Hyporeflexia

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Carlos A Lopez, M.D. [2]

Overview

Hyporeflexia is the condition of below normal or absent reflexes. It can be tested for by using a reflex hammer. Some examples of hyporeflexia are Lambert-Eaton myasthenic syndrome, Drug side effects of all-trans retinoic acid, cevimeline, clonidine, fluphenazine, Jansen's metaphyseal chondrodysplasia and Charcot-Marie-Tooth disease.

Causes

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.

• Spinal cord compression
• Stroke
• Penetrating neck injuries

Common Causes

• Becker muscular dystrophy
• Brown-Sequard syndrome
• Bulimia nervosa
• Down's syndrome
• Folate deficiency
• Friedreich ataxia
• Lambert-Eaton myasthenic syndrome
• Lower motor neuron lesion
• Opioid intoxication
• Vitamin E deficiency
• Stroke

Causes by Organ System

Cardiovascular	Stroke
Chemical / poisoning	Aftershave, barium sulfate, selenious acid, cone shell poisoning, erythrokeratodermia ataxia, eucalyptus oil poisoning, licorice, herbal agent overdose cleistanthus collinus, opioid intoxication, oriental hornet poisoning, potassium, snakebites, sea snake poisoning , white chameleon poisoning
Dermatologic	Vitamin E deficiency
Drug Side Effect	All-trans retinoic acid, cevimeline, clonidine, fluphenazine, imidazoline, lamotrigine, vincristine,lorazepam, nelarabine, oxazepam, oxcarbazepine, perphenazine, phenothiazine, prochlorperazine, saquinavir, thioridazine, tiagabine, trifluoperazine, venlafaxine, vigabatrin, zaleplon
Ear Nose Throat	ARTS syndrome
Endocrine	Hypokalemic thyrotoxic periodic paralysis
Environmental	No underlying causes
Gastroenterologic	Chylomicron retention disease
Genetic	Jansen's metaphyseal chondrodysplasia, Lambert-Eaton myasthenic syndrome, leigh's disease, lower motor neuron lesion, marinesco-Sjogren syndrome, NADH CoQ reductase deficiency, McLeod phenotype, Mental retardation, Miller fisher syndrome, mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes, multifocal motor neuropathy with conduction block, navajo neurohepatopathy, infantile neuroaxonal dystrophy, neuronal intranuclear hyaline inclusion disease, distal hereditary motor type VII, non-ketotic hyperglycemia, Pena-shokeir syndrome type 2, progressive external opthhalmoplegia, autosomal dominant 1, Roussy-levy syndrome, Smith-Magenis syndrome, Southwestern athabaskan genetic diseases, spastic tetraplegic -- cerebral palsy, spinal bulbar motor neuropathy, spinal muscular atrophy, spinocerebellar ataxia
Hematologic	Tang Hsi Ryu syndrome
Iatrogenic	No underlying causes
Infectious Disease	Lyme disease, quaternary syphilis, tabes dorsalis
Musculoskeletal / Ortho	Adducted thumb syndrome recessive form, arthrogryposis due to muscular dystrophy, becker muscular dystrophy, benign congenital hypotonia, brown-Sequard syndrome, bulimia nervosa, CAMFAK syndrome, cauda equina syndrome, cerebro-Oculo-Facio-Skeletal syndrome, charcot-Marie-Tooth disease, type 2, cockayne syndrome, complex 1 mitochondrial respiratory chain deficiency, congenital myopathy, conus medullaris syndrome, distal hereditary motor type VII, Down's