Diagnosis of Reflex sympathetic dystrophy syndrome
Diagnostic Test list for Reflex sympathetic dystrophy syndrome:
The list of medical tests
mentioned in various sources as
used in the diagnosis of Reflex sympathetic dystrophy syndrome
includes:
Reflex sympathetic dystrophy syndrome Diagnosis: Book Excerpts
Tests and diagnosis discussion for Reflex sympathetic dystrophy syndrome:
RSDS is diagnosed primarily through
observation of the symptoms. Some physicians use thermography to detect
changes in body temperature that are common in RSDS. X-rays may also show
changes in the bone.
(Source: excerpt from NINDS Reflex Sympathetic Dystrophy Syndrome Information Page: NINDS)
Diagnostic Tests for Reflex sympathetic dystrophy syndrome: Online Medical Books
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HYPERACTIVE REFLEXES:
Ask the Following Questions:
(Algorithmic Diagnosis of Symptoms and Signs)
- Are they intermittent or persistent? If the hyperactive reflexes are intermittent, one should consider multiple sclerosis and cerebral vascular insufficiency.
- Are they focal? If the hyperactive reflexes are focal, and especially if they are unilateral, one should consider vascular diseases, space-occupying lesions, or multiple sclerosis. Certain degenerative diseases such as amyotrophic lateral sclerosis may also present with focal hyperactive reflexes.
- If the hyperactive reflexes are focal, are they unilateral? Unilateral hyperactive reflexes are characteristic of hemiplegia. Hemiplegia is usually associated with a cerebral vascular disease or space-occupying lesion of the brain, especially if there are cranial nerve signs. However, early spinal cord tumors may present with unilateral hyperactive reflexes.
- Are there cranial nerve signs? The presence of cranial nerve signs suggests that the lesion is above the foramen magnum, and a cerebral or brain stem tumor is the first thing to be considered. A cerebral vascular lesion or multiple sclerosis must also be considered.
- Is there dementia? The presence of dementia along with the hyperactive reflexes, especially if they are diffuse, suggests Alzheimer's disease, Pick's disease, general paresis, and Korsakoff's syndrome. There are many other causes of dementia to consider.
- Are there other long tract signs? The presence of hyperactive reflexes with sensory changes should suggest pernicious anemia, syringomyelia, and Friedreich's ataxia. It may also indicate multiple sclerosis, a spinal cord tumor, a brain stem tumor, or basilar artery insufficiency.
DIAGNOSTIC WORKUP
Hyperactive reflexes, especially if they are unilateral, are a clear indication for an imaging study. It is wise to consult a neurologist or neurosurgeon before determining which imaging study to order. If there are cranial nerve findings and dementia, a CT scan or MRI of the brain should be ordered.
If there are hyperactive reflexes of all four extremities without dementia or cranial nerve signs, MRI of the cervical spine would probably be the most appropriate procedure. It may, however, be necessary to get a CT scan or MRI of the brain anyway.
If only the lower extremities are involved, MRI of the thoracic cord would probably be most appropriate, but then MRI of the cervical spine should be done if the thoracic MRI is negative. Spinal fluid analysis will help diagnose multiple sclerosis, central nervous system syphilis, cerebral hemorrhages, or abscess. A CBC, serum B
12
and folic acid, and Schilling test will help diagnose pernicious anemia. Plain films of the appropriate level of the spine are necessary in trauma cases. An EEG and psychometric testing should be done in cases of dementia. SSEP, VEP, and BSEP studies are helpful in diagnosing multiple sclerosis. Carotid duplex scans and four-vessel angiography may be necessary for diagnosing cerebral vascular disease.
» READ BOOK EXCERPT ONLINE »
Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
PATHOLOGIC REFLEXES:
Ask the Following Questions:
(Algorithmic Diagnosis of Symptoms and Signs)
- Are the findings intermittent? If the pathologic reflexes come and go, transient ischemic attacks, multiple sclerosis, migraine, epilepsy, and hypoglycemia should be considered in the differential diagnosis.
