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Corneal Reflex

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521. Difficulties with the neurological assessment of humans following a chimpanzee attack. (Full text)

, soft-tissue, and eye injuries, and scalp degloving. An emergency tracheotomy was performed at the scene, with an unclear duration of hypoxia. The patient was unresponsive without spontaneous movements, papillary or corneal reflexes, cough, or gag. Attempts to lighten sedation were not tolerated. Brain CTs were normal. Intracranial pressure monitoring was deemed infeasible. Brain MR imaging suggested diffuse axonal injury consistent with severe shaking trauma. Diffusion tensor imaging indicated

2011 Journal of Neurosurgery

522. Predictors of poor neurologic outcome in patients after cardiac arrest treated with hypothermia: A retrospective study. (PubMed)

cardiac arrest treated with hypothermia. All data were collected from medical charts and laboratory files and analyzed from the day of admission to the intensive care unit until day 7, discharge from the intensive care unit or death using the Utstein definitions for the registration of the data.We analyzed the data of 103 patients. The combination of an M1 or M2 on the Glasgow Coma Scale or absent pupillary reactions or absent corneal reflexes on day 3 was present in 80.6% of patients (...) with an unfavourable and 11.1% of patients with a favourable outcome. The combination of M1 or M2 and absent pupillary reactions to light and absent corneal reflexes on day 3 was present in 14.9% of patients with an unfavourable and none of the patients with a favourable outcome. None of the patients with a favourable outcome had a bilaterally absent somatosensory evoked potential of the median nerve. The value of electroencephalogram patterns in predicting outcome was low, except for reactivity to noxious

2011 Resuscitation

523. Propofol and Etomidate Depress Cortical, Thalamic, and Reticular Formation Neurons During Anesthetic-Induced Unconsciousness. (Full text)

an anesthetic effect; peak power occurred at 12 to 13 Hz during propofol infusion. There were 2 major peaks during etomidate anesthesia: one at 12 to 14 Hz and another at 7 to 8 Hz. The cats were heavily sedated, with depressed corneal and whisker reflexes; withdrawal to noxious stimulation remained intact.These data show that neurons in the cortex, thalamus, and reticular formation are similarly depressed by propofol and etomidate. Although anesthetic depression of neuronal activity likely contributes

2011 Anesthesia and Analgesia

524. DASH After TBI Study: Decreasing Adrenergic or Sympathetic Hyperactivity After Traumatic Brain Injury

Criteria: Pre-existing heart disease (i.e. coronary heart disease) Pre-existing cardiac dysrhythmia Allergy to study drugs Penetrating brain injury Pre-existing brain dysfunction (i.e. prior severe TBI, debilitating stroke) Impending brain herniation (i.e. loss of bilateral corneal reflexes) Craniectomy or craniotomy Spinal cord injury Myocardial injury Severe liver disease Current use of beta-blockers and/or alpha-2-agonist Withdrawal of care expected in 24 hours Prisoners Pregnant women Unable

2011 Clinical Trials

525. Aphakia Versus Pseudophakia in Children Under 2 Years Undergoing Bilateral Congenital Cataract Surgery

) assesed on slitlamp or under operating microscope in dilated pupil.VAO is defined as fibrous or proliferative cell growth leadind to a dull retinoscopic reflex. Glaucoma [ Time Frame: 4 years ] Intraocular pressure (IOP) measured with Perkins handheld applanation tonometer. Glaucoma defined as : IOP>21 mmHg >1 occasion with any of these 3 criteria Optic nerve cupping asymmetry >0.2 cd ratio asymmetry , CD ratio >0.4 Abnormal asymmetrical axial length elongation Corneal oedema or enlargement Central (...) Corneal Thickness [ Time Frame: 4 Years ] Corneal thickness assessed by ultrasonic pachymetry. An average of 3 values with an error less than 0.001 would be taken into account. Secondary Outcome Measures : Visual Acuity [ Time Frame: 4 years . ] An Objective visual assessment to be performed using Lea Grating Paddles(Grating Acuity Test developed by Lea Hyvarinen16), Cardiff Acuity Cards(Preferential Looking Test17), or ETDRS (Early Treatment of Diabetic Retinopathy Study) chart. Vision

