A locked-in syndrome, or as it is often called, isolation syndrome is a particular disease in which a person is partially or completely unable t...
Paraplegia - paralysis of upper and lower extremities
One of the most terrible desires - "farewells" to another person: that your hands withered! And they really "wither".In a literal sense.
The deprived possibilities to feel and create, the hands gradually turn into a kind of limbs visibility - the lifeless "endings" of the body, limp dangling downwards, which really "dry": the skin withers, the muscles degenerate to the condition of cords stretched along the limbs between the clearly defined bony protrusions.
- In the labyrinth of terms
- "Plege" means a blow - about the causes available
- The clinical picture depends on the cause and type
- Sluggish development of the disorder
- Paraplegia Stryumpel
- Concomitant symptoms
- General principles of treatment
- From the practice of neurologist
- Possible complications and prognosis
In the labyrinth of terms
The scientific name of this pathology: paraparality( in another name paraplegia).It is remembered very easily: a pair of hands
Paralysis( or plethysy) is a complete loss of ability to move( and not only in the limbs).
In contrast to paraparic, paraparesis is a more "sparing" version of manifestation in the limbs of a pathology "sent down from above" from the brain to both sides of the body.
Here, "repulsed" and therefore do not work only hands, or only legs. Movements in them are so weakened that they can not perform the work intended for them, but there is sensitivity, so the limbs are deprived of life only half.
In other words, paresis is almost paralysis, but not complete: movements that are severely limited in volume and strength are possible, but they are uncontrollable by the host.
For ultimate clarity with strength and sensitivity in the limbs, it is worth remembering the ancient languages:
- mono paresis or monoplegia - a devastating process in one limb;
- pair paresis or paraplegia - the same in two identical limbs( upper or lower);
- hemi paresis or hemiplegia - development of the process in one half of the body;
- tetra paresis or tetraplegia - a pathology of all four( both upper and lower, both right and left) of the limbs.
"Plege" means a blow - the reasons are available for
. For what reason does a decline in muscle strength occur, accompanied by a complete absence of arbitrary movements in both arms( or legs) - paraplegia?
For the development of this condition, one of the motor ways of the nervous system must be affected, each of which bears the name of the researcher who opened it.
Depending on the cause and the speed of the onset of the condition, paraplegia can be:
- Acute , which is able to develop as a result of such an electrolyte balance disorder as pronounced hypokalemia, either due to a stroke, either the brain or spinal cord, or by squeezing the dorsalthe brain, caused by a fracture of the spine( compression myelitis).
- Subacute variant of development is a possible result of the "drama" played out in the brain or spinal cord when exposed to bacterial infection( myelitis and meningomyelitis of infectious, including poliomyelitis), or liquorodynamic( by the type of hydraulic) stroke, or consequence of ischemiaany department of the nervous system, or the cause may be a deformity of the spine of an innate character.
- Sluggish form of disorder may manifest as a parasitic infection of the central nervous system, as well as a tumor in it, or a hernia of the spinal cord, as well as spondylarthrosis. Either there can be no obvious cause at all - an idiopathic variant of sluggish paraplegia.
In case of damage to the nervous system of organic origin, paraplegia is called organic, in the case of psychic genesis - psychogenic, mostly - hysterical.The basis of organic paraplegia, most often spastic, are lesions of the nervous system( both peripheral and central) due to atherosclerosis, arteritis, which lead to the formation of foci of softening the brain of a bilateral character, psychogenic paraplegia is predominantly flaccid in the course of the disorder.
Paraplegia occurs as a consequence of amyotrophic lateral or multiple sclerosis, and also occurs with syringomyelia.
Why is the reason for the development of paraplegia is precisely the "hydraulic shock"?
With this pathology( due to confusion in the control of electrical currents), the normal flow of liquor, the main fluid that connects all the floors of the nervous system, is always disrupted.
So "water breaks the mill" - people's wisdom, you can not say more precisely.
The clinical picture depends on the cause and type of
In the case of paraplegia of the spastic central genesis, the symmetry of the pathology of the cortical-spinal or pyramidal motor tract, which can occur at any of its levels, is diagnosed more often.
The appearance of paraplegia of peripheral origin is usually due to either involvement in the process of both anterior horns of the spinal cord, or there is a connection with the pathology of the anterior roots, plexuses, peripheral nerves.
A characteristic feature of spastic paraplegia in addition to signs of paralysis of the muscles of the same limbs is the appearance of symptoms of muscular hypertonia( spastic hypertension).