- Are they unilateral or bilateral? Unilateral pathologic reflexes should signify either a brain tumor or vascular lesion. Bilateral pathologic reflexes should suggest an inflammatory or degenerative disease. However, multiple sclerosis may present with either unilateral or bilateral pathologic reflexes. Vascular lesions in the basilar circulation may also present with bilateral pathologic reflexes. It should be pointed out that there is no hard-and-fast rule.
- Is there associated facial palsy or other cranial nerve signs? The presence of facial palsy or other cranial nerve signs should make one look for a lesion in the brain or brain stem.
- Is there headache or papilledema? The presence of headache or papilledema should prompt the investigation for a space-occupying lesion of the brain or brain stem.
- Is there hypertension or a possible source for an embolism? These findings would suggest a cerebral vascular accident such as cerebral hemorrhage or embolism.
- Is the sensory examination normal? The findings of bilateral pathologic reflexes or unilateral pathologic reflexes with a normal sensory exam and no cranial nerve signs would suggest amyotrophic lateral sclerosis or primarily lateral sclerosis.
DIAGNOSTIC WORKUP
Routine studies include a CBC, sedimentation rate, urinalysis, chemistry panel, ANA assay, serum B
12
and folic acid, VDRL test, chest x-ray, and EKG. If there are cranial nerve signs, a CT scan or MRI of the brain will usually be necessary. However, it is wise to get a neurology consultation before undertaking these expensive tests. A spinal tap may be done if the imaging study is negative.
If vascular disease is suspected, carotid scans to rule out carotid stenosis or plaque and a search for an embolic source using echocardiography and blood culture should be done. A cardiologist can assist in this search. Four-vessel cerebral angiography may be necessary. In fact, if a cerebral hemorrhage has been ruled out and there is no significant hypertension, a four-vessel cerebral angiographic study should probably be done. Evoked potential studies and HIV antibody titers should also be done. If there are no cranial nerve signs, MRI of the cervical spine or thoracic spine should be done, depending on the level of the lesion. Myelography may also be helpful. Serum protein electrophoresis and immunoelectrophoresis all may be necessary in the workup.
» READ BOOK EXCERPT ONLINE »
Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
ANKLE CLONUS AND HYPERACTIVE AND PATHOLOGIC REFLEXES:
Approach to the Diagnosis
(Differential Diagnosis in Primary Care)
A neurologist should be consulted at the outset. The neurologist will be able to determine whether a CT scan or magnetic MRI should be ordered and whether it should be of the brain, brainstem, or spinal cord. If there are obvious cranial nerve signs, the imaging study will include the brain and brainstem. Spinal cord lesions usually require x-ray of the spine and possibly myelography and spinal fluid analysis. In suspected intracranial pathology, a spinal tap should not be done until a CT scan or MRI has ruled out a space-occupying lesion.
» READ BOOK EXCERPT ONLINE »
Source: Differential Diagnosis in Primary Care, 2007
Deep tendon reflexes, hyperactive:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
After eliciting hyperactive DTRs, take the patient's history. Ask about spinal cord injury or other trauma and about prolonged exposure to cold, wind, or water. Could the patient be pregnant? A positive response to any of these questions requires prompt evaluation to rule out life-threatening autonomic hyperreflexia, tetanus, preeclampsia, or hypothermia. Ask about the onset and progression of associated signs and symptoms. Next, perform a neurologic examination. Evaluate the patient's level of consciousness, and test motor and sensory function in the limbs. Ask about paresthesia. Check for ataxia or tremors and for speech and visual deficits. Test for Chvostek's (an abnormal spasm of the facial muscles elicited by light taps on the facial nerve in a patient who has hypocalcemia) and Trousseau's (a carpal spasm induced by inflating a sphygmomanometer cuff on the upper arm to a pressure exceeding systolic blood pressure for 3 minutes in a patient who has hypocalcemia or hypomagnesemia) signs and for carpopedal spasm. Ask about vomiting or altered bladder habits. Make sure to take the patient's vital signs.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Babinski's reflex [Extensor plantar reflex]:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
After eliciting a positive Babinski's reflex, evaluate the patient for other neurologic signs. Evaluate muscle strength in each extremity by having the patient push or pull against your resistance. Passively flex and extend the extremity to assess muscle tone. Intermittent resistance to flexion and extension indicates spasticity, and a lack of resistance indicates flaccidity.
