Agitation & Hypotension & Spasticity - Hyperreflexia: Causes & Reasons

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Patient File

Sex unknown, Age unknown

Reported Symptoms

Agitation, Hypotension, Spasticity - Hyperreflexia,

Negated

None

Unsure

None

Possible Causes

Hyponatremia

They are primarily central nervous system (CNS) manifestations, such as irritability, restlessness, lethargy, muscular twitching, spasticity and hyperreflexia, all of which [aafp.org]

On admission, the patient was agitated and had slurred speech. Treatment with hypertonic saline lead to full recovery. [ncbi.nlm.nih.gov]

After several weeks of suffering from gastroenteritis with vomiting, she presented with disturbance of consciousness, hypotension, dehydration, and severe hyponatremia (108 [ncbi.nlm.nih.gov]

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Scorpion Sting

There was a right facial nerve palsy (upper motor neuron type); right spastic hemiplegia with hyperreflexia and extensor plantar response. Fundoscopy was unremarkable. [atmph.org]

Almost 84% of patients having a respiratory rate of or 30 breaths/minute associated with agitation and sweating were classified in the pulmonary edema group. [ncbi.nlm.nih.gov]

Myocarditis with Hypotension after a Scorpion Sting Maneesha Erraboina 1, Bucchi Reddy 2, Mamatha Reddy 3, Suresh Bandari 1 Department of 1 Pharmacy Practice, Rohini Superspeciality [casereports.in]

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Phenothiazine Poisoning

[…] occur with more frequency in patients in a toxic condition and in dehydrated and febrile patients.3 There is little mention in the literature of reactions which produce spasticity [jamanetwork.com]

Worse agitation, drier mouth and more blurred vision are the result. [pshm.org]

[…] other arrhythmia, hypotension and even shock. [healthfrom.com]

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Binswanger Disease

Low back pain Progressive encephalopathy Pseudobulbar signs Rigidity Spasticity Urinary incontinence Last updated: 1/1/2017 Source: GARD (NIH) 1 • • • Back to: « Cerebral [familydiagnosis.com]

Patients with this disease usually present with apathy, agitation, and bilateral corticospinal or bulbar signs Tags: binswanger', s-disease, subcortical-dementia, white-matter-atrophy [medicalvideos.com]

This pallor can only be due to cerebral edema, most likely of hypoxic-ischemic, hypotensive, or acidotic origin. [ncbi.nlm.nih.gov]

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Scorpion Envenomation

There was a right facial nerve palsy (upper motor neuron type); right spastic hemiplegia with hyperreflexia and extensor plantar response. Fundoscopy was unremarkable. [atmph.org]

All patients had resolution of abnormal motor activity and agitation during their midazolam infusion. [ncbi.nlm.nih.gov]

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Anterior Spinal Artery Syndrome

At first the lower limb paralysis was flaccid and areflexic but after several weeks spasticity, hyperreflexia, and Babinski signs appeared. [lksom.temple.edu]

Severe Agitation: Severely agitated, irritable, hostile and hyperactive patients can be treated with a short-term course of first-generation antipsychotics irrespective of [ncbi.nlm.nih.gov]

It is characterized by a corresponding loss of motor function, loss of pain and temperature sensation, and hypotension. [en.wikipedia.org]

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Shy Drager Syndrome

hyperreflexia, and Babinski sign), cognitive impairment, visual hallucinations, and REM sleep behavior disorder (RBD). [doi.org]

Reduced production of sweat, tears and saliva Heat intolerance due to reduced sweating Impaired body temperature control, often causing cold hands or feet Sleep disorders Agitated [mayoclinic.org]

We suggest that vasopressin may be the drug of choice in patients with Shy-Drager syndrome with refractory hypotension. [ncbi.nlm.nih.gov]

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Hypernatremia

Muscle twitching, tremor, spasticity, hyperreflexia, and lethargy may also be seen. Coma, seizures, and muscle weakness are later signs. [aneskey.com]

Keep patient safe because they will be confused and agitated. [registerednursern.com]

