quadriplegia
Introduction
Introduction The brain, brainstem and cervical spinal cord lesions are upper motor neurons, and the remaining lesions are lower motor neurons, which refers to the loss or disappearance of the free movement of the limbs. Due to the malfunction of the nerve function, part of the body completely or incompletely loses its athletic ability/metaphoric mechanism; it cannot work normally. refers to the decline or disappearance of voluntary movements. Clinically, sputum is divided into functional sputum and organic sputum. The former is caused by psychogenicity, that is, snoring. Organic sputum can be divided into upper motor neuron, lower motor neuron, and myopathy according to the anatomy of the lesion.
Cause
Cause
Bilateral pyramidal tracts of the brain, brainstem and cervical cord, gray nerve roots of the spinal cord, peripheral neuropathy (eg cerebrovascular disease, tumor, inflammation, etc.), neuromuscular conduction disorders and muscle diseases can cause quadriplegia. Lesions that cause quadriplegia can occur simultaneously.
(1) Causes of the disease Where the cortical motor projection area and the upper motor neuron path are damaged by the lesion, the upper motor neuron may be caused. The common causes are craniocerebral trauma, tumor, inflammation, cerebrovascular disease, degeneration, poisoning. And some diseases of internal medicine, such as diabetes, hematoporphyria, macrocytic anemia and vitamin B12 deficiency.
(B) the common causes of motor neuron spasm caused by pathogenesis are: peripheral nerve injury, such as laceration, contusion, compression, brachial plexus trauma, electric shock, radiation injury, burns, etc.; toxic damage, including drugs , organic matter, inorganic substances, bacterial toxins, etc.; peripheral neuritis, including infectious, post-infection and allergic diseases, connective tissue disease and nodular peripheral neuropathy; peripheral neuropathy in metabolic diseases; peripheral neuropathy in malignant diseases Peripheral neurological tumors, primary and hereditary peripheral neuropathy.
Examine
an examination
Related inspection
Babinski's sputum test for voluntary exercise examination of cerebrospinal fluid-bound myelin basic protein
Quadriplegia caused by cerebral lesions caused by quadriplegia and cerebrovascular disease is more common in the elderly. It is a subtle incomplete paralysis of the limbs, accompanied by pseudo-ball paralysis such as dysarthria and difficulty in swallowing. Repeated episodes of multiple sclerosis can cause bilateral hemiplegia, often accompanied by pseudobulbar palsy, bilateral cerebral hemisphere lesions, such as cerebral edema can have quadriplegia and denervation.
1. Clinical features
(1) Characteristics of upper motor neurons: Because the cortical motor area and the descending pyramidal bundle dominate the muscle group in a concentrated manner, the lesion often leads to the entire limb paralysis (monoplegia), one limb limb paralysis (hemiplegia, hemiplegia Bilateral lesions can cause paraplegia or paraplegia in the lower extremities, increased muscle tone in the affected limb, hyperreflexia, weakened or disappeared shallow reflexes, pathological reflexes, no muscle atrophy and fasciculation, but long-term paralysis After the disappearance of muscle atrophy, the electromyogram showed normal nerve conduction velocity and no denervation potential. Acute severe lesions such as acute stroke, acute myelitis, due to sudden withdrawal of the pyramidal tract, spinal cord shock, muscle stretch reflex is inhibited by soft palate, tendon reflexes are reduced or disappeared, and stretch reflex recovery lasts for several days or weeks , converted to increased muscle tone, hyperreflexia, the length of the shock depends on the degree of disease and whether the infection is combined with infection, because the muscle shuttle is more sensitive to stretch reflex than before the disease, especially the upper limb flexor and lower extremity extensor The muscle tension is higher, the initial resistance is large, and the resistance decreases rapidly afterwards, which is a clasp-knife phenomenon.
(2) Characteristics of lower motor neurons: muscle muscle tension decreased, tendon reflexes weakened or disappeared (lower motor neuron damage interrupted single synaptic stretch reflex), early muscle atrophy (about several weeks) appeared (anterior horn Muscle nourishment of the cells), fasciculation of the muscle bundle, no pathological reflex, EMG showed decreased nerve conduction velocity and denervation potential.
Diagnosis
Differential diagnosis
(A) Acute poliomyelitis (acute poliogmyelitis) onset of fever, sore throat, poor appetite, nausea, vomiting, constipation, diarrhea and other symptoms. Generally, on the 3rd to 5th day after the onset of the disease, limb paralysis occurs after the retreat. It is more common in one lower limb, but also in the lower limbs or limbs. It is asymmetrical flaccid paralysis, muscle tension is relaxed, and tendon reflexes are weakened or disappeared. Feel there. The number of cells in the cerebrospinal fluid increased and the protein content increased slightly.