The lower spastic paraplegia may have the character as:
- flexor flexor;
- and extensor extensor type.
For the flexor type( paraplegia of Babinsky, due to a particularly voluminous process in the spinal cord, or in patients with a high degree of depletion, or with the development of pressure sores), hypertonicity is characteristic, leading to the development of contractures in the flexor muscles of the thigh and lower leg.
For paraplegia extensor, which has a predominant distribution, is characterized by hypertension of the extensor muscles of the thigh and lower leg, with the involvement of plantar flexors of the feet, which leads to the straightening of the lower limbs.
Tendon and periosteal reflexes are redundant in this type of disturbance - but the cutaneous and exfoliating reflections, both extensor and flexor reflexes, as well as protective and syncopeies( global and coordinative) reflexes are extinguished.
Spastic paraplegia is manifested by an increase in the level of reflexes of the knee and Achilles, as well as the appearance of pathological reflexes( Gordon, Scheffer, Babinsky, Oppenheim, Rossolimo).
The possibility of development of this paraparalic can lead to symmetrical subcortical lesion of the radiant crown, and involvement in the process of the pyramidal system( at the level of the inner capsule or on one of the sections of the cortical-spinal path).
One of the most common causes of paraplegia is transverse damage to the spinal cord. And with a symmetrical lesion of the spinal cord,
- is manifested with the involvement of the upper cervical segments - spastic tetraplegia;
- in case of thoracic segment damage - lower spastic paraplegia.
The manifestation of pathology will be expressed by the protective reflex of Bekhterev-Mari-Fua: in response to thermal, cold, or painful irritation, a "shortening" of the limb due to flexion in the hip, knee and ankle joints is noted.
Characteristic is also the emergence of syncopeesis( co-ordinated friendly movements): the tibial phenomenon-synclineiasia of Strympel with involuntary flexion of the foot with its supination and simultaneous extension of its thumb while trying to flex the limb in the knee and hip joints and synkinesia of Raymyst - repetition of the affected leg action( adductionand abduction), performed with the leg healthy.
The motor symptoms of spastic paraplegia are accompanied by impaired coordination, sensitivity, trophism of tissues and pelvic disorders.
With complete transverse intersection of the spinal cord with damage to pyramidal and extrapyramidal tracts, spinal spastic paraplegia can flow into the flaccid with attenuation of not only tendon, but also periosteal reflexes and muscle atony.
Sluggish development of
disorder Sluggish paraplegia is caused by bilateral damage to peripheral motoneurons due to:
- spinal injury;
- of plexites;
- intramedullary tumors.
A characteristic feature is the lack of muscle tone of the limbs, the attenuation of reflexes, both tendon and periosteal, muscle atrophy with depression of electrical excitability( the reaction of degeneration) and with indicators of electromyogram, indicating the defeat of peripheral motoneurons.
The pathology of central motoneurons leads to paraplegia, flaccid or permanent, or in certain stages of development, most often at the beginning or at the very end of the disease.
Pathology, which lasts throughout the period of the disease in a languid form, characterized by atony, fading of tendon and periosteal reflexes is always a manifestation of complete or almost complete breakage of the spinal cord in trauma. It is manifested by depression of sensitivity, far-reaching disorders of the pelvic organs, bedsores.
If flaccid paraplegia emerged suddenly as a result of trauma, this does not always indicate a complete intersection of the spinal cord - this picture may be a consequence of diaschisis. As it weakens, the symptoms of lethargy give way to the symptoms of spastic paraplegia.
Process, more and more spreading through the spinal cord and squeezing it more and more. There is a tumor of the spinal cord, which leads to the fact that spastic at the beginning of his paraplegia eventually turns into sluggish.
Paraplegia, developing due to bilateral damage to peripheral motor neurons - it is always paraplegia flaccid, characterized, apart from atony, by extinction of tendon and periosteal reflexes.
Paraplegia of the Strumpel
Synonyms of the name: Erba-Charcot-Strumpeel's disease, or familial spastic paraplegia.
This disease with an inherited defect of the nervous system - a bilateral degeneration of the glia of pyramidal tracts in the cords( lateral and anterior) at the level of the thoracic and lumbar parts of the spinal cord, involving in the subsequent stages of pyramidal fibers of the brainstem and partial death of Betz cells in the motor zone of the cortex of the cerebral hemispheres.