2011 Clinical Trials

526. Use of Lipid Emulsion or Nanoemulsion of Propofol on Children Undergoing Ambulatory Invasive Procedures.

will be administered by 1mL per 5 seconds, adjustment dose can be given. Drug: propofol 3 - 4 mg/kg IV, adjustment dose if necessary Active Comparator: propofol lipid emulsion 3-4 mg/kg will be administered by 1 ml per 5 seconds. Drug: propofol 3 - 4 mg/kg IV, adjustment dose if necessary Outcome Measures Go to Primary Outcome Measures : Classification of the sedation level [ Time Frame: time 0 ] Instantly after the loss of consciousness (loss of corneal-palpebral reflex) will be measured the sedation using (...) the Ramsay Modified Scale. Secondary Outcome Measures : Time of latency [ Time Frame: 3-10 seconds ] Time between the injection and loss of the corneal-palpebral reflex Pain at injection [ Time Frame: 3 - 10 seconds: during the injection ] The pain will be measured by CHEOPS Scale which evaluates the behavior of the child against pain. Physician satisfaction [ Time Frame: 12 hours: end of procedure ] The satisfaction of the medical specialist will be assessed through a questionnaire that assesses

2011 Clinical Trials

527. Graves' ophthalmopathy (Full text)

/100,000 in women, 3/100,000 in men. About 3–5% have severe disease with intense pain, and sight-threatening corneal ulceration or compression of the optic nerve. Cigarette smoking, which is associated with many autoimmune diseases, raises the incidence 7.7-fold. Mild disease will often resolve and merely requires measures to reduce discomfort and dryness, such as artificial tears and if possible. Severe cases are a medical emergency, and are treated with (steroids), and sometimes . Many anti (...) is spastic. (1842–1932) Ballet's sign Paralysis of one or more EOM (1853–1916) Becker's sign Abnormal intense pulsation of retina's arteries (1828–1890) Boston's sign Jerky movements of upper lid on lower gaze (1871–1931) Cowen's sign Extensive hippus of consensual pupillary reflex Jack Posner Cowen, American ophthalmologist (1906–1989) Dalrymple's sign Upper eyelid retraction (1803–1852) Enroth's sign Edema esp. of the upper eyelid Emil Emanuel Enroth, Finnish ophthalmologist (1879–1953) Gifford's sign

2012 Wikipedia

528. Keratoconjunctivitis sicca (Full text)

cause the eyes to water. This can happen because the eyes are irritated. One may experience excessive tearing in the same way as one would if something got into the eye. These reflex tears will not necessarily make the eyes feel better. This is because they are the watery type that are produced in response to injury, irritation, or emotion. They do not have the lubricating qualities necessary to prevent dry eye. Because blinking coats the eye with tears, symptoms are worsened by activities in which (...) in dry eye, one of which is . Topical lacritin promotes tearing in rabbit preclinical studies. Also, topical treatment of eyes of dry eye mice (Aire knockout mouse model of dry eye) restored tearing, and suppressed both corneal staining and the size of inflammatory foci in lacrimal glands. Additional causes [ ] Aging is one of the most common causes of dry eyes because tear production decreases with age. Several classes of medications (both prescription and OTC) have been hypothesized as a major

2012 Wikipedia

529. Keratoconus

of different factors: genetic, environmental or cellular, any of which may form the trigger for the onset of the disease. Once initiated, the disease normally develops by progressive dissolution of , which lies between the corneal and . As the two come into contact, cellular and structural changes in the cornea adversely affect its integrity and lead to the bulging and scarring characteristic of the disorder. Within any individual keratoconic cornea, regions of degenerative thinning coexisting with regions (...) undergoing wound healing may be found. Scarring appears to be an aspect of the corneal degradation; however, a recent, large, multicenter study suggests abrasion by contact lenses may increase the likelihood of this finding by a factor over two. A number of studies have indicated keratoconic corneas show signs of increased activity by , a class of that break some of the cross-linkages in the stroma, with a simultaneous reduced of protease . Other studies have suggested that reduced activity by the enzyme