A shunt tap revealed intracranial hypotension with good proximal flow. [ncbi.nlm.nih.gov]

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Aromatic L-Amino Acid Decarboxylase Deficiency

[…] clinical features suggesting spasticity. [jn.nutrition.org]

People with AADC deficiency may also experience episodes called oculogyric crises that involve abnormal rotation of the eyeballs; extreme irritability and agitation; and pain [ghr.nlm.nih.gov]

[…] aromatic L-amino acid decarboxylase deficiency who developed serious cardiac rhythm disturbances during treatment with intravenous dopamine and norepinephrine for severe hypotension [ncbi.nlm.nih.gov]

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Lysergic Acid Diethylamide Poisoning

In addition, it can cause tremor, piloerection, pupillary dilatation, salivation, hyperreflexia, ataxia, and spastic paresis. It can cause vomiting. [cameochemicals.noaa.gov]

[…] phenylcyclidine) intoxication will present with similar symptoms as the ones for LSD and/or hallucinogenic mushrooms, but in addition to those symptoms you will see a patient with agitation [usmleforum.com]

Children can appear agitated, withdrawn, or catatonic. In pediatric cases of known LSD intoxication, parental abuse or neglect must be assumed and investigated. [emedicine.medscape.com]

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Extrapyramidal Disorder

Patients will complain of distal paresthesias and weakness of the extremities followed by spastic paresis and ataxia. [forums.studentdoctor.net]

Syndrome potentially fatal reaction is characterized by "lead pipe rigidity," high fever, dehydration, sweating, elevated blood pressure, fast heart rate and respiration, agitation [medicalnewstoday.com]

Symptomatic treatment From the third year its efficacy declines 52.  Peripheral: • GIT: Nausea & Vomiting • CVS: Orthostatic hypotension, Dysrhythmias • Blood dyscrasias [slideshare.net]

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Classic Progressive Supranuclear Palsy Syndrome

Neurological examination at age 67 disclosed pseudobulbar palsy, spastic gait, hyperreflexia, and presence of bilateral Hoffmann and Babinski signs. [okayama.pure.elsevier.com]

It works no better for PSP than the others and can cause confusion and agitation in those patients. [psp.org]

Patients have an autonomic failure that causes urinary incontinence or orthostatic hypotension. [lecturio.com]

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Coma

[…] with hyperreflexia, quadrispasticity, pupillary fixation to light, decorticate rigidity, decerebrate rigidity. [headinjury.com]

Mental status (normal vs. delirium vs. coma) was assessed daily with the Confusion Assessment Method for the ICU and Richmond Agitation-Sedation Scale. [ncbi.nlm.nih.gov]

We report 3 cases of spontaneous intracranial hypotension (SIH) associated with consciousness disorder and coma. [ncbi.nlm.nih.gov]

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Encephalopathy

Hepatic myelopathy [54] is characterized by a progressive spastic paraparesis accompanied by hyperreflexia and extensor plantar responses. [hindawi.com]

Abstract Hyperammonemic encephalopathy secondary to the use of valproate is rare without evidence of hepatotoxicity, and it usually presents with confusion, agitation, irritability [ncbi.nlm.nih.gov]

Cerebrospinal fluid hypotension is also a reported plausible pathogenic mechanism. [ncbi.nlm.nih.gov]

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Posterior Cerebral Artery Thrombosis

Results of an examination showed a right homonymous hemianopia, moderate right hemiparesis with mild spasticity, hyperreflexia, and a Babinski sign on the right. [jamanetwork.com]

Syndrome of agitated delirium and visual impairment: A manifestation of medial temporo-occipital infarction. J Neurol Neurosurg Psychiatry 1977;40:861-4. [PUBMED] 8. [ijpm.info]

Treat hypotension: Intravenous fluids to maintain intravascular volume with isotonic fluids. Inotropes or vasopressors may be required. [patient.info]

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Proximal Myopathy with Extrapyramidal Signs

