Bastian Bruns sign

Bastian-Bruns sign
Specialty	Neurology
Symptoms	Loss of deep tendon reflexes below the level of a spinal cord lesion
Causes	Spinal cord injury
Diagnostic method	Clinical examination
Treatment	Addressing the underlying cause of the spinal cord lesion

The Bastian-Bruns sign is a clinical neurological sign indicative of a specific type of spinal cord injury. It is characterized by the loss of deep tendon reflexes below the level of a spinal cord lesion, despite the presence of an upper motor neuron lesion. This sign is named after the German neurologists Heinrich Bastian and Ludwig Bruns, who first described it.

Pathophysiology

The Bastian-Bruns sign occurs in the context of a spinal cord injury that affects the upper motor neurons. Normally, an upper motor neuron lesion would lead to hyperreflexia due to the loss of inhibitory control from the brain. However, in the case of the Bastian-Bruns sign, there is a paradoxical loss of reflexes. This is thought to be due to the acute phase of spinal shock, where the spinal cord below the level of the lesion becomes temporarily non-functional, leading to areflexia.

Clinical Presentation

Patients with the Bastian-Bruns sign will present with:

• Loss of deep tendon reflexes below the level of the spinal cord lesion.
• Other signs of upper motor neuron lesions, such as spasticity and weakness, may be present above the level of the lesion.
• Sensory deficits may also be observed, depending on the extent and location of the spinal cord injury.

Diagnosis

The diagnosis of the Bastian-Bruns sign is primarily clinical, based on the observation of reflex changes in the context of a known or suspected spinal cord injury. Additional diagnostic tools may include:

• Magnetic Resonance Imaging (MRI) to visualize the spinal cord and identify the level and extent of the lesion.
• Electromyography (EMG) and nerve conduction studies to assess the function of the peripheral nerves and muscles.

Treatment

Treatment of the Bastian-Bruns sign involves addressing the underlying cause of the spinal cord injury. This may include:

• Surgical intervention to relieve compression on the spinal cord.
• Rehabilitation therapies to improve function and mobility.
• Medications to manage symptoms such as spasticity and pain.

Prognosis

The prognosis for patients with the Bastian-Bruns sign depends on the severity and cause of the spinal cord injury. Early intervention and rehabilitation can improve outcomes, but some patients may experience long-term deficits.

History

The Bastian-Bruns sign was first described in the late 19th century by Heinrich Bastian and Ludwig Bruns, who were pioneers in the study of neurological disorders. Their work laid the foundation for understanding the complex interactions between the central and peripheral nervous systems in the context of spinal cord injuries.

Also see

• Spinal shock
• Upper motor neuron lesion
• Deep tendon reflex
• Spinal cord injury

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External links

• Comprehensive information from the National Institute of health.
  

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