WordNet

a mythical Greek hero of the Iliad; a foremost Greek warrior at the siege of Troy; when he was a baby his mother tried to make him immortal by bathing him in a magical river but the heel by which she held him remained vulnerable--his `Achilles heel
an automatic instinctive unlearned reaction to a stimulus (同)reflex response, reflex action, instinctive reflex, innate reflex, inborn reflex, unconditioned_reflex, physiological reaction
(of leaves) bent downward and outward more than 90 degrees

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アキレス(Homer作のIliadに出てくるギリシア軍の勇将;右足首以外は不死身であったが,ここに矢を射られ戦死をとげたという.このため,「唯一の弱点」のことを『Achilles' heel』「アキレスのかかと」という.《米》では'(アポストロフィ)をつけない)
反射(刺激に対する無意識の反応) / 《複数形で》反射的な動き / (光などの)反射,反射光;映像 / 反射性の / (カメラが)レフ鋼の,反射型の

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/11/03 14:21:39」(JST)

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The ankle jerk reflex, also known as the Achilles reflex, occurs when the Achilles tendon is tapped while the foot is dorsi-flexed. A positive result would be the jerking of the foot towards its plantar surface. Being a deep tendon reflex, it is monosynaptic. It is also a stretch reflex. These are monosynaptic spinal segmental reflexes. When they are intact, integrity of the following is confirmed: cutaneous innervation, motor supply, and cortical input to the corresponding spinal segment.

Root Value[edit]

This reflex is mediated by the S1 spinal segment of the spinal cord^[1]

Procedure and Components[edit]

Ankle of the patient is relaxed. It is helpful to support the ball of the foot at least somewhat to put some tension in the Achilles tendon, but don’t completely dorsiflex the ankle. A small strike is given on the Achilles tendon using a rubber hammer to elicit the response. If you are not able to elicit a response, a Jendrassik maneuver can be tried by having the patient cup their fingers on each hand and try to pull the hands apart. A positive response is marked by a brisk plantarflexion of the foot. The response is also graded into Grade 1-4 according to the reflex grading system ^[2]

Absent ankle jerk[edit]

The Achilles reflex checks if the S₁ and S₂^[3] nerve roots are intact and could be indicative of sciatic nerve pathology. It is classically delayed in hypothyroidism. This reflex is usually absent in disk herniations at the L₅—S₁ level. A reduction in the ankle jerk reflex may also be indicative of peripheral neuropathy.

Common causes[edit]

Lumbar herniated disk syndrome
Lumbar spinal stenosis
Endocrine Disorders
- Hypothyroidism
Sciatic neuropathy
Lumbosacral plexus disorder
Motor neuron disease
Cauda equina syndrome
Lumbar Radiculopathy
Idiopathic
Trauma
- Concussion, spinal cord
Hypothermia
Infectious Diseases
- Tabes dorsalis
- Poliomyelitis, acute
- Lumbar disk infection/pyogenic
- Arachnoiditis lumbosacral
Neoplastic Disorders
- Primary
- Secondary
Allergic, Collagen, Autoimmune Diseases
Diabetic neuropathy

Rarer causes[edit]

Abetalipoproteinemia (Bassen Kornzweig)
Electrolyte abnormalities
- Hypokalemia
Deficiency Disorders
- Vitamin E deficiency
Congenital, Developmental Disorders
- Spina bifida
Genetic Disorders
- Hypokalemic periodic paralysis
- Charcot–Marie–Tooth disease
- Spinal muscle atrophy
- Friedreich's Ataxia
Drugs
- Tubocurarine
- Pyridoxine excess/megadose
- Chronic Alcoholism

^[4]

Ankle Clonus[edit]

Grade 4 ankle hyper reflexia is called ankle clonus. There is repetitive ankle dorsiflexion and plantarflexion on passive dorsiflexion of the foot by the examiner till the force applied by the examiner is withdrawn.

Causes[edit]

Any spinal cord lesions, be it traumatic, neoplastic, pyogenic, vascular above the level of S1 can cause clonus. This is because of the spasticity caused by the UMN type of injury causing hyper reflexia and clonus. Some other causes of clonus are

Meningitis
Tetanus
CJD
Cerebral Palsy
Multiple Sclerosis
Syringomyelia

References[edit]

^ "Medscape- Neurologic examination". Retrieved 6 February 2013.
^ "Neurological Examination- Kansas University Medical Centre". Retrieved 6 February 2013.
^ William J. Weiner (30 July 2010). Neurology for the Non-Neurologist. Lippincott Williams & Wilkins. pp. 499–. ISBN 978-1-60547-239-3. Retrieved 4 July 2011.
^ "Diagnosis". Retrieved 6 February 2013.

UpToDate Contents

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English Journal

Triceps surae fascicle stretch is poorly correlated with short latency stretch reflex size.

Cronin NJ1, Rantalainen T, Avela J.
Muscle & nerve.Muscle Nerve.2014 Dec 9. doi: 10.1002/mus.24538. [Epub ahead of print]
Introduction: The short latency stretch reflex (SLR) is well described, but the stimulus that evokes the SLR remains elusive. One hypothesis states that reflex size is proportional to muscle fiber stretch, so this study examined the relationship between these 2 parameters in human triceps surae musc
PMID 25487638

[Detection rate analysis on neurological sign of workers exposed to different concentrations of carbon disulfide].

Li K1, Zhou W, Gu G, Zhou S, Zheng Y, Yu S2.
Zhonghua yu fang yi xue za zhi [Chinese journal of preventive medicine].Zhonghua Yu Fang Yi Xue Za Zhi.2014 Oct;48(10):888-92.
OBJECTIVE: To study the effects of exposed to different concentrations of carbon disulfide on neurological signs of workers.METHODS: Collection the information of concentration of carbon disulfide in the workplace or workers individuals exposed of a chemical fiber industry from 2004 to 2011, a total
PMID 25573128

The muscle findings in a pediatric patient with live attenuated oral polio vaccine-related flaccid monoplegia.

Uchiyama S1, Nishino I2, Izumi T3.
Vaccine.Vaccine.2014 Sep 22;32(42):5379-81. doi: 10.1016/j.vaccine.2014.07.089. Epub 2014 Aug 12.
A pediatric patient, who was given live-attenuated oral polio vaccine twice without distinct gait disturbance during infancy, begun to present limp at 3 years. His gait disturbance became remarkable with aging. At 7 years, he was unable to dorsiflex the left ankle, and presented flaccid monoplegia o
PMID 25131733

Japanese Journal

足趾での振動覚・小足筋萎縮・アキレス腱反射を指標とした糖尿病性神経障害の評価の試み

長谷川修,河崎さつき,松本俊介
末梢神経 = Peripheral nerve 21(1), 71-77, 2010-06-01
NAID 10027578652

脊柱管硬膜外のgasの貯留にて腰神経根症状をきたした1例

三木潤一郎,今栄信治,大川都史香,北山真理,西岡和哉,板倉徹
脳神経外科ジャーナル 18(10), 765-769, 2009-10-20
症例は58歳,女性.右下肢のS_1領域の疼痛を主訴に来院した.腰椎手術歴や外傷歴はなし.腰椎単純X線にて軽度の椎間板腔狭小化を認めたが,気体像を含めその他の明らかな異常を指摘できなかった.しかし腰椎MRIにてT1強調画像およびT2強調画像ともにlow intensityを示す円形の構造物が右S_1神経根を圧迫する所見を認めた.脊髄造影および造影後CTにおいて円形のlow densityを認め,気体 …
NAID 110007363289