Trousseau’s sign

doi:10.4236/crcm.2013.25087

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Vol.2, No.5, 326-327 (2013) Case Reports in Clinical Medicine

http://dx.doi.org/10.4236/crcm.2013.25087

Trousseau’s sign

Anwar Alam

Department of Neurology, Ruban Emergency Hospital, Patna, India; [email protected]

Received 22 May 2013; revised 23 June 2013; accepted 1 July 2013

permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

The trousseau’s sign is carpopedal spasm that

results from ischemia that is induced by pres-

sure applied to the upper arm. It is a sensitive

and specific sign of hypocalcemia. Here the au-

thor is sending the short case summary, images

of the demonstration of the Trousseau’s sign.

This case als o h ad a cl ust er of s ei zur es induced

by hypocalcemia.

Keyw ords: Trousseau’s Sign; Hypocalcemia

1. INTRODUCTION

Hypocalcemia is caused by a number of clinical enti-

ties and frequently presents with signs of generalized

neuromuscular irritability including paresthesia, muscle

cramps, laryngospasm, tetany, and seizures. This neuro-

muscular instability can also be demonstrated through

the elicitation of Trousseau’s sign and Chvostek’s sign.

2. CASE

A 20 years old male was a known case of chronic kid-

ney disease who had undergone renal transplantation in

the year 2007 and since then he was on multiple immu-

nosuppressant’s (mycophenolate mofetil 1 gm tacrolimus

and steroids 5 mg). He was admitted with complaints of

pain abdomen, anorexia nausea and deteriorating renal

function. Diagnosis of acu te pancreatitis with chron ic al-

lograft nephropathy was made and he was also found to

have steroid induced diabetes. On the fourth day of ad-

mission the patient developed a cluster of four episodes

of seizures, all tonic clonic type. There was no history of

seizures in the past or in the family. On examination vi-

tal’s were stable he was in the post ictal state, confused.

Pupils were normal in size reacting to light. Fundus ex-

amination was normal, other cranial nerve examination

was normal. He was moving all his limbs equally and

symmetrically DTRs were brisk plantars down going,

and there was no meningeal sign. Relatives gave history

that he had developed intermittent carpopedal spasm

which was corrected spontaneously. Metabolic cause of

seizure was suspected and on clinical demonstration he

developed carpo pedal spasm within one minute of in-

flating the blood pressure cuff (Trousseaus sign). We

were not able to demonstrate Chvostek sign .

His initial blood parameters were Hb 10.1 gm/dl, TLC

13,700 P 69L22E02 blood urea 75.5 mg/dl, seru m creati-

nine was 3.5 mg/dl total bilirubin 0.93 mg/dl direct—

0.45 mg/dl and indirect—0.48 IU SGO T 97.78 IU SGPT

= 57.62 serum albumin 3.19 mg/dl, Serum amylase was

found to be elevated 885 IU (30 - 110 IU/L) and lipase

379.8 IU (0 - 200 IU/L). At the time of seizures his se-

rum total calcium was 6.45 mg/dl (8.5 - 10.5 mg/dl) cor-

rected total calcium 7.25 mg/dl, phosphorus 3.93 (3.0 -

4.5 mg/dl) magnesium 2.28 (1.3 - 2.25 mg/dl).

3. DISCUSSION

The sign of neuromuscular irritability (Trousseau’s

sign) in hypocalcemia was first described by Armand

Trousseau (180 1-1867), who was a Fr ench physician [1].

Hypocalcemia is a common condition characterized by a

net loss of calcium in greater quantities from extracellu-

lar fluid than replaced by the intestine or bone [2]. Trous-

seau’s sign is carpopedal spasm that results from ische-

mia, such as that induced by pressure applied to the up-

per arm from an inflated sphygmomanometer cuff (Fig-

ures 1 and 2). Carpal spasm is induced by inflation of a

blood pressur e cuff to 20 mmHg above the patient’s sys-

tolic blood pressure for 3 min (Trousseau’s sign), in

which metacarpophalangeal joint found in flexion with

extension of the distal interphalangeal and proximal in-

terphalangeal joints and finger adduction. It is sensitive

and specific for hypocalcemia; it is present in 94% of

patients with hypocalcemia and in only 1% of persons

with normal calcium levels, other common condition in

which this sign can be elicitated is hypomagnesemia. Our

patient’s seizures were controlled after correction of hy-

pocalcemia by intravenous calcium gluconate infusion

and further intravenous calcium, but his condition dete-

A. Alam / Case Reports in Clinical Medicine 2 (2013) 326-327 327

Figure 1. Metacarpophalangeal joint flexion, extension of the

distal interphalangeal and proximal interphalangeal joints and

finger adduction (Trousseau’s sign) few seconds after inflation

of blood pressure cuff.

Figure 2. Severe carpopedal spasm within one minute after in-

flation of BP cuff.

riorated further. He had to undergo hemodialysis repeat-

edly for deteriorating renal function (creatinine—8.6

mg/dl), he also developed septicemia and expired 20

days after admission.

REFERENCES

[1] Firkin, B.G. and Whitworth, J.A. (1996) Dictionary of

medical eponyms. 2nd Edition, The Parthenon Publishing

Group, New York, 401.

[2] Bushinsky, D.A. and Monk, R.D. (1998) Calcium. Lancet,

352, 306-311. doi:10.1016/S0140-6736(97)12331-5