Chvostek's and Trousseau's Signs

Abstract

images in clinical medicineT h e n e w e ng l a n d j o u r na l o f m e dic i n e n engl j med 367;11 nejm.org september 13, 2012 e15 A 38-year-old man presented to the emergency department with facial paresthesias and upper-extremity muscle cramping. His symptoms were progressive, beginning as mild paresthesias on postoperative day 1; by the time he presented, they had been getting worse for about 24 hours. His medical history was noteworthy only for papillary thyroid carcinoma, for which he had undergone a total thyroidectomy 2 days earlier. Physical examination revealed apparent Chvostek's sign ( Fig. 1A and Video 1) and Trousseau's sign ( Fig. 1B and Video 2), a result of postsurgical acquired hypoparathyroidism. His total calcium level was 5.8 mg per deciliter (normal range, 8.4 to 10.3) (1.45 mmol per liter [2.1 to 2.6]), his free calcium level was 1.68 mEq per liter (normal range, 2.24 to 2.64) (0.84 mmol per liter [1.12 to 1.32]), and his serum phosphate level was 6.6 mg per deciliter (normal range, 2.7 to 4.5) (2.13 mmol per liter [0.87 to 1.45]). The parathyroid hormone level was 7 pg per milliliter (normal range, 15 to 65). Chvostek's sign is described as the twitching of facial muscles in response to tapping over the area of the facial nerve (Video 1). Trousseau's sign is carpopedal spasm that results from ischemia, such as that induced by pressure applied to the upper arm from an inflated sphygmomanometer cuff (Video 2). Chvostek's sign is neither sensitive nor specific for hypocalcemia, since it is absent in about one third of patients with hypocalcemia and is present in approximately 10% of persons with normal calcium levels. Trousseau's sign, however, is more sensitive and specific; it is present in 94% of patients with hypocalcemia and in only 1% of persons with normal calcium levels. Our patient's symptoms resolved with intravenous administration of calcium gluconate, and he was discharged with instructions to begin oral calcium supplementation and to maintain close follow-up with his endocrinologist.

Hypoparathyroidism, an innate risk of thyroidectomy

“…The Chovstek sign is elicited by tapping the facial nerve in the preauricular area and observing for facial contractions; Trousseaus sign by induction of carpal spasm upon inflation of blood pressure cuff above the systolic value. 8,9 The best way to reserve the PT function is the deliberate identification of them and safeguarding its blood supply. In a cadaveric study, 77% of the superior PT was at the cricothyroid junction, intimately associated with the RLN.…”

Chronic hypoparathyroidism in adults: clinical features, diagnosis, management and treatment

“…Повышение нервно-мышечной возбудимости может быть диагностировано с помощью пробы Хвостека (подергивание мышц лица при постукивании по области выхода тройничного нерва) и пробы Труссо (появление судорог в кисти («рука акушера») через 1-3 минуты после сдавления плеча манжетой для измерения артериального давления) (рис. 2) [12][13][14][15].…”

“…Клинические проявления кальцификации различных отделов центральной нервной системы у пациентов с длительным анамнезом гипопаратиреоза неспецифичны. Прямой связи с симптомами паркинсонизма (неврологические нарушения движения, характеризующиеся тремором, брадикинезией, ригидностью и постуральной нестабильностью) и дистонии (неврологические расстройства движения, связанные со «скручиванием» или аномальными фиксированными позами) не выявлено, и эти нарушения отмечаются гораздо реже, чем, например, кальцификация базальных ганглиев [15,16,20]. Вопрос о наличии взаимосвязи между объемом, локализацией обызвествлений и неврологическими симптомами остается противоречивым [16,17,20].…”

Spontaneous fractures in a 30-year-old woman following a simple fall

“…Three days after surgery, the patient developed hungry bones syndrome manifesting as symptomatic hypocalcaemia with signs and symptoms such as a positive Chvostek’s sign, carpopedal spasm and paraesthesias 1. This syndrome occurs because of rapid calcium deposition into the bone after levels of PTH have normalised, causing serum calcium levels to decrease 2.…”