Hyporeflexia

Hyporeflexia

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

Hyporeflexia is the opposite of hyperreflexia: the presence of below normal or absent reflexes. It can be tested for by using a reflex hammer. Hyporeflexia is generally associated with a lower motor neuron deficit (lower motor neuron dysfunction) at the alpha motor neurons from the spinal cord to muscle; whereas, hyperreflexia is often attributed to upper motor neuron lesions (along the long motor tracts from the brain).

Diagnosis

Laboratory Findings

• Complete blood count (CBC)
• Calcium
• Glucose
• Antinuclear antibody (ANA)
• Rheumatoid factor (RF)
• HIV
• Rapid plasma reagin (RPR)
• Vitamin B12 levels
• Thyroid function tests
• Heavy metal screen
• Hemoglobin A1c
• Creatinine phosphokinase (CK)
• Erythrocyte sedimentation rate (ESR)
• Serum protein electrophoresis (SPEP)
• Urine protein electrophoresis (UPEP)

Other Diagnostic Studies

• Nerve conduction studies
• Cerebrospinal fluid (CSF) analysis

Differential Diagnosis

In alphabetical order.

• Brachial or lumbosacral plexopathy
• Cauda equina syndrome
• Guillain-Barre Syndrome
• Isolated peripheral nerve injury/dysfunction
• Lambert-Eaton Myasthenic Syndrome
• Motor neuron disease
• Multifocal motor neuropathy
• Myopathy
• Obesity
• Peripheral neuropathy
• Radiculopathy
• Spinal shock

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [3] Carlos A Lopez, M.D. [4]

Causes

Life Threatening Causes

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

Common Causes

• Acetaminophen
• Albuterol
• Biliary disease
• Caffeine
• Cystic fibrosis
• Clostridium difficile
• Diverticulitis
• Lisinopril
• Irritable bowel syndrome
• Intermittent bowel obstruction
• Malabsorption
• Obesity

Causes by Organ System

Cardiovascular	No underlying causes
Chemical / poisoning	Polyethylene glycol
Dermatologic	Carbohydrate malabsorption, malabsorption , HIV related malabsorption, intestinal tuberculosis, tropical sprue, whipple's disease
Drug Side Effect	Acetaminophen, acarbose, acamprosate calcium, albuterol , bexarotene, bupropion, butalbital, calcium carbonate , levodopa and carbidopa, cevimeline, cidofovir, chloral hydrate, citalopram , clindamycin, codeine, denosumab, disopyramide, dolutegravir, dulaglutide , etodolac, exenatide, flurbiprofen, glipizide, glycopyrrolate, lactulose, lanreotide, lisinopril, lithium, lovastatin, medications, megestrol acetate, megestrol, meropenem, mesalazine, metformin, midodrine, misoprostol, miglitol, modafinil, moxifloxacin, naproxen, niacin, nitrofurantoin, norfloxacin, octreotide, ofloxacin, oxaprozin, pantoprazole, pergolide, polyethylene glycol, piroxicam, rabeprazole, Human chorionic gonadotropin, rifampicin, ritonavir, simethicone, simvastatin, sotalol, sunitinib, tacrolimus, tramadol, thalidomide, tolcapone, tolmetin, varenicline, vilazodone
Ear Nose Throat	No underlying causes
Endocrine	Pancreatic cancer, pancreatic disease, pancreatic insufficiency
Environmental	No underlying causes
Gastroenterologic	Abdominal surgery, aerophagia, alteration of intestinal motility, amebiasis, biliary disease, blastocystis, bowel fermentation, caffeine, carcinoid tumors, celiac disease, cholesterolosis, chronic constipation in adults, chronic diarrhea in developed countries, chronic functional constipation and fecal incontinence in infants and children, chronic mesenteric ischemia, cirrhosis of liver, crohn's disease, diverticulitis, diverticulosis, fecal incontinence in infants and children, gallbladder disease, gallbladder disorders, gallbladder polyps, gallstone ileus, gallstones, gastric intestinal metaplasia, gastroesophageal reflux disease, gastrointestinal toxicity of radiation therapy, giardiasis, hepatic encephalopathy in adults, hypersalivation, intermittent bowel obstruction, human growth hormone, intestinal bacterial overgrowth, intestinal motility disorders, intestinal obstruction, irritable bowel syndrome, lactase deficiency, metorchis, pancreatic carcinoma, pancreatic insufficiency, pneumatosis intestinalis, postoperative ileus, probiotics for gastrointestinal diseases, short bowel syndrome , small bowel diverticular, swallowed air, lactase deficiency, metorchis, pancreatic carcinoma, pancreatic insufficiency, pneumatosis intestinalis, postoperative ileus, probiotics for gastrointestinal diseases, short bowel syndrome, small bowel diverticular , swallowed air
Genetic	Autosomal dominant polycystic kidney disease, cystic fibrosis, colon cancer , enteropathy-type intestinal T-cell lymphoma, glucose-6-phosphatase deficiency
Hematologic	No underlying causes
Iatrogenic	No underlying causes
Infectious Disease	Amebiasis, blastomycosis, clonorchis, clostridium difficile, colonic bacterial fermentation, cyclospora infection, dientamoeba fragilis, giardiasis, hookworm infection, metorchis, opisthorchis, small intestine bacterial infection
Musculoskeletal / Ortho	Abdominal surgery
Neurologic	Hepatic encephalopathy in adults
Nutritional / Metabolic	Acarbose, apples, beans, bowel fermentation, brussel sprouts, cabbage, caffeine, malabsorption, carbonated beverages, chewing gum, chronic diarrhea in developed countries, crayfish, dietary factors, eating too quickly, food allergies, glucose-6-phosphatase deficiency, gut fermentation, herbal products, high fiber diet, high legume diet,increased intake of fructose, increased intake of lactose, increased intake of sorbitol, introducing solid foods and vitamin and mineral supplementation during infancy, lactase deficiency, lactulose, lobster, tropical sprue, traveler's diarrhea, mixed nuts, metabolic syndrome, obesity, onions, peanut, pork, prunes, raisins, shellfish, shrimp, undigestible starches in fruits, undigestible starches in vegetables, undigestible starches legumes
Obstetric/Gynecologic	No underlying causes
Oncologic	Colon cancer, anal cancer, carcinoid tumors, cirrhosis of liver, enteropathy-type intestinal T-cell lymphoma, pancreatic carcinoma
Ophthalmologic	No underlying causes
Overdose / Toxicity	No underlying causes
Psychiatric	Aerophagia , anxiety
Pulmonary	Pneumatosis intestinalis
Renal / Electrolyte	Autosomal dominant polycystic kidney disease
Rheum / Immune / Allergy	No underlying causes
Sexual	No underlying causes
Trauma	No underlying causes
Urologic	No underlying causes
Miscellaneous	3-month infant due immature gut, aerophagia, eating too quickly, fecal incontinence in infants and children, habitual air swallowing, normal in healthy individuals, normal infant, normal physical needs, obesity

Causes in Alphabetical Order

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3

See also

• Areflexia, the absence of reflexes, often it is caused by spinal shock.
• Hyperreflexia, exaggerated reflexes.

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