Next, check for evidence of incoordination by asking the patient to perform a repetitive activity. Test deep tendon reflexes (DTRs) in the patient's elbow, antecubital area, wrist, knee, and ankle by striking the tendon with a reflex hammer. An exaggerated muscle response indicates hyperactive DTRs; little or no muscle response indicates hypoactivity.
Then evaluate pain sensation and proprioception in the feet. As you move the patient's toes up and down, ask the patient to identify the direction in which the toes have been moved without looking at his feet.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Complex regional pain syndrome:
Diagnosis
(Professional Guide to Diseases (Eighth Edition))
There’s no laboratory test for CRPS, so the diagnosis is based on the patient’s history and clinical findings. A history of injury to an extremity may point to CRPS. Bone X-rays may aid in ruling out other conditions, such as osteomyelitis and stress fractures, which cause similar signs and symptoms. Additional tests may include bone scans, nerve conduction studies, and thermography (a test to show temperature changes and lack of blood supply in the painful area of the affected limb). With early diagnosis, prognosis improves.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Posttraumatic stress disorder:
Diagnosis
(Professional Guide to Diseases (Eighth Edition))
For characteristic findings in patients with this condition, see Diagnosing posttraumatic stress disorder, page 470.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Deep tendon reflexes, hyperactive:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
After eliciting hyperactive DTRs, take the patient’s history. Ask about spinal cord injury or other trauma and about prolonged exposure to cold, wind, or water. Could the patient be pregnant? A positive response to any of these questions requires prompt evaluation to rule out life-threatening autonomic hyperreflexia, tetanus, preeclampsia, or hypothermia. Ask about the onset and progression of associated signs and symptoms. Next, perform a neurologic examination. Evaluate level of consciousness, and test motor and sensory function in the limbs. Ask about paresthesia. Check for ataxia or tremors and for speech and visual deficits. Test for Chvostek’s sign (an abnormal spasm of the facial muscles elicited by light taps on the facial nerve in patients who have hypocalcemia) and Trousseau’s sign (a carpal spasm induced by inflating a sphygmomanometer cuff on the upper arm to a pressure exceeding systolic blood pressure for 3 minutes in patients who have hypocalcemia or hypomagnesemia) and for carpopedal spasm. Ask about vomiting or altered urination habits. Be sure to take vital signs.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Babinski's reflex [Extensor plantar reflex]:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
After eliciting a positive Babinski’s reflex, evaluate the patient for other neurologic signs. Evaluate muscle strength in each extremity by having the patient push or pull against your resistance. Passively flex and extend the extremity to assess muscle tone. Intermittent resistance to flexion and extension indicates spasticity, and a lack of resistance indicates flaccidity.
Next, check for evidence of incoordination by asking the patient to perform a repetitive activity. Test deep tendon reflexes (DTRs) in the patient’s elbow, antecubital area, wrist, knee, and ankle by striking the tendon with a reflex hammer. An exaggerated muscle response indicates hyperactive DTRs; little or no muscle response indicates hypoactivity.