The essential clinical findings are slowly progressive and often include severe spasticity, hyperreflexia, and weakness in a pyramidal distribution, noticeably in both lower [emedicine.medscape.com]

[…] heartbeat sweating swelling of the feet or lower legs trouble with sleeping unusual tiredness weight gain or loss Rare Skin rash yellow eyes or skin Incidence Not Known Agitation [drugs.com]

Dizziness or significant hypotension after treatment with the injection is a rare occurrence. [mentalhealth.com]

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Spinal Trauma

It presents with spastic paresis, hyperreflexia, and continued sensory loss. [amboss.com]

Be wary if the child is agitated and distressed by the collar, as overzealous immobilisation may increase leverage on the neck and increase the risk of further injury. [pch.health.wa.gov.au]

What is the most likely cause of hypotension in a major trauma patient with a possible spinal cord injury? [lifeinthefastlane.com]

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X-linked Parkinsonism-Spasticity Syndrome

Clinical manifestations include progressive MUSCLE SPASTICITY; hyperreflexia; MUSCLE RIGIDITY; DYSTONIA; DYSARTHRIA; and intellectual deterioration which progresses to severe [medvik.cz]

（英语：Psychomotor agitation） Stereotypy（英语：Stereotypy） Psychogenic non-epileptic seizures（英语：Psychogenic non-epileptic seizures）克魯爾-布西症候群 [wikipedia.starlog.cn]

Abnormal autonomic nervous system physiology Hypometric saccades Hypotension Optic atrophy Delayed speech and language development Behavioral abnormality Substantia nigra [mendelian.co]

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Olivopontocerebellar Atrophy

However, this symptomatic component does not own a subtype. [4] Signs of corticospinal tract dysfunction (hyperreflexia, impaired muscle performance, spasticity, and a positive [physio-pedia.com]

Reduced production of sweat, tears and saliva Heat intolerance due to reduced sweating Impaired body temperature control, often causing cold hands or feet Sleep disorders Agitated [mayoclinic.org]

A Japanese woman without a remarkable family history showed hand tremor at the age of 35 years, followed by bradykinesia, muscle rigidity, orthostatic hypotension, neurogenic [ncbi.nlm.nih.gov]

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Pallidopyramidal Syndrome

Symptoms * Pyramidal signs * Parkinson disease * Tremor * Rigidity * Hyperreflexia * Spastic muscle tone * Gait disturbance * Bradykinesia * Dysarthria * Dysphagia Diagnosis [checkorphan.org]

Incubate membrane for 30 min at 50 C in stripping buffer (with slight agitation). Wash membrane six times for 5 min each in TBST. [cellsignal.com]

Parkinsonism w orthostatic hypotension Parkinsonism with orthostatic hypotension Parkinsons variant Pigmentary pallidal degeneration Progressive supranuclear ophthalmoplegia [icd9data.com]

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Spastic Ataxia with Congenital Miosis

Clinical features included severe mental retardation, dysarthria, ataxia, athetoid movements, muscle hypoplasia, and spastic paraplegia with hyperreflexia, clonus, an... [findzebra.com]

Dryness of skin and mucous shells, increased intraocular pressure, headache, loss of consciousness, agitation of the central nervous system, delay of urine. [onhealthing.com]

S/S of orthostatic hypotension and treatment in the elderly* Definition The most common symptom of orthostatic hypotension is feeling lightheaded or dizzy when you stand up [flashcardmachine.com]

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Autosomal Dominant Spastic Paraplegia Type 17

Central Nervous System: spasticity hyperreflexia clonus difficulty standing walking on tiptoes more Clinical features from OMIM: 607584 UMLS symptoms related to Spastic Paraplegia [malacards.org]

The genetic screening test for CF is usually based on mouthwash samples collected by agitating sucrose or saline in the mouth. [aetna.com]

[…] hour sleep–wake disorder Jet lag CSF Intracranial hypertension Hydrocephalus / NPH Choroid plexus papilloma Idiopathic intracranial hypertension Cerebral edema Intracranial hypotension [maria-online.com]