(B) acute infection polyneuritis (acute infectious polyneuritis) also known as acute polyneuritis or Guillain-Barre syndrome. A history of non-specific infections often occurs within 1 to 3 weeks before the onset of illness. Acute onset, first weakness of the lower limbs, and soon developed upward, quadriplegia occurred within 1 to 2 days. The sputum is flaccid and the tendon reflexes weaken or disappear. The muscles have compression pain. Distal muscle atrophy, no obvious sensory disturbance. Often accompanied by cranial nerve damage, more common in one or both sides of the nerve damage. Severe cases may have hoarseness, difficulty in swallowing and other symptoms of medullary paralysis, and may have respiratory muscle paralysis. Cerebrospinal fluid is a protein-cell separation phenomenon in which the protein is increased and the number of cells is normal or near normal.
(3) brachial plexus nearyitis (brachial plexus nearyitis) acute onset, upper extremity pain is the characteristic of this disease, first in the neck and the upper part of the clavicle, and then quickly spread to the back of the shoulder, arms and hands, the pain began to be intermittent, Later turned into continuity. It disappears within 1 to 2 weeks. The affected upper limb muscle strength is weakened, the tendon reflex is reduced or disappeared, the shallow feeling of the hands and fingers is reduced, and the muscle atrophy is not obvious. When the body is examined, there is tenderness in the nerve trunk. The characteristics of the upper brachial plexus are mainly the upper arm spasm, and the function of the hand and finger muscles is normal. The lower brachial plexus is mainly characterized by the distal paralysis of the upper limb and the atrophy of the small muscles of the hand. "Eagle Hand", the ulnar side of the forearm and hand and autonomic dysfunction. The electromyogram has a denervation potential, a decrease in the unit of motion, an increase in multiphase potential, and an extended time course.
(D) polyneuritis (polyneuritis) mainly manifested as distal symmetry of the distal extremity sensory disturbance, lower motor neuron spasm and autonomic dysfunction. The characteristics of the sputum are the motoneurons of the distal symmetry of the limb, depending on the severity of the nerve involvement, which may be from sputum to total sputum. The muscle tone is reduced, the tendon reflex is reduced or disappeared, and the reduction of tendon reflex is often earlier than the knee reflex. Muscles can appear atrophy, characterized by a distal end that is heavier than the proximal end. Muscular atrophy of the lower extremity with the tibialis anterior muscle, the tibialis anterior muscle, the upper limb with the interosseous muscle, the sacral muscle, the large and small intermuscular muscles are obvious, and the hand and foot can sag, and the walk can be a cross-threshold gait.
(5) The main manifestation of paralysis of the nerves is that the wrist, fingers and thumb cannot extend and abduct, that is, the wrist is drooping, and the back of the thumb and the first and second metacarpal spaces are reduced or disappeared. According to the different parts of the injury, there are different effects. In addition to the wrist drooping, the elbow joint can not be stretched due to the triceps tendon, and the forearm can be flexed to the elbow joint due to the tendon tendon, as in the humerus. When 1/3 is damaged, the triceps function is good. When the injury is at the lower end of the humerus or the arm is 1/3, the function of the diaphragm, the supinator, and the diaphragm is preserved. When the forearm is less than 1/3 of the injury, only the function of the extension finger is lost, and there is no sagging of the wrist. If the injury is in the wrist, symptoms of dyskinesia can occur.
(6) palsy of ulnar nerve ulnar nerve palsy, the finger sacral side deflection, abduction to the ulnar side and the movement of the little finger movement, small fish muscle and interosseous muscle atrophy. The ulnar side of the palm and back of the hand and the ulnar side of the entire little finger and ring finger are sensory.
(7) Caypal tunnel syndrome may be caused by a fracture, trauma or thickening of the transverse ligament of the wrist to compress the median nerve. The main manifestation is that the finger flexion function is weakened, the thumb and forefinger cannot be bent, the thumb can not be used for the palm movement, and the big fish muscle is obviously atrophied. The first to third fingers are half of the fourth finger, and the palmar side is sensory. There are symptoms of autonomic dysfunction such as dry skin, cold, and brittle nails.
(8) The paralysis of common peroneal nerve produces ankles of the tibialis and tibialis anterior muscles after injury. The performance is that the foot is drooping, the foot and the foot can not be dorsiflexed, and it is difficult to walk with the heel. When walking, raise the foot high, when the foot falls, the toes sag and the whole foot touches the ground, similar to the gait of the chicken, called the cross-threshold gait. The anterior and lateral shank feels impaired.
A physical examination can be diagnosed.
