locked-in syndrome
Introduction
Introduction to atresia syndrome Locked-insyndrome, also known as the atresia syndrome, is the state of the efferent state, which is caused by the basal lesion of the pons. Mainly seen in the cerebral vasculopathy, mostly bilateral occlusion of the basilar artery pons, resulting in bilateral infarction at the base of the pons. The patient's cerebral hemisphere and brainstem are protected by the reticular activation system, so the consciousness remains awake, and the understanding of the language is unobstructed. Because of the function of the oculomotor nerve and the trochlear nerve, it can illuminate the surrounding environment with the eyeball. build connection. However, due to basal damage of the pons, both bilateral cortical brain stem and corticospinal tract were blocked, and the motorized efferent function of the abductor nucleus was lost. The patient showed that he could not speak, had horizontal dyskinesia, and bilateral paralysis. Tongue, pharynx, articulation, swallowing movements have obstacles, can not turn neck shrug, limbs full sputum, can have bilateral pathological reflex. Therefore, although the consciousness is clear, but because the body can not move, can not speak, often mistaken for coma. Treatment is based on etiological treatment, but patients often die from serious complications. Therefore, once diagnosed as LS, the cause should be as clear as possible, early attention should be paid to the treatment of primary disease, and the brain stem function should be restored. The late stage is mainly to prevent complications, preventive application of antibiotics and gastric mucosal protective drugs to prevent lung infection. important. basic knowledge The proportion of illness: 0.005% Susceptible people: no special people Mode of infection: non-infectious Complications: upper gastrointestinal bleeding, sepsis
Cause
Causes of atresia syndrome
Traumatic brain injury (35%):
Due to basal damage of the pons, bilateral cortical brainstem bundles and corticospinal tracts were blocked, and the motorized efferent function of the abductor nucleus was lost. The patient showed that he could not speak, had horizontal dyskinesia, bilateral paralysis, tongue There are obstacles in pharyngeal and pharyngeal movements, swallowing movements, and it is not possible to turn neck and shoulders, and all limbs are paralyzed, which may have bilateral pathological reflexes.
Disease factors (15%):
Circulatory diseases caused by damage to nerve cells caused by certain diseases (hypotonic over-torsion torsion secondary to central cerebral myelinolysis), especially the destruction of myelin, occlusion or rupture of cerebrovascular (usually basilar artery) Bleeding.
Drug factors (10%):
Poisoning caused by the body due to excessive medication or self-awareness.
Poisoning (2%):
Bitten by a snake (Indian Golden Snake).
Prevention
Atresia prevention
Therefore, once the disease is diagnosed, in addition to effective etiological treatment, complications should be actively addressed. Patients with controlled complications can survive for a long time. The diet should be regular and reasonable, that is, high-protein, high-vitamin foods. Choose plant or animal protein with high nutritional value, such as milk, eggs, fish, lean meat, various soy products, etc. A variety of fresh vegetables, fruits and fruits are rich in vitamins and have high nutritional value.
Complication
Complications of atresia syndrome Complications upper gastrointestinal bleeding sepsis
This syndrome is caused by cough and coughing in the brain stem, can not swallow, and the patient is in bed, the resistance is reduced, and it is prone to lung infection, upper gastrointestinal bleeding, sepsis, respiratory and circulatory failure and death. Therefore, once the disease is diagnosed, in addition to effective etiological treatment, complications should be actively addressed. Patients with controlled complications can survive for a long time.
Symptom
Symptoms of atresia syndrome Common symptoms, pronunciation disorder, quadriplegia, slow response
Clinically, patients often have the following performance:
1. Consciousness is clear, you can understand other people's speeches, understand the questions, and use the sly, closed eyes or eye movements to answer.
2, all extremities, bilateral pathological reflex positive.
3, the pain stimulation and sound can be perceived, normal hearing, occasional partial sensory disturbance, stimulating the limbs can appear to brain rigidity.
4, poor prognosis, more than a few hours or days to die, can survive for several days are rare.
Examine
Examination of atresia syndrome
For patients with suspected coma, you can give the patient a speech command such as "open your eyes, close your eyes" and "look up, look down" to observe the patient's ability to perceive the sound stimulation. If the patient can understand the question, If you can use , closed eyes or eye movements to answer, you can make an identification. The normal or mild slow wave of the atresia syndrome helps to distinguish it from true disturbance of consciousness (especially de-cortical syndrome).
Diagnosis
Diagnosis and identification of atresia syndrome
diagnosis
Diagnosis can be based on medical history, clinical symptoms, and laboratory tests.
Differential diagnosis
Since the cortical brain stem of the cranial nerve is maintained intact by the inner capsule knee (near the caudate nucleus head), the paracentral nucleus near the abducens nucleus and its frontal lobe The cortical contact pathway is intact, so the patient's horizontal movement of the eye remains normal, which is the most significant difference from the clinical manifestations of LS. Clinically, it should be identified based on imaging changes, laboratory tests, etc. In addition, the disease needs to be differentiated from apathic mutism and cortical syndrome. In addition to the different clinical manifestations, the electroencephalogram of LS is mainly composed of and fast rhythm, which responds to acousto-optic and painful stimuli. According to this, it can be distinguished from the above two.