Then evaluate pain sensation and proprioception in the feet. As you move the patient’s toes up and down, ask him to identify the direction in which the toes have been moved without looking at his feet.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Complex regional pain syndrome:
Diagnostic tests
(Handbook of Diseases)
There is no laboratory test for CRPS, so the diagnosis is based on the patient’s history and clinical findings. A history of injury to an extremity may point to CRPS. Bone X-rays may aid in ruling out other conditions, such as osteomyelitis and stress fractures, which cause similar signs and symptoms. With early diagnosis, prognosis improves.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Posttraumatic stress disorder:
Diagnosis
(Handbook of Diseases)
For characteristic findings in patients with this condition, see Diagnosing posttraumatic stress disorder.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Deep tendon reflexes, hyperactive:
History
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
After eliciting hyperactive DTRs, take the patient’s history. Ask about spinal cord injury or other trauma and about prolonged exposure to cold, wind, or water. Also find out if the patient could be pregnant. A positive response to any of these questions requires prompt evaluation to rule out life-threatening autonomic hyperreflexia, tetanus, preeclampsia, and hypothermia. Ask about the onset and progression of associated signs and symptoms. Also ask about paresthesia, vomiting, and altered bladder habits.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Babinski's reflex:
History
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Ask the patient about his recent medical history. Has the patient experienced a recent head trauma, spinal cord injury, or an animal bite? Then ask whether he has a personal or family history of neurologic disorders.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Deep tendon reflexes, hyperactive:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
After eliciting hyperactive DTRs, take the patient's history. Ask about spinal cord injury or other trauma and about prolonged exposure to cold, wind, or water. Could the patient be pregnant? A positive response to any of these questions requires prompt evaluation to rule out life-threatening autonomic hyperreflexia, tetanus, preeclampsia, or hypothermia. Ask about the onset and progression of associated signs and symptoms. Next, perform a neurologic examination. Evaluate the patient's level of consciousness, and test motor and sensory function in the limbs. Ask about paresthesia. Check for ataxia or tremors and for speech and visual deficits. Test for Chvostek's (an abnormal spasm of the facial muscles elicited by light taps on the facial nerve in a patient who has hypocalcemia) and Trousseau's (a carpal spasm induced by inflating a sphygmomanometer cuff on the upper arm to a pressure exceeding systolic blood pressure for 3 minutes in a patient who has hypocalcemia or hypomagnesemia) signs and for carpopedal spasm. Ask about vomiting or altered bladder habits. Be sure to take the patient's vital signs.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Babinski's reflex [Extensor plantar reflex]:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
After eliciting a positive Babinski's reflex, evaluate the patient for other neurologic signs. Evaluate muscle strength in each extremity by having the patient push or pull against your resistance. Passively flex and extend the extremity to assess muscle tone. Intermittent resistance to flexion and extension indicates spasticity, and a lack of resistance indicates flaccidity.
Next, check for evidence of incoordination by asking the patient to perform a repetitive activity. Test deep tendon reflexes (DTRs) in the patient's elbow, antecubital area, wrist, knee, and ankle by striking the tendon with a reflex hammer. An exaggerated muscle response indicates hyperactive DTRs; little or no muscle response indicates hypoactivity.
Then evaluate pain sensation and proprioception in the feet. As you move the patient's toes up and down, ask the patient to identify the direction in which the toes have been moved without looking at his feet.
Obtain a complete medical and surgical history as well as a complete drug history.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
ANKLE CLONUS AND HYPERACTIVE AND PATHOLOGIC REFLEXES:
Approach to the Diagnosis
(Differential Diagnosis in Primary Care)
A neurologist should be consulted at the outset. The neurologist will
be able to determine whether a CT scan or MRI should be ordered and whether
it should be of the brain, brainstem, or spinal cord. If there are obvious
cranial nerve signs, the imaging study will include the brain and brainstem.
Spinal cord lesions usually require x-ray of the spine and possibly
myelography and spinal fluid analysis. In suspected intracranial pathology,
a spinal tap should not be done until a CT scan or MRI has ruled out a
space-occupying lesion.
» READ BOOK EXCERPT ONLINE »
Source: Differential Diagnosis in Primary Care, 2007
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