226:
similar patients mentioned by German physicians called “jactitations” but the reference was vague. Foley consulted Father
Cadigan, a Jesuit classics scholar, who suggested “anisosterixis” (an "negative"–iso "equal"–sterixis "firmness") but Foley shortened this to asterixis due to the former being too difficult to pronounce. They introduced the term in 1953 by way of a medical abstract and later Adams solidified its medical use as he was an author and editor of the widely influential
99:
To elicit the sign the patient should be asked to hold constant posture against gravity. This can be done by extending the arms at 90° to the body and extending the wrists with the fingers spread. This position should be held for at least 30 seconds and in that duration the examiner should look for
225:
and J. M. Foley first described asterixis in 1949 in patients with severe liver failure and encephalopathy. Initially Foley and Adams referred to asterixis simply as "tremor" but realized that they needed a more appropriate term. On a literature search they found a poorly described phenomenon in
95:
Asterixis is normally asymptomatic and found during clinical examination for other reasons, but more rarely it can also be the leading symptom. Usually there are brief, arrhythmic interruptions of sustained voluntary muscle contraction causing brief lapses of posture, with a frequency of
67:
is characterized by an inability to maintain a position, which is demonstrated by jerking movements of the outstretched hands when bent upward at the wrist (which can be similar to a bird flapping its wings, hence the name "flapping tremor").
557:
542:
75:
motor centers in the brain, which regulate the muscles involved in maintaining position. Asterixis is associated with various encephalopathies due especially to faulty metabolism. The term derives from the
213:(when it is known as phenytoin flap). Other drugs implicated include benzodiazepines, salicylates, barbiturates, valproate, gabapentin, lithium, ceftazidime, and metoclopramide.
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Adams RD, Foley JM. The neurological changes in the more common types of severe liver disease. Trans
American Neurology Association 1949; 74: 217–219.
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228:
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349:
325:
460:"Vision loss due to coincident ocular and central causes in a patient with Heidenhain variant Creutzfeldt-Jakob disease"
96:
3–5 Hz. It is bilateral, but may be asymmetric. Unilateral asterixis may occur with structural brain disease.
448:
Anne M. Larson, Diagnosis and management of acute liver failure, Curr Opin
Gastroenterol., 2010, 26(3):212:221, 2010
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Pal G, Lin, Laureno R. Asterixis: a study of 103 patients. Metabolic Brain
Disease . September 2014;29(3):813–824.
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damages the brain cells. The cause is thought to be predominantly related to abnormal ammonia
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Foundas, Maria; Donaldson, Mark D.; McAllister, Ian L.; Bridges, Leslie R. (March 2008).
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115:(for which the term was firstly described). The inability of the liver to metabolize
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35:
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1026:
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656:
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345:
280:
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131:
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134:(often in conjuction with drowsiness or stupor), especially in decompensated
475:
459:
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Agarwal R, Baid R. Asterixis. J Postgrad Med 2016;62:115-7. Available from:
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and neoplasia, which usually cause contraleteral one-sided asterixis.
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135:
60:
40:
637:
1247:
1087:
925:
906:
375:
Ellul, Mark A.; Cross, Timothy J.; Larner, Andrew J. (2017-02-01).
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149:
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996:
457:
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891:
886:
858:
816:
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1001:
991:
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120:
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intermittent loss of posture in fingers, wrists or arms.
431:
http://www.jpgmonline.com/text.asp?2016/62/2/115/180572
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338:
71:The tremor is caused by abnormal function of the
1368:
374:
316:, Treasure Island (FL): StatPearls Publishing,
623:
307:
248:
630:
616:
229:Harrison's Principles of Internal Medicine
87:, meaning "support" or "stable position".
284:
266:
103:
1369:
611:
370:
368:
366:
308:Zackria, Rasiq; John, Savio (2021),
108:Possible causes for asterixis are:
51:, more colloquially referred to as
13:
1377:Symptoms and signs: Nervous system
680:Festinating gait/Parkinsonian gait
14:
1388:
520:
363:
1274:Overpronation/Flexible flat feet
255:Journal of Postgraduate Medicine
202:Structural brain problems, like
393:10.1136/practneurol-2016-001393
352:from the original on 2014-12-05
328:from the original on 2022-06-01
90:
507:
498:
451:
442:
423:
301:
249:Agarwal, R.; Baid, R. (2016).
