By E. Gunock. Queens College.
Aphemia was the name originally given by Broca to the language disorder subsequently named “Broca’s aphasia order azithromycin 500mg on line antibiotics for uti infection. Broca’s aphasia is sometimes associated with a right hemiparesis discount 500mg azithromycin mastercard antibiotic resistance patterns, especially affecting the arm and face; there may also be bucco-lingual-facial dyspraxia. Classically Broca’s aphasia is associated with a vascular lesion of the third frontal gyrus in the inferior frontal lobe (Broca’s area), but in practice such a circumscribed lesion is seldom seen. More commonly there is infarction in the perisylvian region affecting the insula and operculum (Brodmann areas 44 and 45), which may include underly- ing white matter and the basal ganglia (territory of the superior branch of the middle cerebral artery). The terms “small Broca’s aphasia,” “mini-Broca’s aphasia,” and “Broca’s area aphasia,” have been reserved for a more circumscribed clinical and neuroanatomical deficit than Broca’s aphasia, wherein the damage is restricted to Broca’s area or its subjacent white matter. There is a mild and transient aphasia or anomia which may share some of the characteristics of aphemia/phonetic disintegration (i. Broca’s area aphasias: apha- sia after lesions including the frontal operculum. Neurology 1990; 40: 353-362 Mohr JP, Pessin MS, Finkelstein S, Funkenstein HH, Duncan GW, Davis KR. London: Imperial College Press, 2003: 84-89 Cross References Agrammatism; Agraphia; Alexia; Aphasia; Aphemia; Aprosodia, Aprosody; Paraphasia; Wernicke’s aphasia Brown-Séquard Syndrome The Brown-Séquard syndrome is the consequence of anatomical or, more usually, functional hemisection of the spinal cord (spinal hemisec- tion syndrome), producing the following pattern of clinical findings: ● Motor: Ipsilateral spastic weakness, due to corticospinal tract involvement - 60 - Bruit B Segmental lower motor neurone signs at the level of the lesion, due to root and/or anterior horn cell involvement. Spinal cord lesions producing this syndrome may be either extramedullary (e. Lancet 2000; 356: 61-63 Cross References Dissociated sensory loss; Myelopathy; Proprioception; Spasticity; Weakness Brudzinski’s (Neck) Sign Brudzinski described a number of signs, but the one most often used in clinical practice is the neck sign, which is sometimes evident in cases of meningeal irritation, for example due to meningitis. Passive flexion of the neck to bring the head onto the chest is accompanied by flexion of the thighs and legs. As with nuchal rigidity and Kernig’s sign, Brudzinski’s sign may be absent in elderly or immunosuppressed patients with meningeal irritation. London: Imperial College Press, 2003: 365-366 Cross References Kernig’s sign; Meningism; Nuchal rigidity Bruit Bruits arise from turbulent blood flow causing arterial wall vibrations that are audible at the body surface with the unassisted ear or with a stethoscope (diaphragm rather than bell, better for detecting higher frequency sounds). They are associated with stenotic vessels or fistulae where there is arteriovenous shunting of blood. Dependent on the clin- ical indication, various sites may be auscultated: eye for orbital bruit in carotico-cavernous fistula; head for bruit of AV fistula; but proba- bly the most frequently auscultated region is the carotid bifurcation, high up under the angle of the jaw, in individuals thought to have had - 61 - B Bruxism a transient ischemic attack or ischemic stroke. Examination for carotid bruits in asymptomatic individuals is probably best avoided, other than in the clinical trial setting, since the optimal management of asymptomatic carotid artery stenosis has yet to be defined. Practical Neurology 2002; 2: 221-224 Bruxism Bruxism is forcible grinding or gnashing of the teeth. This is common in children, and as a parasomnia, said to occur in 5-20% of the popu- lation during nonREM sleep. Dysfunction of efferent and/or afferent thalamic and stri- atopallidal tracts has been suggested as the neural substrate. If necessary, a rubber device or bite may be worn in the mouth to protect the teeth. Psychological Bulletin 1977; 84: 767-781 Cross References Encephalopathy; Masseter hypertrophy Buccofacial Dyspraxia - see OROFACIAL DYSPRAXIA Bulbar Palsy Bulbar palsy is weakness of bulbar musculature of lower motor neu- rone origin. This may be differentiated clinically from bulbar weakness of upper motor neurone origin (pseudobulbar palsy). Clinical features of bulbar palsy include: Dysarthria of flaccid/nasal type Dysphonia Dysphagia, often with nasal regurgitation Weak (“bovine”) cough; risk of aspiration +/− Wasted, fasciculating tongue +/− absent jaw jerk +/− absent gag reflex. Recognized causes include: ● Brainstem disorders affecting cranial nerve motor nuclei (intrin- sic): motor neurone disease (which may also cause a pseudobul- bar palsy) poliomyelitis glioma syringobulbia - 62 - Butt-First Maneuver B ● Cranial nerve lesions outside the brainstem (there may be associ- ated sensory signs): Infiltration by carcinoma, granuloma ● Neuromuscular junction transmission defect: myasthenia gravis. A myogenic bulbar palsy may be seen in oculopharyngeal muscular dystrophy, inclusion body myositis, or polymyositis. Cross References Bovine cough; Dysarthria; Dysphagia; Dysphonia; Fasciculation; Gag reflex; Jaw jerk; Lower motor neurone (LMN) syndrome; Pseudobulbar palsy; Upper motor neurone (UMN) syndrome Bulbocavernosus Reflex A test of the integrity of the S2, S3 and S4 spinal roots, looking for contraction of the anal sphincter (may be felt with a gloved finger in the rectum) when squeezing the glans penis or clitoris. Cross References Cauda equina syndrome; Reflexes Buphthalmos Buphthalmos, or ox-eye, consists of a large and bulging eye caused by raised intraocular pressure due to congenital or secondary glaucoma. Cacosmia - see PAROSMIA Calf Hypertrophy Calf enlargement has many causes; it may reflect true hypertrophy (enlargement of muscle fibers) or, more commonly, pseudohypertro- phy, due to infiltration with tissue elements other than muscle.
