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60Bulbar is defined in Dorland's Medical Dictionary as "pertaining to or involving the medulla oblongata". Thus, examination of the bulbar system pertains to examination of the function of lower cranial nerves originated from the medulla oblongata, i.e. 9th to 12th cranial nerves.Asymmetry of structure (atrophy), persistent movement at rest (fasciculation and tremor), with movement (deviation and tremor), and absence or impaired reflex activities are the usual clinical observations interpreted as indicative of pathology in clinical examination of the bulbar system. There is considerable range of normality in the function of the bulbar structure particularly among the elderly in the healthy population. For ABSTRACT: Background and Objectives: There is lack of published data on bulbar signs among the healthy population. This study aims to determine the range of normality of bulbar signs particularly among the elderly. Methods: Systemic examination of bulbar signs was carried out according to a predetermined protocol on a cohort of young and elderly healthy subjects. Results: A total of 206 subjects were recruited in the study, 104 young adults with mean age of 20 years, and 102 elderly with mean age of 73 years. Uvula deviation was seen in 28 (26.9%) young subjects and 22 (21.6%) elderly. Irregular tongue border was seen in 17 subjects, unilateral in 4 subjects. Fourteen (6.8%) subjects had deviation on tongue protrusion. Occasional tremor of tongue on protrusion is common in both young and old. Persistent (severe) tongue tremor on protrusion was seen in 18.6% of the elderly, and 4.8% of the young. None of the subjects had tremor of tongue at rest. In gag reflex, absence of gagging response was common in elderly, seen in two thirds of the subjects on stimulation of the posterior pharyngeal wall. However, all the subjects had uvular movement. Habituation or suppression of gagging response was seen in close to 90% of young males. Conclusion: There is wide range of normality in bulbar signs in normal population, particularly among the elderly. RÉSUMÉ: Signes bulbaires dans la population normale. Contexte et objectifs :Il n'existe pas de données dans la littérature sur la présence de signes bulbaires dans la population en bonne santé. Le but de cette étude était de déterminer les limites de la normale concernant la présence de signes bulbaires, particulièrement chez les gens âgés. Méthodes : Nous avons examiné systématiquement une cohorte de sujets jeunes et de sujets âgés en bonne santé pour détecter des signes bulbaires selon un protocole prédéterminé. Résultats : Nous avons recruté 206 sujets, soit 104 jeunes adultes dont l'âge moyen était de 20 ans et 102 sujets âgés dont l'âge moyen était de 73 ans. Une déviation de la luette a été observée chez 28 sujets jeunes (26,9%) et chez 22 sujets âgés (21,6%) ; le bord de la langue était irrégulier chez 17 sujets et c'était unilatéral chez 4 ; 14 sujets (6,8%) avaient une déviation de la langue à la protraction ; un tremblement occasionnel de la langue à la protraction es...

Introduction:Approximately 5%–11% of neurologically normal population has extensor plantar response (EPR).Method:This study is aimed to identify differentiating features of EPR between physiological and pathological population.Results:A total of 43 patients with pyramidal lesions and 113 normal controls were recruited for this study. The pathological EPRs were more reproducible, with 89.4% having at least two positive Babinski responses and 91.5% having two positive Chaddock responses (vs. 14.3% and 4.8% in controls, P < 0.001). The pathological EPR was more sensitive to stimulation, in which 89.1% were elicited when the stimulation reached mid-lateral sole (vs. 11.9% in controls, P < 0.001). Most (93.6%) pathological cases had sustained big toe extension throughout stimulation (vs. 73.8% in controls, P < 0.001). As compared to those with brain lesion, the plantar responses in those with spinal lesion are less likely to have ankle dorsiflexion (5.3% vs. 25%, P < 0.05) more likely to have sustained extensor response with Babinski (94.7% vs. 71.4%, P < 0.05), Chaddock (89.5% vs. 64.3%, P < 0.05), and Schaefer (26.3% vs. 3.6%, P < 0.05) methods. A scoring system was computed using four variables, i.e., two consecutive positive Babinski or Chaddock responses, extensor response at mid-lateral sole, and sustained extension throughout stimulation. A score ≥3 is predictive of pathological origin, with sensitivity and specificity of 78.7% and 95.2%, respectively.Conclusion:The pathological EPR is more reproducible, sensitive to stimulation, and sustainable compared to physiological extensor response.

Background: Kaposiform hemangioendothelioma (KH) is an uncommon tumor in infants and children. The typical clinical presentations include ill-demarcated, red to purple, indurated plaque and are frequently complicated by the Kasabach-Merritt phenomenon (KMP), a condition of severe thrombocytopenia and consumptive coagulopathy. It might be misdiagnosed as infantile hemangioma at birth, leading to a delay in delivering optimal treatment. Therefore, imaging differential diagnosis of KH should be included in pediatric patients presented with atypical vascular lesion for timely management. Case Presentation: We present a case of a 2-month-old male child, born with right lower limb hypertrophy and bluish discoloration, initially diagnosed as a hemangioma. Magnetic resonance imaging diagnosis was suggestive of KH complicated with KMP in correlating with clinical history. Therefore, optimal treatment is possible at a time if correct diagnosis is made early. Conclusion: KH should be retained as one of the differential diagnoses in pediatric patients presenting with vascular tumor. Imaging could help in reaching the diagnosis without invasive surgical interventions in order to initiate proper treatment.

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