242:
1:
235:
725:Myopathic gait/Waddling gait
7:
161:Respiratory failure due to
30:Flapping tremor, liver flap
10:
1393:
217:
1256:
1174:
1141:
1126:Lower motor neuron lesion
1121:Upper motor neuron lesion
1043:
959:
926:Myotonia / Pseudomyotonia
872:
807:
649:
641:relating to movement and
528:
209:Some drugs, particularly
198:Creutzfeldt-Jakob disease
34:
26:
21:
346:"Asterixis – Definition"
268:10.4103/0022-3859.180572
180:Electrolyte imbalances
113:Hepatic encephalopathy
59:but rather a negative
1233:Boutonniere deformity
476:10.1093/ageing/afm191
104:Associated conditions
1304:Clasp-knife response
83:, meaning "not" and
55:, is not actually a
1336:Conversion disorder
1238:Swan neck deformity
1161:Locomotive syndrome
381:Practical Neurology
140:acute liver failure
1073:Spastic paraplegia
1063:Spastic paraplegia
1058:Periodic paralysis
967:Abnormal posturing
832:Dysdiadochokinesia
768:Asynchronous gait
730:Trendelenburg gait
690:Marche Ă petit pas
639:Signs and symptoms
436:2018-06-03 at the
1364:
1363:
1053:Flaccid paralysis
874:Abnormal movement
864:Hemimotor neglect
822:Cerebellar ataxia
772:Gunslinger's gait
670:Cerebellar ataxia
598:
597:
172:) or low oxygen (
65:movement disorder
46:
45:
16:Medical condition
1384:
1068:Spastic diplegia
1035:Tonic immobility
1027:Waxy flexibility
971:Stooped posture
777:Hemiparetic gait
758:Asymmetric gait
657:Gait abnormality
632:
625:
618:
609:
608:
526:
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299:
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270:
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194:Encephalopathies
156:Wilson's disease
132:encephalopathies
130:Other metabolic
19:
18:
1392:
1391:
1387:
1386:
1385:
1383:
1382:
1381:
1367:
1366:
1365:
1360:
1331:Motion sickness
1264:Rachitic rosary
1252:
1201:Joint stiffness
1176:Range of motion
1170:
1137:
1133:Sleep paralysis
1117:General causes
1039:
955:
868:
803:
715:Vestibular gait
695:Propulsive gait
645:
636:
599:
594:
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537:
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518:
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438:Wayback Machine
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188:hypomagnesaemia
106:
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53:flapping tremor
17:
12:
11:
5:
1390:
1380:
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1362:
1361:
1359:
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1343:
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1328:
1323:
1321:Astasia-abasia
1318:
1313:
1308:
1307:
1306:
1296:
1291:
1286:
1284:Bow-leggedness
1281:
1276:
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899:
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889:
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876:
870:
869:
867:
866:
861:
856:
851:
849:Sensory ataxia
846:
845:
844:
839:
837:Pronator drift
834:
829:
819:
813:
811:
805:
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790:
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756:
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739:
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719:
718:
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712:
710:Truncal ataxia
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529:Classification
522:
521:External links
519:
516:
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497:
470:(2): 231–232.
464:Age and Ageing
450:
441:
422:
362:
337:
300:
261:(2): 115–117.
240:
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219:
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215:
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200:
191:
177:
163:carbon dioxide
159:
153:
146:Kidney failure
143:
128:
105:
102:
92:
89:
44:
43:
38:
32:
31:
28:
24:
23:
15:
9:
6:
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3:
2:
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1356:Dancing mania
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1324:
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1309:
1305:
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1299:Hyperreflexia
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1219:
1217:
1214:
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1212:
1211:Hypermobility
1209:
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1199:
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1048:
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1042:
1036:
1033:
1030:
1028:
1025:
1023:
1020:
1018:
1017:Joint locking
1015:
1013:
1010:
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1005:
1003:
1000:
998:
995:
993:
990:
988:
985:
981:
978:
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972:
970:
968:
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929:
927:
924:
922:
918:
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913:
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905:
903:
900:
898:
897:Fasciculation
895:
893:
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879:
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875:
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865:
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835:
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828:
825:
824:
823:
820:
818:
815:
814:
812:
810:
806:
798:
795:
794:
792:
788:
787:Antalgic gait
785:
783:
780:
778:
775:
773:
770:
769:
767:
763:
760:
759:
757:
753:
750:
748:
747:Steppage gait
745:
744:
743:
740:
736:
733:
731:
728:
726:
723:
722:
720:
716:
713:
711:
708:
706:
703:
701:
700:Stomping gait
698:
696:
693:
691:
688:
686:
685:Magnetic gait
683:
681:
678:
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671:
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469:
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461:
454:
445:
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406:
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378:
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351:
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341:
327:
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69:
66:
62:
58:
54:
50:
42:
39:
37:
33:
29:
25:
20:
1294:Hyporeflexia
1189:Bethlem sign
1156:Gowers' sign
1111:Quadruplegia
987:Opisthotonus
980:Osteoporosis
975:Camptocormia
917:Hyperkinesia
902:Fibrillation
853:
809:Coordination
762:Leaping gait
705:Spastic gait
675:Choreic gait
665:Scissor gait
582:
571:
556:
541:
509:
500:
467:
463:
453:
444:
425:
387:(1): 60–62.
