symptoms, early symptoms and signs of paralysis
- 2021-07-24 02:10:32
- How To Prevent paralysis And Nursing Measures Of paralysis
- paralysis Examination, paralysis Diagnosis
Symptoms of paralysis
Typical symptoms: abnormal posture, abnormal motor system, abnormal reflex and abnormal muscle tone. It varies according to different clinical types. Spastic type is characterized by increased muscle tone, while hypotension type is characterized by paralyzed limbs with soft limbs, but tendon reflex can still be induced.
Related symptoms: Paraplegia, sensory disturbance, strong facial muscles and disappearance of facial striations
Diagnosis of paralysis symptoms
1. Clinical characteristics
(1) Characteristics of upper motor neuron paralysis:
Because the cortical motor area and descending pyramidal tract dominate muscle groups intensively, the lesion often leads to paralysis of the whole limb (monoplegia) and paralysis of one limb (hemiplegia); Bilateral lesions can cause paraplegia of both lower limbs or quadriplegia. The muscle tension of the affected limb increased, tendon hyperreflexia, shallow reflex weakened or disappeared, pathological reflex appeared, and there was no muscular atrophy and muscle bundle tremor, but apraxia muscular atrophy could be seen after long-term paralysis. Electromyography showed that nerve conduction velocity was normal and there was no denervation potential.
Acute severe lesions such as acute stroke and acute myelitis, due to sudden interruption of pyramidal tract, spinal cord shock occurs, muscle stretch reflex is inhibited, showing flaccid paralysis, and tendon reflex decreases or disappears. After several days or weeks, the stretch reflex recovered and turned into hypertonia and hyperreflexia of tendon. The length of shock period depends on the degree of lesion and whether it is complicated with infection and other complications. Because the muscle spindle is more sensitive to distraction reflex than before illness, especially the muscle tension of upper limb flexor and lower limb extensor is higher. It shows that the initial resistance is large, and then the resistance drops rapidly, showing clasp-knife phenomenon.
(2) Characteristics of lower motor neuron paralysis:
Muscle tension of paralyzed muscles decreased, tendon reflex weakened or disappeared (single synapse stretch reflex was interrupted by lower motor neuron injury), and muscular atrophy appeared in the early stage (about several weeks) (muscular trophic disorder of anterior horn cells), and muscle bundle tremor was seen without pathological reflex. Electromyography showed decreased nerve conduction velocity and denervated potential.
Lower motor neuron lesions are mostly caused by one or several adjacent spinal nerve roots, peripheral nerves or nerve plexus lesions, which often only invade a certain muscle group and cause partial muscle paralysis or single limb paralysis; Multiple nerve roots or neuropathy can also cause quadriplegia such as Guillain-Barr syndrome.
2. Localization diagnosis of upper and lower motor neuron paralysis
(1) Clinical manifestations of upper motor neuron disease:
① Cortex motor area: Localized lesion leads to contralateral monoplegia, or contralateral upper limb paralysis complicated with central facial paralysis. Irritating lesions cause focal twitch seizures, spats and epilepsy in corresponding parts of the contralateral body.
② Subcortical white matter: It is a radial crown formed by projection fibers between cortex and internal capsule. The closer the nerve fibers are to cortex, the more dispersed they are, which can cause contralateral monoplegia, and the deeper the fibers are, the more concentrated they are, which can lead to contralateral unequal hemiplegia.
③ InteRNAl capsule: The motor fibers are the most concentrated, and the small lesions are enough to damage the whole pyramidal tract, causing tripartite sign. The involvement of the knee and the front 2/3 of the hind limb of the internal capsule causes contralateral equal hemiplegia (central facial paralysis, tongue paralysis and limb paralysis), the involvement of the back 1/3 of the hind limb causes contralateral hemiplegia, and the involvement of visual radiation causes contralateral homogeneous hemianopia.