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Parkinson's Disease Type 3

This ultimately leads to hyperreflexia, an exaggerated deep tendon reflex. [en.wikipedia.org]

[…] apathy, anxiety disorders (including panic disorders, generalized anxiety disorder, and social phobia), depression, psychosis (hallucinations), behavioral disturbances (agitation [orpha.net]

[…] or presence of orthostatic hypotension at the screening or baseline visit defined as greater than or equal to 20 mmHg change in systolic BP and greater than or equal to 10 [clinicaltrials.gov]

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Spinal Neoplasm

Physical Findings on physical examination correspond to the location of the tumor, degree of cord impingement, and duration, and may include the following: Spasticity; hyperreflexia [emedicine.medscape.com]

[…] steroids are taken over a longer time and will improve when your steroids are reduced • difficulty sleeping – avoid taking your steroids after 6pm • feeling restless or agitated [macmillan.org.uk]

Effect of intraoperative hypotension and hypothermia on IOM In our study, six false positive MEP cases were with intraoperative hypotension and/ or hypothermia. [omicsonline.org]

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Hepatic Encephalopathy

Hepatic myelopathy [54] is characterized by a progressive spastic paraparesis accompanied by hyperreflexia and extensor plantar responses. [hindawi.com]

Extreme confusion, along with sleepiness and/or an agitated mood, are symptoms of a condition called hepatic encephalopathy. [catie.ca]

[…] protein Portosystemic shunt (iatrogenic and spontaneous) Impaired toxin clearance Dehydration due to excessive fluid restriction, excessive diuresis or paracentesis, diarrhea Hypotension [cancertherapyadvisor.com]

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Spinal Cord Injury

Spasticity is characterized as hyperreflexia and hypertonicity as a result of damage to the supraspinal tracts in the aftermath of SCI. [ncbi.nlm.nih.gov]

The long backboard can induce pain, patient agitation, and respiratory compromise. [doi.org]

The patient also had orthostatic hypotension and post-prandial hypotension associated with an increased insulin level. [ncbi.nlm.nih.gov]

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Spinal Cord Tumor

Effect of intraoperative hypotension and hypothermia on IOM In our study, six false positive MEP cases were with intraoperative hypotension and/ or hypothermia. [omicsonline.org]

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Amyotrophic Lateral Sclerosis Type 1

hyperreflexia ( ) Hoffman's ( ) Babinski's spastic dysarthria lower motor neuron (LMN) signs muscular atrophy weakness clinical fasciculations clumsiness Evaluation Diagnosis [orthobullets.com]

[…] serotonin reuptake inhibitors such as fluoxetine (Prozac), in a dosage of 20 mg once or twice daily, are effective but have the potential adverse effects of insomnia and agitation [aafp.org]

On physical exam, signs of hyperreflexia, spasticity, fasciculations, and muscle atrophy are present in an asymmetric fashion. Tongue fasciculations are also present. [medbullets.com]

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Parkinson Disease

Unlike Parkinson disease, corticospinal tract lesions cause Paresis (weakness or paralysis), preferentially in distal antigravity muscles Hyperreflexia Extensor plantar responses [merckmanuals.com]

At this period the patient seldom experiences a suspension of the agitation of his limbs. [web.archive.org]

[…] orthostatic hypotension that manifests with falls or cognitive impairment, but without postural lightheadedness or near syncope. [ncbi.nlm.nih.gov]

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Meningeal Disorder

hyperreflexia/extensor plantar response (upgoing toe) vacuolar myelopathy vacuolation of myelin in the posterior and lateral columns of the primarily thoracic spinal cord [strokecenter.org]

These blood culture systems continuously and simultaneously monitor, agitate and incubate blood culture vials. [kolweb.lf2.cuni.cz]

[…] disorders of nervous system, not elsewhere classified G97.0 Cerebrospinal fluid leak from spinal puncture G97.1 Other reaction to spinal and lumbar puncture G97.2 Intracranial hypotension [icd10data.com]

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