syndrome, Duchenne muscular dystrophy, Dykes-Markes-Harper syndrome, emerinopathy, Erb-goldflam, Fazio Londe syndrome , Gerstmann-Straussler-Scheinker syndrome, Guillain-Barré syndrome, Holmes-Adie syndrome, hyperkalemic periodic paralysis, hypokalemic periodic paralysis, hypokalemic thyrotoxic periodic paralysis, Lambert-Eaton myasthenic syndrome, lower motor neuron lesion, muscular dystrophy, multifocal muscular fibrosis, nervous system injuries due to penetrating neck injury, Infantile neuroaxonal dystrophy, neuronal intranuclear hyaline inclusion disease, paramyotonia congenita, penetrating neck injuries, peripheral nerve and muscle disease, polymyositis, progressive external opthhalmoplegia, rommen-mueller-sybert syndrome, scapuloperoneal amyotrophy, schwartz-jampel syndrome, Smith-Magenis syndrome, spinal cord compression, spinal muscular atrophy, transverse myelitis, Treft-sanborn-carey syndrome, Zellweger syndrome
Neurologic	Acute weakness in the emergency department, anterior cord syndrome, ARTS syndrome, Brown-sequard syndrome, Bulimia nervosa, CAMFAK syndrome,Cauda equina syndrome, central cord syndromes, cerebellar stroke syndrome, Cerebro-Oculo-Facio-Skeletal syndrome, Charcot-Marie-Tooth disease, type 2, coloboma chorioretinal cerebellar vermis aplasia, conus medullaris syndrome , Down's syndrome, Friedreich ataxia, folate deficiency, Gerstmann-Straussler-Scheinker syndrome, hypertrophic neuropathy of dejerine-sottas, infantile axonal neuropathy,Krabbe disease,Marinesco-Sjogren syndrome,neuroacanthocytosis, Miller fisher syndrome, muscular dystrophy, navajo neurohepatopathy, nervous system injuries due to penetrating neck injury, paramyotonia congenita, peripheral nerve and muscle disease, spinal muscular atrophy, posterior cord syndrome, pure motor lacunar syndrome, quaternary syphilis, rommen-mueller-sybert syndrome, segmental syndrome, spinal cord compression, spinocerebellar ataxia, , transverse myelitis, vitamin E deficiency, ventral cord syndrome
Nutritional / Metabolic	Congenital disorder of glycosylation, cytochrome c oxidase deficiency, folate deficiency, hypermagnesaemia, hypokalemia, hypokalemic periodic paralysis, Krabbe disease, Leigh syndrome, Mcleod phenotype, NADH CoQ reductase deficiency, mitochondrial acetoacetyl-CoA thiolase deficiency, navajo neurohepatopathy, non-ketotic hyperglycemia, Pena-shokeir syndrome type 2, tabes dorsalis, vitamin E deficiency
Obstetric/Gynecologic	No underlying causes
Oncologic	No underlying causes
Ophthalmologic	Cerebro-Oculo-Facio-Skeletal syndrome, Coloboma chorioretinal cerebellar vermis aplasia, Schwartz-jampel syndrome, Treft-sanborn-carey syndrome, Zellweger syndrome
Overdose / Toxicity	No underlying causes
Psychiatric	No underlying causes
Pulmonary	No underlying causes
Renal / Electrolyte	Bartter syndrome, neuroaxonal dystrophy renal tubular acidosis,
Rheum / Immune / Allergy	Chediak-Higashi Syndrome, multifocal motor neuropathy with conduction block, severe combined immunodeficiency
Sexual	No underlying causes
Trauma	No underlying causes
Urologic	Conus medullaris syndrome
Miscellaneous	Hypothermia, stroke

