Woltman sign

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Woltman sign
Differential diagnosis hypothyroidism or anorexia nervosa

Woltman's sign (also called Woltman's sign of hypothyroidism or, in older references, myxedema reflex [1] ) is a delayed relaxation phase of an elicited deep tendon reflex, usually tested in the Achilles tendon of the patient.

Contents

Woltman's sign is named for Henry Woltman, an American neurologist. [2]

Associated conditions

The delayed ankle jerks are associated with: [3] [4]

History

In 1924, [5] William Calvert Chaney (1888–1965), [6] who worked under Henry Woltman at the Mayo Clinic, seems to have been the first to publish a description of the sign, but Woltman had no authorship and was not mentioned in Chaney's manuscript. The eponym "Woltman's sign of myxedema" was first published in 1956 at the time of Woltman's retirement. [7]

Related Research Articles

<span class="mw-page-title-main">Congenital iodine deficiency syndrome</span> Medical condition

Congenital iodine deficiency syndrome is a medical condition present at birth marked by impaired physical and mental development, due to insufficient thyroid hormone (hypothyroidism) often caused by insufficient dietary iodine during pregnancy. It is one cause of underactive thyroid function at birth, called congenital hypothyroidism, historically referred to as cretinism (obsolete). If untreated, it results in impairment of both physical and mental development. Symptoms may include goiter, poor length growth in infants, reduced adult stature, thickened skin, hair loss, enlarged tongue, a protruding abdomen; delayed bone maturation and puberty in children; and mental deterioration, neurological impairment, impeded ovulation, and infertility in adults.

Kocher–Debré–Semelaigne syndrome is hypothyroidism in infancy or childhood characterised by lower extremity or generalized muscular hypertrophy, myxoedema, short stature and cognitive impairment. The absence of painful spasms and pseudo-myotonia differentiates this syndrome from its adult form, which is Hoffmann syndrome.

<span class="mw-page-title-main">Hypothyroidism</span> Endocrine disease

Hypothyroidism is a disorder of the endocrine system in which the thyroid gland does not produce enough thyroid hormone. It can cause a number of symptoms, such as poor ability to tolerate cold, a feeling of tiredness, constipation, slow heart rate, depression, and weight gain. Occasionally there may be swelling of the front part of the neck due to goitre. Untreated cases of hypothyroidism during pregnancy can lead to delays in growth and intellectual development in the baby or congenital iodine deficiency syndrome.

The ankle jerk reflex, also known as the Achilles reflex, occurs when the Achilles tendon is tapped while the foot is dorsiflexed. It is a type of stretch reflex that tests the function of the gastrocnemius muscle and the nerve that supplies it. A positive result would be the jerking of the foot towards its plantar surface. Being a deep tendon reflex, it is monosynaptic. It is also a stretch reflex. These are monosynaptic spinal segmental reflexes. When they are intact, integrity of the following is confirmed: cutaneous innervation, motor supply, and cortical input to the corresponding spinal segment.

In biology, a reflex, or reflex action, is an involuntary, unplanned sequence or action and nearly instantaneous response to a stimulus.

<span class="mw-page-title-main">Plantar reflex</span> Reflex elicited when the sole of the foot is stimulated with a blunt instrument

The plantar reflex is a reflex elicited when the sole of the foot is stimulated with a blunt instrument. The reflex can take one of two forms. In healthy adults, the plantar reflex causes a downward response of the hallux (flexion). An upward response (extension) of the hallux is known as the Babinski response or Babinski sign, named after the neurologist Joseph Babinski. The presence of the Babinski sign can identify disease of the spinal cord and brain in adults, and also exists as a primitive reflex in infants.

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

Myxedema is a term used synonymously with severe hypothyroidism. However, the term is also used to describe a dermatological change that can occur in hypothyroidism and (rare) paradoxical cases of hyperthyroidism. In this latter sense, myxedema refers to deposition of mucopolysaccharides in the dermis, which results in swelling of the affected area. One manifestation of myxedema occurring in the lower limb is pretibial myxedema, a hallmark of Graves disease, an autoimmune form of hyperthyroidism. Myxedema can also occur in Hashimoto thyroiditis and other long-standing forms of hypothyroidism.

<span class="mw-page-title-main">Patellar reflex</span> Monosynaptic reflex

The patellar reflex, also called the knee reflex or knee-jerk, is a stretch reflex which tests the L2, L3, and L4 segments of the spinal cord. Many animals, most significantly humans, have been seen to have the patellar reflex, including dogs, cats, horses, and other mammalian species.

The jaw jerk reflex or the masseter reflex is a stretch reflex used to test the status of a patient's trigeminal nerve and to help distinguish an upper cervical cord compression from lesions that are above the foramen magnum. The mandible—or lower jaw—is tapped at a downward angle just below the lips at the chin while the mouth is held slightly open. In response, the masseter muscles will jerk the mandible upwards. Normally this reflex is absent or very slight. However, in individuals with upper motor neuron lesions the jaw jerk reflex can be quite pronounced.