2012 Wikipedia

530. List of cutaneous conditions

) (generalized lichen myxedematosus, sclerodermoid lichen myxedematosus, scleromyxedema) (cutaneous mucinosis of infancy) (midline mucinosis, plaque-like cutaneous mucinosis, REM syndrome) (congenital fascial dystrophy) Neurocutaneous [ ] See also: Neurocutaneous conditions are due disease or are in . (dysmorphic syndrome, dysmorphophobia) (reflex sympathetic dystrophy) (delusions of parasitosis, Ekbom syndrome, monosymptomatic hypochondriacal psychosis) (dermatitis artefacta, factitial dermatitis) (burning (...) seed dermatoses, palmar keratoses, papulotranslucent acrokeratoderma, punctate keratoderma, punctate keratoses of the palms and soles, maculosa disseminata) (erythrokeratodermia progressiva Burns, ichthyosiform erythroderma with corneal involvement and deafness, KID syndrome) (acral keratoderma, Gamborg–Nielsen keratoderma, mutilating palmoplantar keratoderma of the Gamborg–Nielsen type, palmoplantar ectodermal dysplasia type VIII, palmoplantar keratoderma of the Norrbotten type) (diffuse non

2012 Wikipedia

531. Creutzfeldt-Jakob disease

, and . This is accompanied by physical problems such as impairment, balance and coordination dysfunction ( ), changes in , rigid . In most people with CJD, these symptoms are accompanied by and the appearance of an atypical, diagnostic tracing. The duration of the disease varies greatly, but sporadic (non-inherited) CJD can be fatal within months or even weeks. Most victims die six months after initial symptoms appear, often of due to impaired coughing reflexes. About 15% of people with CJD survive for two or more years (...) of suspected CJD was published in 1974. Animal experiments showed that corneas of infected animals could transmit CJD, and the causative agent spreads along visual pathways. A second case of CJD associated with a corneal transplant was reported without details. In 1977, CJD transmission caused by silver electrodes previously used in the brain of a person with CJD was first reported. Transmission occurred despite decontamination of the electrodes with ethanol and formaldehyde. Retrospective studies

2012 Wikipedia

532. Cavernous sinus thrombosis

are abrupt onset of unilateral periorbital , , , and bulging of the eye ( ). Other common signs and symptoms include: , , (III, IV, V, VI). Sixth nerve palsy is the most common. Sensory deficits of the ophthalmic and maxillary branch of the fifth nerve are common. Periorbital sensory loss and impaired corneal reflex may be noted. , , and decreased visual acuity and blindness may occur from venous congestion within the retina. , and may be present. Headache with may occur. may be dilated and sluggishly

2012 Wikipedia

533. Visual acuity

and functioning of the , and (iii) the sensitivity of the interpretative faculty of the brain. A common cause of low visual acuity is , or errors in how the light is refracted in the eyeball. Causes of refractive errors include aberrations in the shape of the or the , and reduced flexibility of the . Too high or too low refractive error (in relation to the length of the eyeball) is the cause of or (normal refractive status is referred to as ). Other optical causes are or more complex corneal irregularities (...) special attention to. A simple but less-used technique is checking oculomotor responses with an drum, where the subject is placed inside the drum and surrounded by rotating black and white stripes. This creates involuntary abrupt eye movements ( ) as the brain attempts to track the moving stripes. There is a good correspondence between the optokinetic and usual eye-chart acuities in adults. A potentially serious problem with this technique is that the process is reflexive and mediated in the low-level

2012 Wikipedia

534. General anaesthesia (Full text)

, also known as surgical anaesthesia , the skeletal muscles relax, vomiting stops, respiratory depression occurs, and eye movements slow and then stop. The patient is unconscious and ready for surgery. This stage is divided into four planes: The eyes roll, then become fixed; Corneal and laryngeal reflexes are lost; The pupils dilate and light reflex is lost; Intercostal paralysis and shallow abdominal respiration occur. Stage 4 Stage 4, also known as overdose , occurs when too much anaesthetic (...) or more general anaesthetic agents. It is carried out to allow medical procedures that would otherwise be intolerably painful for the patient; or where the nature of the procedure itself precludes the patient being awake. A variety of may be administered, with the overall aim of ensuring , , , loss of reflexes of the , and in some cases of . The optimal combination of drugs for any given patient and procedure is typically selected by an , or another provider such as an operating department

2012 Wikipedia

535. Fundus camera (Full text)

, and prominent corneal reflexes that reduced the clarity detail. It would be several decades before these problems could be rectified. There has been some controversy regarding the first ever successful human fundus photo. Most accounts state William Thomas Jackman and J.D. Webster since they published their technique along with a reproduction of a fundus image in two photography periodicals in 1886. Three other names played a prominent role in early fundus photography. According to some historical accounts

