Lead pipe rigidity

Want to experience the greatest in board studying? Check out our interactive question bank podcast- the FIRST of its kind here: emrapidbombs.supercast.com Author:Daniel Phillips, MS4, Blake Briggs, MD Peer Reviewer:Mary Claire O’Brien, MD Introduction Neuroleptic Malignant Syndrome (NMS) is a rare, but life threatening, complication in patients on antipsychotic medications. Prior incidence rates for patients taking antipsychotic agents NMS are ~3%; however, incidence has dropped 38°C are typical, and occasionally temperatures can be >40°C. Autonomic instabilitymanifests as tachycardia, labile/high blood pressures, tachypnea, diffuse diaphoresis, and occasionally dysrhythmias. Associated lab findings are not diagnostic but can include elevated serum CK, leukocytosis, acute kidney failure. Diagnosis There is no diagnostic test for NMS, however it is important to rule out other diseases as well as monitor for complications of NMS. Brain imaging and LP are required to exclude structural intracranial disease & infection. EEG may be done if there is suspicion for to nonconvulsive status epilepticus. Differential Diagnosis 1.Serotonin syndrome – hyperreflexia, myoclonus, nausea/vomiting/diarrhea, more acute in onset, history of serotonergic medication initiation/increased dose. 2.Malignant hyperthermia – similar symptoms (hyperthermia, muscle rigidity, autonomic instability), but more severe and sudden in onset; hx succinylcholine/inhaled anesthetic– think recent intubation and/o...

The physical exam in Parkinson’s disease (PD) is essential both for making a diagnosis and following the patient over time. It consists of a series of tests and maneuvers that help us identify and evaluate the four main characteristics of the disease: - Bradykinesia - Rigidity - Tremor - Gait & Balance abnormalities In order to make a diagnosis, we must observe bradykinesia plus either one of the other motor abnormalities. Once a diagnosis is made and the patient is started on treatment, it is important to check these four features at every follow up visit, so that we can gauge the treatment based on how the exam has changed over time. Before beginning the interactive part of the physical exam, it is very important to focus on observing the patients while they are giving the history, to notice any motor disturbances present at rest. In particular we should focus on: - Spontaneous movements, generally reduced in PD - Hands gestures while talking, usually reduced or absent - Eyeblink, whose spontaneous rate is reduced - Resting tremor, usually affecting one hand only - Fidgeting and crossing/uncrossing of the legs, that may indicate dyskinesia, a complication of chronic Levodopa therapy It is important to remember that the inspection starts as soon as the patient walks in to the room. To test for the presence of bradykinesia we will have the patient perform rapid alternating movements. It is important to remember that these movements must be performed as fast as possible and...

Contents • 1 Background • 2 Clinical Features • 2.1 Complications • 3 Differential Diagnosis • 3.1 Movement Disorders and Other Abnormal Contractions • 3.2 Altered mental status and fever • 4 Evaluation • 4.1 Serotonin syndrome vs Neuroleptic malignant syndrome • 5 Management • 5.1 Supportive Care • 5.2 Directed Medical Therapy [6] • 5.3 Electroconvulsive Therapy • 6 Disposition • 7 See Also • 8 References Background • Life threatening neurologic emergency associated with the use of neuroleptic agents • Can occur with single dose, increasing dose, or same dose as usual • Most often seen with "typical" high potency antipsychotics ( • also occurs with newer "atypicals" ( • antiemetics ( • withdrawal of anti-Parkinson medication • Develops over 1-3 days • Majority of deaths occur from complications of muscle rigidity • Mortality rates up to 5 to 20% Clinical Features • Develops over 1-3 days • Tetrad of: • • Muscle rigidity - generalized, "lead pipe" rigidity • • Autonomic instability - Complications • • • • • • • Chest wall rigidity, aspiration • • • • Differential Diagnosis • • Serotonin syndrome more likely to have hyperreflexia, myoclonus, ataxia, nausea and vomiting, diarrhea • Rigidity and hyperthermia, if present, is less severe than in NMS; more commonly presents with clonus and hyperreflexia • • Distinguish by clinical setting (use of inhalational anesthetics or sux) • Hyperthermia, muscle rigidity, and dysautonomia is similar to NMS though more fulminant • • Diaphor...

In the neurology ward, there’s a mother with her child, named Justin, who is 2 years old. Justin’s mother is worried because she palpated a mass in his abdomen while bathing him. Justin also has been having episodes of rapid, dancing Okay, so all of them have movement disorders. The Alright, when it comes to Okay, the four cardinal symptoms of • "Robbins Basic Pathology" Elsevier (2017) • "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018) • "Neurology in Clinical Practice: Principles of diagnosis and management" Taylor & Francis (2004) • "Principles and Practice of Movement Disorders E-Book" Elsevier Health Sciences (2011) • "Mayo Clinic Neurology Board Review: Clinical Neurology for Initial Certification and MOC" Oxford University Press (2015) • "Movement Disorders in Neurologic and Systemic Disease" Cambridge University Press (2014) • "Movement Disorders in Childhood" Academic Press (2015) • "Parkinson’s Disease: Basic knowledge" Med Monatsschr Pharm (2016) • "Parkinson's disease" The Lancet (2015) Sitemap USMLE® is a joint program of the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME). COMLEX-USA® is a registered trademark of The National Board of Osteopathic Medical Examiners, Inc. NCLEX-RN® is a registered trademark of the National Council of State Boards of Nursing, Inc. Test names and other trademarks are the property of the respective trademark ...

Contents • What does cogwheel rigidity feel like? • How do you test for Parkinson’s disease? • What causes cogwheel rigidity? • What can be mistaken for Parkinson’s? • How do you test for bradykinesia? • What is cogwheel rigidity in medical terms? • How do you check for spasticity? • What is lead pipe rigidity? • What is lead pipe syndrome? • How do you determine spasticity and rigidity? • How do you assess for axial rigidity? • How do you manage rigidity? • What is meant by cogwheel? • What is cogwheel used for in Granny? • How do you detect early Parkinson’s? • What is truncal rigidity? • What is Hypokinetic? • How does Bradykinesia manifest at first? • What does Bradykinesia look like? • What are the four cardinal signs of Parkinson’s disease? • What is PSP syndrome? • Can blood test detect Parkinson’s disease? Diagnosing rigidity A doctor will test for rigidity by flexing and extending your relaxed wrist and the elbow joint. He or she will look for sustained (lead pipe) rigidity when performing these tests or intermittent (cogwheel) rigidity if you also have tremor. What does cogwheel rigidity feel like? In cogwheel rigidity, your limbs move with small jerky movements. It’s intermittent and ratchet-like. You might feel a click or catch in your muscle as you move your arm in a circular motion. Though cogwheel rigidity is found in other forms of Parkinsonism, it’s most common in Parkinson’s. How do you test for Parkinson’s disease? No specific test exists to diagnose Par...