④ Brain stem: Unilateral brain stem lesions involve ipsilateral motor nucleus of cranial nerves and uncrossed corticospinal tract and corticomedullary tract, resulting in cross paralysis syndrome, that is, ipsilateral cranial nerve palsy, contralateral limb palsy and upper motor neuron palsy of cranial nerves below the lesion level.
For example, Weber syndrome: oculomotor nerve paralysis on the focus side, contralateral nerve, hypoglossal nerve and motor neuron paralysis on limbs; Millard-Gubler syndrome: the lesion is abducent nerve, facial nerve paralysis, motor neuron paralysis and hypoglossal nerve paralysis on the contralateral limb, which are lateral lesions at the basal part of pons; Foville syndrome: Lateral abducent nerve paralysis, binocular gaze paralysis, contralateral hemiplegia, medial lesion at the basal part of pons. It is common in occlusion of paramedic branch of basilar artery; Jackson syndrome: Peripheral hypoglossal nerve paralysis on the focus side (extending tongue to the focus side, tongue muscle atrophy), contralateral hemiplegia, internal olive lesion in the anterior medulla oblongata, mostly caused by anterior spinal artery occlusion.
⑤ Spinal cord:
A. Hemisection damage: Spastic paralysis and deep sensory disturbance on the same side below the lesion injury plane, pain and temperature disturbance on the opposite side, and signs of the same segment of the lesion are often not obvious.
B. Transverse damage: Spinal cord injury often involves bilateral pyramidal tract, resulting in spastic paralysis of limbs below the damaged plane, complete sensory disturbance and sphincter dysfunction. The upper motor neuron paralysis of limbs appeared in the lesions above the level of cervical enlargement, and the lower motor neuron paralysis of both upper limbs and upper motor neuron paralysis of both lower limbs appeared in the lesions of cervical enlargement, and spastic paraplegia was caused by thoracic myelopathy. Lumbar swelling lesions lead to double lowerSublimb motor neuron paralysis.
(2) Clinical manifestations of lower motor neuron disease:
① Anterior horn cells: Paralysis is distributed in segments without sensory disturbance, such as paralysis and atrophy of deltoid muscle caused by anterior horn cell lesion of neck 5, paralysis and atrophy of small hand muscles in neck 8 ~ chest 1, atrophy and weakness of quadriceps femoris in waist 3, and dorsiflexion of ankle joint and toe in waist 5. Acute onset is more common in poliomyelitis, while chronic patients have fasciculation that can be recognized by naked eyes or fibrillation that can only be seen on electromyography because some injured anterior horn cells are stimulated by pathological changes, which is common in progressive spinal muscular atrophy, amyotrophic lateral sclerosis and syringomyelia.
② Anterior root: Flaccid paralysis with segmental distribution, which is more common in extramedullary tumor compression, spinal membrane inflammation or vertebral lesions. Because posterior root is often involved at the same time, it may be accompanied by root pain and segmental sensory disturbance.
③ Nerve plexus: It causes paralysis of most peripheral nerves in one limb, sensory and autonomic nerve dysfunction, such as paralysis of deltoid muscle, biceps brachii muscle, brachial muscle and brachioradialis muscle caused by injury of superior brachial plexus, unaffected small muscles of hand, sensory dysfunction of deltoid muscle area, hand and radial forearm.
④ Peripheral nerve: The distribution of paralysis is consistent with the innervation area of peripheral nerve, which can be accompanied by sensory disturbance in corresponding areas, such as paralysis of extensor wrist, extensor finger and extensor pollicis caused by radial nerve damage, and sensory loss of thumb and first and second metacarpal spaces on the back of hand; Polyneuropathy has symmetrical flaccid paralysis of distal limbs, muscular atrophy, glove-sock sensory disorder and skin nutritional disorder.
In addition, when judging paralysis, we should first exclude motor restriction caused by some diseases, such as myotonia or bradykinesia caused by Parkinson's disease and other diseases, and fear of movement due to limb pain.
According to the medical history and clinical symptoms, the diagnosis can be made.