2012 Wikipedia

536. Familial dysautonomia

help by . Unsourced material may be challenged and . ( March 2009 ) ( ) Clinical diagnosis [ ] inheritance A clinical diagnosis of FD is supported by a constellation of criteria: No fungiform papillae on the tongue Decreased deep tendon reflexes Lack of an axon flare following intradermal histamine No overflow tears with emotional crying Genetic testing [ ] Genetic testing is performed on a small sample of blood from the tested individual. The is examined with a designed probe specific to the known (...) of corneal problems as well as the use of punctal cautery. This education has resulted in decreased corneal scarring and need for more aggressive surgical measures such as , conjunctival flaps, and . Epidemiology [ ] Familial dysautonomia is seen almost exclusively in Jews and is inherited in an autosomal fashion. Both parents must be carriers in order for a child to be affected. The carrier frequency in Jewish individuals of Eastern and Central European (Ashkenazi) ancestry is about 1/30, while

2012 Wikipedia

537. Facial nerve (Full text)

Nerve's innervation of the muscles of facial expression, namely , responsible for blinking. Thus, the corneal reflex effectively tests the proper functioning of both Cranial Nerves V and VII. Additional images [ ] Inferior view of the human brain, with the cranial nerves labelled. Mandibular division of the trifacial nerve. Plan of the facial and intermediate nerves and their communication with other nerves. The course and connections of the facial nerve in the . Upper part of medulla spinalis (...) as both upper and lower facial weakness on the same side of the lesion. Taste can be tested on the anterior 2/3 of the tongue. This can be tested with a swab dipped in a flavoured solution, or with electronic stimulation (similar to putting your tongue on a battery). . The afferent arc is mediated by the General Sensory afferents of the . The efferent arc occurs via the Facial Nerve. The reflex involves consensual blinking of both eyes in response to stimulation of one eye. This is due to the Facial

2012 Wikipedia

538. Eyeblink conditioning (Full text)

(the (CS)) with an eye -eliciting (US) (e.g. a mild puff of air to the cornea or a mild shock). Naïve organisms initially produce a reflexive, (UR) (e.g. blink or extension of nictitating membrane) that follows US onset. After many CS-US pairings, an association is formed such that a learned blink, or (CR), occurs and precedes US onset . The magnitude of is generally gauged by the percentage of all paired CS-US that result in a CR. Under optimal conditions, well-trained animals produce a high (...) onset precedes the US onset and the two stimuli overlap and coterminate, with the stimuli converging in the cerebellar cortex and interpositus nucleus . In the trace EBC, the CS precedes the US and there is a stimulus free period (trace interval) between CS offset and US onset. While both of these procedures require the , the trace procedure also requires the and medial prefrontal cortex. Neural circuitry [ ] The blink reflex [ ] When a US is delivered to the cornea of the eye, sensory information

2012 Wikipedia

539. Hyperkinesia (Full text)

: Head turning to shift eye position Facial movements, including grimaces Slow, uncontrolled movements Quick, sudden, sometimes wild jerking movements of the arms, legs, face, and other body parts Unsteady gait Abnormal reflexes “prancing,” or a wide walk The disease is characterized further by the gradual onset of defects in behavior and cognition, including dementia and speech impediments, beginning in the fourth or fifth decades of life. Death usually occurs within 10–20 years after a progressive (...) -onset DRPLA presents with ataxia and symptoms consistent with progressive myoclonus epilepsy (myoclonus, multiple seizure types and dementia). Other symptoms that have been described include cervical , corneal endothelial degeneration , and surgery-resistant . Management [ ] Athetosis, chorea and hemiballismus [ ] Before prescribing medication for these conditions which often resolve spontaneously, recommendations have pointed to improved skin hygiene, good hydration via fluids, good nutrition

2012 Wikipedia

540. Coma (Full text)

ear and the patient is observed for eye movement If the patient's eyes slowly deviate toward the ear where the water was injected, then the brainstem is intact, however failure to deviate toward the injected ear indicates damage of the brainstem on that side. The cortex is responsible for a rapid away from this deviated position and is often seen in patients who are conscious or merely lethargic. The corneal reflex assess the proper function of the (CN 5) and (CN 7) and is present at infancy (...) . Lightly touching the with a tissue or cotton swab induces a rapid blink reflex of both eyes. Touching the sclera or eyelashes, presenting a light flash, or stimulating the will induce a less rapid but still reliable response. Those in a comatose state will have altered corneal reflex depending on the severity of their unconscious and the location of their lesion. The gag, or pharyngeal, reflex is centered in the medulla and consists of the reflexive motor response of pharyngeal elevation

2012 Wikipedia

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