine cases occurring at the Philadelphia Hospital found that the relative condition of the knee-jerks in the entire series was in the following proportion: Increased in 49 per cent.; diminished in 10 per cent.; absent in 31 per cent., and normal in 10 per cent. Under eye symptoms will be found pupillary reflexes. 'The Philadelphia Medical Journal, Vol. 9, p. 581. II 126 PARTICULAR SYMPTOMATOLOGY. A CASE OF GENERAL PARESIS WITH REFLEXES.' ti CROSSED Male, set. 55, with the usual mental and physical signs of general paralysis. ** Crossed reflexes** were noticed after the disease had advanced to the stage that compelled the patient to be kept continually in bed. At this time, in addition to the exaggerated knee-jerks, it was noticed that the patellar tendon was associated with a contraction over the outer and upper part of the opposite thigh in front. This crossing occurred with both knee-jerks, but the contraction was more on the right thigh than on the left. The same crossed contractions were associated with the plantar reflexes. Ankle clonus was faintly present, but there was not any crossing. There was no crossing with the other reflexes. The interscapular, abdominal and epigastric were absent, the gluteal brisk, cremasteric faint and pupillary sluggish. <Callout type="important" title="Key Reflex Changes">The presence of crossed reflexes can indicate significant progression in general paresis.</Callout>
Key Takeaways
- Absent knee-jerks correlate with pain, wet habits, and hallucinations.
- Exaggerated knee-jerks are associated with quasi-syncopal seizures and spastic movements.
- Crossed reflexes can indicate advanced stages of general paresis.
Practical Tips
- Monitor for crossed reflexes as they may signal severe progression in patients with general paresis.
- Use the presence or absence of knee-jerks to infer other symptoms and adjust treatment accordingly.
Warnings & Risks
- Misinterpreting reflex changes can lead to incorrect diagnosis and ineffective treatment plans.
- Advanced stages of general paresis may require more intensive care, including bed rest.
Modern Application
While the specific medical context has evolved since 1902, understanding historical diagnostic criteria for conditions like general paresis remains valuable. Reflex changes are still crucial indicators in neurological assessments today, though modern diagnostics include advanced imaging and blood tests.
Frequently Asked Questions
Q: What symptoms accompany absent knee-jerks according to the text?
Absent knee-jerks correlate with pain, wet habits, hallucinations, epileptiform seizures, ataxiform gait, lessened feeling of pinches and tickling in the feet.
Q: What does an exaggerated knee-jerk suggest about a patient's condition?
An exaggerated knee-jerk is associated with quasi-syncopal seizures and spastic movements, indicating specific neurological symptoms.
Q: How can crossed reflexes be identified in patients with general paresis?
Crossed reflexes are observed when a contraction occurs over the outer and upper part of the opposite thigh during knee-jerk tests, often more pronounced on one side than the other.