Extensor plantar response

An 83-year-old woman developed coma, respiratory depression, hypotonia with generalized hyporeflexia, bilateral extensor plantar responses, and bullous eruptions containing serous fluid over the medial aspects of the knees after taking seven temazepam tablets (12). 

A 55-year-old man developed confusion, behavioral change, aggression, poor attention, disorientation in time, and impaired short-term memory. He had full ocular movements with no nystagmus, brisk deep tendon reflexes, and bilateral extensor plantar responses. He became progressively drowsy with myoclonic jerks and died 2 weeks later. 

A 36-year-old man with a history of substance abuse became unresponsive, with his eyes in mid-position gaze, with pinpoint pupils, brisk deep tendon reflexes, and bilateral extensor plantar responses. On day 9 he spontaneously opened his eyes. However, he died 1 month later with persistent pyrexia from methicillin resistant Staphylococcus aureus. 

Consciousness is commonly dulled and respiration depression and h5q othermia may develop. Neurological signs include hyperreflexia, myoclonus and divergent strabismus. Extensor plantar responses may accompany lesser degrees of impaired... 

Lidocaine has been used to treat some of the symptoms of multiple sclerosis in 30 patients with painful tonic seizures, attacks of neuralgia, paroxysmal itching, and Lhermitte s sign (8). Lidocaine was given by intravenous infusion for 5.5 hours in a maintenance dose of 2.0-2.8 mg/kg/hour after a loading dose, and the mean steady-state concentration was 2.4 pg/ml. Lidocaine almost completely abolished the paroxysmal symptoms and markedly alleviated the persistent symptoms of multiple sclerosis. Adverse effects were not specifically mentioned, but in one case, when the plasma concentration of lidocaine rose above 3.5 qg/ml, weakness of the left leg became marked and was associated with an extensor plantar response this disappeared when the lidocaine was replaced by saline single-blind, but subsequently the positive symptoms recurred. 

Examination-. He has prominent weakness and atrophy of the right deltoid, biceps, triceps, and finger-extensor muscles and moderate-prominent weakness of the same muscles on the left. Occasional fascieolations were evident in muscles of both upper limbs. Tendon reflexes were absent in both upper limbs and moderately reduced in the lower limbs. Plantar responses were flexor. Sensory and cerebellar examination was normal. 

At the medial ankle, the tibial nerve, a continuation of the medial trunk of the sciatic nerve, passes deep to the flexor retinaculum in the space between the medial malleolus and the medial wall of the calcaneus (Fig. 16.10a). The retinaculum consists of a thin fascia and forms the roof of the tarsal tunnel (Fig. 16.10). In addition to the nerve, the tarsal tunnel encloses the tibialis posterior, flexor digitorum longus and flexor hallucis longus tendons, the posterior tibial artery and two veins (Fig. 16.10a,b). Posteroinferior to the medial malleolus, the tibial nerve divides into the medial and lateral plantar nerves and the calcaneal nerve, which is responsible for the sensitive supply of the heel (Fig. 16.11). The plantar nerves supply the intrinsic foot muscles, except for the extensor digitorum brevis, which is innervated by the deep peroneal nerve. The posterior tibial artery accompanies the nerve deep to the flexor retinaculum and, inferior to the medial malleolus, it divides into medial and lateral plantar arteries (Fig. 16.11). 

---