A patient with alcoholism is brought in with confusion. You ask him to "stop traffic" with his palms and notice that every few seconds his palms suddenly move toward the floor. What does this indicate?

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Quizplus · Accepted Answer

This is asterixis and represents the inability to maintain a sustained contraction of the muscles. It is usually due to various metabolic diseases. A variant of this is called "milkmaid's grip" in which the patient is asked to grasp two fingers. A positive occurs if the patient is unable to sustain the grip and it feels as if the patient is trying to milk a cow. Most would consider checking an ammonia level in this patient. A stroke is less likely to produce bilateral symptoms. Carpal tunnel represents a sensory loss in the median nerve distribution.

A Patient with Alcoholism Is Brought in with Confusion