384:
380:
354:. Retrieved
340:
330:, retrieved
313:
303:
258:
254:
244:
227:
221:
184:hypokalaemia
107:
98:
94:
91:Presentation
84:
80:
73:diencephalic
70:
52:
48:
47:
1341:Shell shock
1316:Hypnic jerk
1216:Gorlin sign
1184:Contracture
1151:Hemiparesis
1107:Tetraplegia
921:Hypokinesia
842:Dyssynergia
752:Toe walking
735:Pigeon gait
377:"Asterixis"
310:"Asterixis"
251:"Asterixis"
223:R. D. Adams
204:haemorrhage
182:, such as
170:hypercapnia
27:Other names
1279:Knock-knee
1097:Hemiplegia
1092:Paraplegia
1083:Monoplegia
1079:Syndromes
1012:Hypertonia
946:Echopraxia
936:Stereotypy
797:Lotus gait
793:Deformity
584:DiseasesDB
356:2014-11-30
332:2021-03-12
314:StatPearls
236:References
196:, such as
125:metabolism
1351:Catatonia
1311:Shivering
1289:Back knee
1269:Flat feet
1243:Scoliosis
1206:Ankylosis
1194:Club foot
1102:Triplegia
1045:Paralysis
1031:Grimacing
1022:Catalepsy
960:Posturing
951:Echolalia
941:Akathisia
931:Hypotonia
912:Myoclonus
882:Athetosis
854:Asterixis
827:Dysmetria
742:Foot drop
721:Muscular
484:1468-2834
417:219191248
401:1474-7758
277:0972-2823
211:phenytoin
174:hypoxemia
136:cirrhosis
61:myoclonus
49:Asterixis
41:Neurology
36:Specialty
22:Asterixis
1371:Category
1248:Kyphosis
1143:Weakness
1088:Diplegia
907:Myokymia
492:18065777
434:Archived
409:27807107
350:Archived
326:archived
322:30571066
295:27089111
166:toxicity
150:azotemia
85:stērixis
1326:Vertigo
997:Trismus
603:Diagram
578:D020820
286:4944342
218:History
117:ammonia
63:. This
1346:Stupor
1166:Ptosis
1007:Tetany
892:Tremor
887:Chorea
859:Abasia
817:Ataxia
490:
482:
415:
407:
399:
320:
293:
283:
275:
57:tremor
1257:Other
1002:Cramp
992:Spasm
589:33950
567:781.3
552:R27.8
413:S2CID
78:Greek
782:Limp
661:CNS
650:Gait
643:gait
573:MeSH
562:9-CM
488:PMID
480:ISSN
405:PMID
397:ISSN
318:PMID
291:PMID
273:ISSN
186:and
148:and
121:urea
1226:HSD
1221:EDS
558:ICD
543:ICD
472:doi
389:doi
281:PMC
263:doi
138:or
119:to
1373::
1109:/
1090:/
919:/
587::
576::
565::
550::
547:10
486:.
478:.
468:37
466:.
462:.
411:.
403:.
395:.
385:17
383:.
379:.
365:^
348:.
324:,
312:,
289:.
279:.
271:.
259:62
257:.
253:.
232:.
631:e
624:t
617:v
560:-
545:-
535:D
494:.
474::
419:.
391::
359:.
297:.
265::
190:.
176:)
168:(
158:.
152:.
142:.
127:.
81:a
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