Loss knee and  reflexes at defects in pupils and disorder of their reactions to light solves a question on presence, more often, spinal сухотки. Their absence can testify to the polyneuritis transferred earlier or a poliomyelitis (sometimes thus remain some паретические or the atrophic phenomena in stops). Occasionally loss of reflexes (more often ахилловых) is a myelodisplasia symptom, i.e. Congenital defect of development of a spinal cord, being accompanied by loss of plantar reflexes, sometimes a deep crest of foot, когтеобразными fingers (фридрейхова foot), cold cyanochroic stops etc.
As the rare case, loss knee and buy cipro reflexes as absolutely isolated symptom can be caused by congenital absence сухожильных reflexes at absolutely healthy and normal nervous system. Usually congenital areflexia happens full, i.e. Reflexes and on the top extremities are lost. Loss knee and ахилловых reflexes at the kept reflexes of the top extremities always is suspicious.
In essence always in the absence of knee and ахилловых reflexes of the patient should be carefully investigated, it is better in a hospital; the x-ray film of lumbosacral department of a backbone, the analysis of a spinal liquid and blood on a Wassermann reaction and other researches are necessary.
Unilateral loss сухожильных reflexes of the bottom extremities (or one of them) specifies in most cases in organic changes of nervous system, peripheric or central. Such value has also non-uniformity of reflexes. Therefore at research сухожильных reflexes it is necessary to check up not only presence, but also their uniformity. The technics of research should be faultless that нe to receive an erroneous difference in reflexes.
Some words about rising сухожильных reflexes. Unilateral rising with unilateral клонусами, especially in a combination to weakening of abdominal reflexes and a distortion plantar, specifies on пирамидное a lesion. Absolutely uniform rising of reflexes, even with клонусами, but in the absence of pathological reflexes at live abdominal, yet is not convincing for a recognition of organic disease and can enter, for example, into a neurosis symptom-complex.
For check of coordination of movements of the bottom extremities, except a gait estimation, the pjatochno-knee assay which is finding out атаксию in the bottom extremities at cerebellar disorders or at disturbance of sustavno-muscular feeling is made.
The objective estimation of neurotic conditions represents often more difficult problem, than an establishment of an organic lesion of nervous system.
Such symptoms as weakening of reflexes with mucous, dermographism changes, rising of mechanical excitability of muscles, at fast survey can not be investigated at all as phenomena, for. Neurosises insufficiently demonstrative. The tremor of close eyelids, fingers of the extended arms, rising сухожильных reflexes have relative value for an estimation of a neurosis and become perceptible in the course of plan of research already planned by us. Registration of vegetative disorders (a Crocq’s disease, a sweating, live game вазомоторов, the raised warm excitability) which, not demanding in the course of fast rough survey of special receptions of research, easily are evident (to the attentive and observant researcher has much bigger value. A number of other phenomena noted sometimes in passing with survey, is rather characteristic for sick of neurosises: vigilance, fearfulness. Start at a touch, the general tremor, «neurotic synkineses» at calling сухожильных reflexes. At last, the estimation of behaviour, manners, facial expressions, reactions, эмотивности, moods, intonations, vivacity investigated is extremely important. buy rimonabant Impressions about these features of behaviour and reactions of the patient develop in interrogation, conversation and research.
We result the scheme of short and fast research of nervous system (by performance by the patient of separate receptions and tasks of the doctor).
1. Investigated approaches to the doctor undressed to a girdle, becomes against it, faced to a light source - exterior survey.
2. Look afar or a little up, do not close eyes and do not blink - an estimation of uniformity and the correct form of pupils, research of reactions to light at first one, then other pupil.

Quite often investigated holds a prelum abdominale the strained; in that case abdominal reflexes cause hardly; then it is necessary to put a shaped boring at the moment of an exhalation, in a short pause before an inspiration. Abdominal reflexes can order ultram not arise in the presence of flabbiness of an abdominal wall or at very fat stomach; in this case usually it is possible to cause at least the top abdominal reflexes, having pulled from top to bottom a skin of a stomach fingers of the left arm which have grasped a cord of a skin of a stomach below a belly-button. Occasionally non-uniformity of abdominal reflexes is caused by the big cicatrixes on a stomach after operations.
At an exception of the mentioned circumstances loss or non-uniformity of abdominal reflexes, especially at young men, is in most cases the proof of presence of those or other organic changes of nervous system. Weakening of abdominal reflexes - one of early and thin symptoms of a lesion пирамидного a fascicle and as organic disease of the central nervous system rather seldom does without a lesion пирамидной system value which has research of abdominal reflexes is clear. Often quite good check of uniformity of dermal abdominal reflexes is research сухожильных (deep) abdominal reflexes (the chapter II).
For reception of knee reflexes lying position of the investigated also is used. The doctor brings the left forearm under knee joints of the laying patient (the head of the last is to the left of investigating), raises its passively relaxed feet so that heels remained on a couch, and in knee joints there was a flexion under a stupid angle. Having checked up similarity of vpxl a flexion in knee joints and having made sure of absence of a strain of a musculation, the doctor puts молоточком the exact blows, whenever possible identical force, on a tendon the four-head of a muscle below a knee cup, alternately on the right and left parties, comparing intensity of reflexes.
Further, having put back on a couch already straightened feet of the patient, the doctor puts the handle молоточка a shaped boring at first on one, then on other sole for the purpose of reception of plantar reflexes. Stroke carrying out should be not so fast and with some pressing. Unlike a normal plantar reflex (a plantar flexion of all five fingers) at many organic diseases of the central nervous system the symptom Babinsky becomes perceptible, i.e. A back flexion of the big finger (other fingers thus often get divorced as “fan”).
Sometimes for research of a plantar reflex preliminary raise feet of the patient and slightly incurvate century a knee joint. Stroke carrying out on internal edge of a sole is unessential: sometimes the reflex turns out more distinctly at its carrying out on external edge. At last, it is more favourable to take a direction of a stroke from top to down, i.e. From fingers to a heel; at such reception it is less often observed any отдергивание and the extension of fingers making false impression of a symptom Babinsky. Here speed отдергивания and, secondly, compatibility of movement of all five fingers to back is characteristic, first. At a symptom Babinsky the extension of the big finger usually occurs in slowed more down rate, after the small latent period; other fingers either are incurvated, or fan.
As the symptom Babinsky, on a level with fading of abdominal reflexes, is one of lesion precursory symptoms пирамидной systems, value of research of plantar reflexes undoubtedly. Besides a Babinski’s reflex, it is recommended to check up also presence or absence of symptom Россолимо sometimes even more expressed, than a symptom Babinsky, and also Bekhterev’s symptom.
For research ахилловых reflexes it is offered investigated to kneel on a couch or on a chair so that its stops freely, without a strain, hanged down; palms is better to lean about a wall or to keep arms for a chair backrest. Blow молоточком on ахиллову to a tendon causes a reflex. Blow also should be exact and identical force that there was no false difference in reflexes.
Knee and ахилловы reflexes are most constant of all reflexes and consequently their absence gets essential value. It is necessary to remind, that a strain of muscles reflexes can be braked. The method of derivation of attention sometimes possible to receive rather live reflexes there where at first they did not manage to be caused at all. Often reception Ендрашека is applied to attention derivation, consisting that investigated is offered to link the incurvated fingers of one arm to fingers another and with force to pull arms in the parties. It is possible to suggest for the patient to look up, strongly to squeeze a teeth, to consider, answer questions etc.