Myxedema psychosis is a relatively uncommon consequence of hypothyroidism, such as in Hashimoto's thyroiditis or in patients who have had the thyroid surgically removed and are not taking thyroxine. A chronically under-active thyroid can lead to slowly progressive dementia, delirium, and in extreme cases to hallucinations, coma, or psychosis, particularly in the elderly.

<span class="mw-page-title-main">Adie syndrome</span> Neurological disorder

Adie syndrome, also known as Holmes-Adie syndrome, is a neurological disorder characterized by a tonically dilated pupil that reacts slowly to light but shows a more definite response to accommodation. It is frequently seen in females with absent knee or ankle jerks and impaired sweating.

<span class="mw-page-title-main">Stretch reflex</span> Muscle contraction in response to stretching

The stretch reflex, or more accurately "muscle stretch reflex", is a muscle contraction in response to stretching within the muscle. The reflex functions to maintain the muscle at a constant length. The term deep tendon reflex is often wrongfully used by many health workers and students to refer to this reflex. "Tendons have little to do with the response, other than being responsible for mechanically transmitting the sudden stretch from the reflex hammer to the muscle spindle. In addition, some muscles with stretch reflexes have no tendons ".

Desiccated thyroid, also known as thyroid extract, is thyroid gland that has been dried and powdered for medical use. It is used to treat hypothyroidism. It is less preferred than levothyroxine. It is taken by mouth. Maximal effects may take up to three weeks to occur.

Primitive reflexes are reflex actions originating in the central nervous system that are exhibited by normal infants, but not neurologically intact adults, in response to particular stimuli. These reflexes are suppressed by the development of the frontal lobes as a child transitions normally into child development. These primitive reflexes are also called infantile, infant or newborn reflexes.

<span class="mw-page-title-main">Édouard Brissaud</span>

Édouard Brissaud was a French physician and pathologist. He was taught by Jean Martin Charcot at Pitié-Salpêtrière Hospital. He had interests in a number of medical disciplines including motion disturbances, anatomy, neurology and psychiatry. He died of a brain tumour, aged 57.

Hoffmann's reflex is a neurological examination finding elicited by a reflex test which can help verify the presence or absence of issues arising from the corticospinal tract. It is named after neurologist Johann Hoffmann. Usually considered a pathological reflex in a clinical setting, the Hoffmann's reflex has also been used as a measure of spinal reflex processing (adaptation) in response to exercise training.

Myxedema coma is an extreme or decompensated form of hypothyroidism and while uncommon, is potentially lethal. A person may have laboratory values identical to a "normal" hypothyroid state, but a stressful event precipitates the myxedema coma state, usually in the elderly. Primary symptoms of myxedema coma are altered mental status and low body temperature. Low blood sugar, low blood pressure, hyponatremia, hypercapnia, hypoxia, slowed heart rate, and hypoventilation may also occur. Myxedema, although included in the name, is not necessarily seen in myxedema coma. Coma is also not necessarily seen in myxedema coma.

The Lazarus sign or Lazarus reflex is a reflex movement in brain-dead or brainstem failure patients, which causes them to briefly raise their arms and drop them crossed on their chests. The phenomenon is named after the Biblical figure Lazarus of Bethany, whom Jesus raised from the dead according to the Gospel of John.

Henry William Woltman was an American neurologist and the first neurologist at the Mayo Clinic in Rochester, MN. In his career as a research and clinical neurologist he discovered several new diseases, several of which still bear his name, including: Moersch-Woltman syndrome, the Woltman sign. Woltman obtained a BS in 1911 before proceeding to medical school.

References

  1. Houston CS (1958). "The diagnostic importance of the myxoedema reflex (Woltman's sign)". Canadian Medical Association Journal. 78 (2): 108–112. PMC   1829539 . PMID   13489635.
  2. "Woltman's sign of hypothyroidism". www.whonamedit.com.
  3. Dennis, Mark; Bowen, William Talbot; Cho, Lucy (2012). "Hyporeflexia/delayed ankle jerks". Mechanisms of Clinical Signs. Elsevier. p. 537. ISBN   9780729540759.
  4. Marinella MA (2004). Kamath B (ed.). "Review of Clinical Signs: Woltman's Sign of Hypothyroidism" (PDF). Hospital Physician. 40 (1): 31–32.
  5. Chaney WC (1924). "Tendon reflexes in myxedema: a valuable aid in diagnosis". Journal of the American Medical Association. 82 (25): 2013–2016. doi:10.1001/jama.1924.02650510013005.
  6. "William Calvert Chaney, ancestry.com".
  7. Burkholder D; Klaas J; Kumar N; Boes C (2013). "The Origin of Woltman's Sign of Myxedema (P05. 256)". Neurology. 80 (7 Supplement): P05-256.