Trousseau sign of latent tetany

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Trousseau sign of latent tetany
Trousseau's Sign of Latent Tetany.jpg
The flexed wrist and metacarpophalangeal joint, and the extended distal and proximal interphalangeal joint are characteristic of Trousseau sign of latent tetany.
Differential diagnosis low calcium

Trousseau sign of latent tetany is a medical sign observed in patients with low calcium. [1] From 1 to 4 percent of normal patients will test positive for Trousseau's sign of latent tetany. [2] This sign may be positive before other manifestations of hypocalcemia such as hyperreflexia and tetany, as such it is generally believed to be more sensitive (94%) than the Chvostek sign (29%) for hypocalcemia. [3] [4] This sign may also be observed as a symptom of hyperventilation syndrome as a result of hypocapnia-induced reduction of calcium levels in the blood. [5]

To elicit the sign, a blood pressure cuff is placed around the arm and inflated to a pressure greater than the systolic blood pressure and held in place for 3 minutes. This will occlude the brachial artery. In the absence of blood flow, the patient's hypocalcemia and subsequent neuromuscular irritability will induce spasm of the muscles of the hand and forearm. The wrist and metacarpophalangeal joints flex, the DIP and PIP joints extend, and the fingers adduct. The sign is also known as main d'accoucheur (French for "hand of the obstetrician ") because it supposedly resembles the position of an obstetrician's hand in delivering a baby. [6]

History

The sign is named after French physician Armand Trousseau, who described the phenomenon in 1861. [7] It is distinct from the Trousseau sign of malignancy, which is a type of abnormal blood clot due to certain types of cancer. [8]

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<span class="mw-page-title-main">Hypocalcemia</span> Low calcium levels in ones blood serum

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<span class="mw-page-title-main">Electrolyte imbalance</span> Medical condition

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<span class="mw-page-title-main">Hypocapnia</span> State of reduced carbon dioxide in the blood

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The Chvostek sign is a clinical sign that someone may have a low blood calcium level. The Chvostek sign is the abnormal twitching of muscles that are activated (innervated) by the facial nerve. When the facial nerve is tapped in front of the ear, the facial muscles on the same side of the face will contract sporadically. The muscles that control the nose, lips and eyebrows are often the ones that will spasm.

Trousseau sign is the name of two distinct phenomena observed in clinical medicine. Both are attributed to Armand Trousseau:

<span class="mw-page-title-main">Gitelman syndrome</span> Medical condition

Gitelman syndrome (GS) is an autosomal recessive kidney tubule disorder characterized by low blood levels of potassium and magnesium, decreased excretion of calcium in the urine, and elevated blood pH. It is the most frequent hereditary salt-losing tubulopathy. Gitelman syndrome is caused by disease-causing variants on both alleles of the SLC12A3 gene. The SLC12A3 gene encodes the thiazide-sensitive sodium-chloride cotransporter, which can be found in the distal convoluted tubule of the kidney.

<span class="mw-page-title-main">Armand Trousseau</span> French physician

Armand Trousseau was a French internist. His contributions to medicine include Trousseau sign of malignancy, Trousseau sign of latent tetany, Trousseau–Lallemand bodies. He is sometimes credited with the quip "use new drugs quickly, while they still work", though Michel-Philippe Bouvart had said the same over 40 years earlier.

<span class="mw-page-title-main">Bartter syndrome</span> Medical condition

Bartter syndrome (BS) is a rare inherited disease characterised by a defect in the thick ascending limb of the loop of Henle, which results in low potassium levels (hypokalemia), increased blood pH (alkalosis), and normal to low blood pressure. There are two types of Bartter syndrome: neonatal and classic. A closely associated disorder, Gitelman syndrome, is milder than both subtypes of Bartter syndrome.

Catastrophic antiphospholipid syndrome (CAPS), also known as Asherson's syndrome, is a rare autoimmune disease in which widespread, intravascular clotting causes multi-organ failure. The syndrome is caused by antiphospholipid antibodies that target a group of proteins in the body that are associated with phospholipids. These antibodies activate endothelial cells, platelets, and immune cells, ultimately causing a large inflammatory immune response and widespread clotting. CAPS was first described by Ronald Asherson in 1992. The syndrome exhibits thrombotic microangiopathy, multiple organ thromboses, and in some cases tissue necrosis and is considered an extreme or catastrophic variant of the antiphospholipid syndrome.

The Trousseau sign of malignancy or Trousseau's syndrome is a medical sign involving episodes of vessel inflammation due to blood clot (thrombophlebitis) which are recurrent or appearing in different locations over time. The location of the clot is tender and the clot can be felt as a nodule under the skin. Trousseau's syndrome is a rare variant of venous thrombosis that is characterized by recurrent, migratory thrombosis in superficial veins and in uncommon sites, such as the chest wall and arms. This syndrome is particularly associated with pancreatic, gastric and lung cancer and Trousseau's syndrome can be an early sign of cancer sometimes appearing months to years before the tumor would be otherwise detected. Heparin therapy is recommended to prevent future clots. The Trousseau sign of malignancy should not be confused with the Trousseau sign of latent tetany caused by low levels of calcium in the blood.

<span class="mw-page-title-main">Tetany</span> Medical condition, exhibiting involuntary contraction of muscles

Tetany or tetanic seizure is a medical sign consisting of the involuntary contraction of muscles, which may be caused by disorders that increase the action potential frequency of muscle cells or of the nerves that innervate them.

Kenny-Caffey syndrome type 2 (KCS2) is an extremely rare autosomal dominant genetic condition characterized by dwarfism, hypermetropia, microphthalmia, and skeletal abnormalities. This subtype of Kenny-Caffey syndrome is caused by a heterozygous mutation in the FAM111A gene (615292) on chromosome 11q12.

References

  1. Kumar, Abbas, Fausto. Pathologic Basis of Disease, 7th edition. Philadelphia: Elsevier-Saunders, 2005. 1188.
  2. Dennis, Mark; Bowen, William Talbot; Cho, Lucy (2012). "Trousseau's sign". Mechanisms of Clinical Signs. Elsevier. p. 555. ISBN   978-0729540759; pbk{{cite book}}: CS1 maint: postscript (link)
  3. Fonseca, OA; Calverley, JR (August 1967). "Neurological manifestations of hypoparathyroidism". Archives of Internal Medicine. 120 (2): 202–6. doi:10.1001/archinte.1967.00300020074009. PMID   4952674.
  4. Schaat M, Payne CA. Effect of diphenylhydantoin and phenobarbital on latent tetany
  5. "Hyperventilation Syndrome Clinical Presentation: History, Physical Examination". emedicine.medscape.com. Retrieved 2024-05-24.
  6. "Main d'accoucheur - Oxford Reference". www.oxfordreference.com.
  7. Trousseau a. Clinique médicale de l'Hôtel-Dieu de Paris. Paris, 1861. Volume 2: 112-114.
  8. Trousseau's sign of visceral malignancy in GPnotebook, retrieved May 2022