Causes in Alphabetical Order

• Acute weakness in the emergency department
• Adducted thumb syndrome
• Aftershave
• Alagille syndrome
• All-trans retinoic acid
• Arima syndrome
• Arthrogryposis
• ARTS syndrome
• Arthrogryposis
• Severe combined immunodeficiency
• Bartter syndrome
• Becker muscular dystrophy
• Benign congenital hypotonia
• Boylan-dew-greco syndrome
• Brown-sequard syndrome
• Bulimia nervosa
• CAMFAK syndrome
• Cauda equina syndrome
• Congenital disorder of glycosylation type I
• Central cord syndromes
• Cerebellar syndrome
• Cerebro-Oculo-Facio-Skeletal syndrome
• Cevimeline
• Charcot-marie-tooth
• Chediak-higashi syndrome
• Barium
• Selenious acid
• Neuroacanthocytosis
• Chylomicron retention disease
• Clonidine
• Cockayne syndrome
• Coloboma chorioretinal cerebellar vermis aplasia
• Complex 1 mitochondrial respiratory chain deficiency
• Cone shell poisoning
• Congenital myopathy
• Conus medullaris syndrome
• Cytochrome c oxidase
• Folate deficiency
• Decreased reflex response
• Posterior cord syndrome
• Down's syndrome
• Duchenne muscular dystrophy
• Dykes-Markes-Harper syndrome
• Emerinopathy
• Erb-goldflam
• Erythrokeratodermia ataxia
• Eucalyptus oil poisoning
• Fazio-londe syndrome
• Fluphenazine
• Friedreich ataxia
• Gerstmann-sträussler-scheinker syndrome
• Griscelli disease
• Guillain-barré syndrome
• Licorice
• Herbal Agent overdose
• Holmes-adie syndrome
• Hyperkalemic periodic paralysis
• Hypermagnesaemia
• Hypertrophic neuropathy of dejerine-sottas
• Hypokalemic periodic paralysis
• Hypothermia
• Imidazoline
• Infantile axonal neuropathy
• Insensitivity to pain with anhidrosis
• King cobra poisoning
• Jansen's metaphyseal chondrodysplasia
• Krabbe disease
• Lambert-Eaton myasthenic syndrome
• Lamotrigine
• Leigh syndrome
• Lorazepam
• Lower motor neuron lesion
• Lyme disease
• Marinesco-Sjogren syndrome
• McLeod phenotype
• Mental retardation
• Microlissencephaly
• Miller fisher syndrome
• Mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes
• Multifocal motor neuropathy with conduction block
• Muscular dystrophy
• Muscular fibrosis multifocal
• NADH CoQ reductase deficiency
• Navajo neurohepatopathy
• Nelarabine
• Nervous system injuries due to penetrating neck injury
• Infantile neuroaxonal dystrophy
• Neuroaxonal dystrophy, infantile
• Neuronal intranuclear hyaline inclusion disease
• Non-ketotic hyperglycemia
• Opioid intoxication
• Oriental hornet poisoning
• Oxazepam
• Oxcarbazepine
• Paramyotonia congenita
• Pena-shokeir syndrome type 2
• Penetrating neck injuries
• Perphenazine
• Pharyngeal-cervical-brachial weakness
• Phenothiazine
• Polymyositis
• Potassium
• Prochlorperazine
• Spinal muscular atrophy
• Pure motor lacunar syndrome
• Quaternary syphilis
• Rommen-mueller-sybert syndrome
• Roussy-levy syndrome
• Saquinavir
• Scapuloperoneal amyotrophy
• Schwartz-jampel syndrome
• Snakebites
• Segmental syndrome
• Skeletal dysplasia
• Smith-Magenis syndrome
• Spastic tetraplegic -- cerebral palsy
• Spinal bulbar motor neuropathy
• Spinal cord compression
• Spinal muscular atrophy
• Spinocerebellar ataxia
• Stroke
• Tabes dorsalis
• Tang hsi ryu syndrome
• Mitochondrial acetoacetyl-CoA thiolase deficiency
• Thioridazine
• Thyrotoxic periodic paralysis
• Tiagabine
• Transverse myelitis
• Treft-sanborn-carey syndrome
• Trifluoperazine
• Venlafaxine
• Vincristine
• Anterior cord syndrome
• Vigabatrin
• Vitamin E deficiency
• White chameleon poisoning
• Zaleplon
• Zellweger syndrome