The inheritance mechanism is autosomal dominant, either autosomal recessive, or it is X-linked;genes responsible for the transmission of pathology have already been identified.
Due to genetic heterogeneity, the disease can manifest itself at the age from the 1st to the 7th years of life by the symmetrical lower spastic paraplegia, manifested:
- by the gradual development;
- early onset of tendon reflexes;
- rapid foot fatigue from walking;
- cramps in the muscles of the legs constrictive nature;
- spastic gait;
- increased level of tendon reflexes;
- clone of feet and patella;
- formation of contractures and deformations of feet with the formation of a "hollow foot" - with its shortening and height increase.
With the involvement of the upper limbs, which happens in a deeply advanced stage of the disease, this does not affect the sensitivity and intelligence.
Possible damage to the visual and oculomotor nerves( II and III pairs of cranial nerves), the emergence of dysarthria, ataxia, nystagmus, intentional tremor.
MRI shows a picture of the characteristic atrophy of the spinal cord throughout its extent with a special expression in the area of the "ponytail".
For this disease in differential diagnosis indicate:
- later onset of the disease with slowly progressing course, complicated by spastic paraplegia, with normal psychomotor development;
- retaining the patient's ability to walk to adulthood;
- Health of heterozygous family members.
Concomitant symptoms of
In a bilateral process in the cerebral cortex with a tumor in the upper third of the precentral gyrus, the spastic lower paraparalytic is often accompanied by Jackson epilepsy with the advent of clonic seizures with the onset of their muscles in the legs.
In children, spastic diplegia is characterized by an insurmountable spasticity of leg muscles with a pronounced adductor dominance and the formation of a characteristic gait, or even the inability to walk alone. Pathology is also manifested by combined athetosis hyperkinesis of the muscles of the hands and face.
General principles of treatment
The main actions should be aimed at eliminating the causes that caused paraplegia:
- prompt removal of the tumor;
- elimination of cerebrospinal hernia;
- treatment of a nervous system infection;
- and similar measures.
The prescription of medicines is made taking into account the nature of the pathology.
With spastic paraplegia, electrotherapy can lead to an increase in contractures, while with its peripheral origin this method of treatment will yield a favorable result.
In case of multiple sclerosis, or with systemic sclerosis, spondylitis of tuberculosis etiology is contraindicated in mud cure.
With lower paraplegia the emphasis should be on the development of the musculature of the upper limbs, on the condition of which the subsequent fate of the patient depends. And here the first step to getting out of helplessness is teaching art to sit in bed.
Symptomatic treatment is prescribed for relief of underlying comorbid conditions. Appointed antihypertensive, anticonvulsant and antispasmodic drugs, means for improving trophism of tissues.
Balneotherapy procedures are also used, mud, massage and exercise therapy are indicated.
From the practice of the neurologist
An example is the treatment scheme for lower paraplegia, the central genesis, as a result of a spinal cord injury in a young patient, where the complex effect produced a complex treatment:
- Actovegin - intravenously sprayed;
- Trental - intravenously;
- Proserin ;
- vitamin B12 intramuscularly;
- massage of the lower extremities in combination with exercise therapy;
- acupuncture and electrical myostimulation extensor muscles
This is a set of measures that has been prescribed apart from self-loading on the shoulder girdle and early training in sitting in bed, help overcome the fear of which psychotherapy sessions have helped.
A satisfactory result was also given by the combination:
- muscle relaxant Midokalm ;
- providing a complex sedative-hypnotic, anticonvulsant and anxiolytic effect of Sibazone ;
- Pentoxifylline - a means for improving microcirculation;
- Milgamma is a complex of B vitamins;
- ATP is a tissue energy stimulator;
- Cerebrolysin is a nootropic drug.
Possible complications and prognosis
Prognostically weak and spastic flexor paraplegia is less favorable than spastic extensor. The inability to develop work skills due to muscle weakness of the legs should also be attributed to an unfavorable prognosis for the patient.
Complications of the same disease is the complete loss of the ability to move independently due to the progression of the pathology that has arisen, disability and the appearance of pelvic disorders and trophic bedsore disorders.
There are currently no proven, reliable methods of treating paraplegia.
A comparatively good result is only the application of traditional Chinese medicine methods in the form of acupressure, reflexotherapy, acupuncture, the use of electric needles and a lamp with Chinese herbs, drinking fresh herbal decoctions prepared according to an individual prescription, herbal boluses and similar methods of influence.