Does this person have emotional prob- lems or stresses on their shoulders that’s causing this problem? Generic According to Lowenberg (1992) a central parameter of alternative healing from the practitioner perspective is belief in the uniqueness of the indi- vidual versus the allopathic medical assumption of generic disease and treatment regimes (Mishler 1989) cheap 100 mg azithromycin fast delivery treatment for uti in goats. Thus a few informants mentioned that order 100mg azithromycin visa antibiotics qt prolongation, in contrast to a biomedical understanding, within alternative healing symp- toms vary from person to person. Furthermore, what works as a remedy for one person may not work for another. Lindsay explained it this way: “Finding out more of what of how a person works as opposed to every- body’s symptoms mean the same thing, just giving everybody the same thing.... Curative For several of the people who took part in the interviews, alternative healing is preventative, versus allopathic healing, which is cure-oriented An Alternative Model of Healing | 57 (Deierlein 1994; McGuire and Kantor 1987; O’Connor 1995; Pawluch et al. Natalie, a practitioner as well as a user of alternative therapies, believes that “traditional medicine is definitely not preventative medicine; mine’s more preventative. There are diseases today that are horrendous that medication does wonders for, but [doctors are] totally mystified in preventing. For example, Lindsay and Greg both believe that allopathic therapy treats symptoms rather than addressing the underlying cause of health problems. According to Lindsay, “The problem I have with Western medicine, they treat the symptoms, not the problem. Don’t just treat the fact that the nerves are pinched; treat the fact that you can fix why it’s being pinched. Chemical Most of these informants defined alternative healing by claiming that alternative therapies are natural, versus allopathic medicine, which is chemically produced (Pretorius 1993; Sharma 1992); or in Natalie’s words, poisonous: “They push pills, and pills I do not like taking, except for the odd vitamin. I don’t think there is anything you put into your body that’s so poisonous like a pill. I think it will keep you alive, but that’s all it’s doing; it’s not really healing. I don’t mean that I’m averse to taking penicillin or anything, but if you can help it, I don’t believe in taking chemicalized things, synthetics. Fast and Brutal Several of these informants said that one difference between allopathic and alternative approaches is that alternative healing takes time, versus 58 | Using Alternative Therapies: A Qualitative Analysis allopathic treatment, which produces quick results (Glik 1988). Natural healing is the whole body, not just this, this, and this we’re correcting: it’s total health. In Nora’s words, “I really do think that allopathic medicine is really slam bang. Invasive Most of the people who participated in this research said that alternative therapies are different from allopathic medicine because they are non- invasive (Coward 1989; Cant and Calnan 1991; Goldstein et al. In telling me why she chose a midwife for the birth of her child, Laura said, “I wanted a home birth because I wanted to avoid unnecessary medical intervention during the labour and delivery. If you’re prepared to undergo the knife, and all the problems and complications that could happen, rather than looking at another method that may be able to prevent surgery, why would you not think about it? These people also believe that the invasive nature of allopathic medical therapy puts them at risk of “clinical iatrogenesis” (Illich 1975:22). For example, more than half the people I spoke with were concerned about unpleasant and/or dangerous side effects caused by medication (Monson 1995; Pawluch et al. In Laura’s words, “Garlic and vitamin C may not work as well as an antibiotic, but it works enough to justify its use and it doesn’t have the side effects. An Alternative Model of Healing | 59 According to Marie, “It was very hard getting off the muscle relaxants, the codeine, the over-the-counter pain medication. I’ve had high blood pressure for five years now, because anyone I know who has gone on the medication, you never come off of it. Some people when they come off the pills, boom: they’ve had a stroke or a heart attack because the body can’t regulate itself without that medication any more. In contrast to the dangers they felt were inherent in allopathic medical treatment, these informants believe that alternative therapies are non- invasive, non-iatrogenic, and consequently safe to use, a belief mirrored in general lay perceptions of alternative approaches to healing (Boon et al. Grace put it this way: “What the ear candling can do, they go back to their doctor after it’s been done and the ear’s fine, or maybe just a little more cleaning needs to be done. You could take the whole rack and other than having a real lactose kind of over-reaction and sugar reaction, you know it’s not going to harm you. In describing their encounters with alternative practitioners, they often began by giving an account of an unpleasant interaction with a physician, which they then contrasted with a positive depiction of their relationships with alternative practitioners. Simply put, what they value about alternative practitioners is that they are not medical doctors.