The lecture is paralyzed

2021-02-05 12:00 AM

Cranial tomography without contrast injection will see a convex lens-shaped increased density mass, located between the skull and the sclera.

Define

Paralysis is a decrease or loss of involuntary movement of one arm and one leg on the same side due to pyramidal injury with or without paralysis of one or more cranial nerves of the same or different sides as the paralysis of the limbs.

Functional anatomy of the tower bundle

Line diagram of the movement of the tower

The active motor path consists of two main neutrons: The first neutron is located in the motor region of the cerebral cortex (up front, in front of the Rolando groove), the axon of these neurons forms the active motor bundle (tower bundle). The bundle goes from the cerebral cortex down through a very narrow area in the inner envelope and down to the brain stem, brain stem, spinal cord. When down to the lower 1/3 of the medulla, most of the fibers of the bundle cross the middle line to the opposite side forming a diagonal bundle to go down depending. A small portion of the fibers of the remaining bundle continue to go straight down the medulla to form a straight bundle. The second neuron is located in the anterior medullary horn, when coming to the respective segments of the spinal cord, the splitting turret bundle dominates the motor neurons of the anterior medullary horn, the straight bundle also allows the fibers to cross the middle line to dominate. motor neurons on the opposite side.

Symptom learning

When the patient is awake

Soft paralysis:

Decreased or lost movement of one arm and one leg on the same side predominates the upper and lower extremities stretching muscles.

Often there is paralysis of the central face together with the limbs are paralyzed or can be paralyzed on the other side of the face. Other cranial nerves may be paralyzed.

Muscle tone decreased in paralyzed limbs.

Decreased or absent tendon reflexes in paralyzed limbs, abdominal skin reflex and often scrotum (in men) decreased or lost paralysis, decreased anal reflex or paralysis, Babinski's mark or equivalent can (+) paralyzed, Hoffmann can (+) paralyzed.

May be accompanied by a sense of paralysis.

Walking gait (the hand on the side is paralyzed and the legs drop, then sweep the ground)

When lying on the side, paralyzed feet fall out.

Spastic paralysis:

Lateral muscle paralysis decreased or lost.

Paralysis of the central face on the same side or other peripheral facial paralysis with paralysis of limbs, possibly other cranial nerve palsy.

Increased paralysis muscle tone leads to limb spasms on other fingers tightly grasping the thumb and lower limbs stretching, so when walking has a bowed gait (fine grass).

Paralytic lateral tendon reflex increase, pathological reflex such as Babinski or equivalent. Abdominal, scrotum and anal reflexes decrease or lose paralysis.

May be accompanied by sensory disorders of paralysis.

When the patient is in a coma

The paralyzed side foot spilled out.

You can turn your eyes and head to the side with the paralyzed limbs or to the side with the paralyzed limbs.

Imbalance in the face such as the central core is deviated to the healthy side, the cheek is palsy and bulging according to the breathing rhythm, stimulating pain in the angle of the two sides, if it is still responding, only the side edge is healthy up and the paralysis remains the sign Pierre. -Marie- Foix.

Pain stimulation in the limbs on both sides, the opposite side hardly reacts or reacts weaker than the opposite side.

Abdominal skin reflex, scrotum decreased or paralysis, may have Babinski (+) sign paralysis.

Diagnosis of the zone

Damage to the brain

Paralysis of hands, feet and sides. There may be paralysis, Broca-type aphasia when the dominant hemisphere is damaged (hemisphere facing the dominant hand), epilepsy, homosexuality or loss of practicality, diagram loss awareness body, not knowing limbs are paralyzed.

Inner injury

Paralysis of limbs at the same side, heavy and proportional, pure movement. If the lesion spreads inward, there will be symptoms of the thalamus such as subjective sensory disturbances.

Brain stem damage

Brain stem injury: Causes Weber's syndrome (paralysis of the III on the damaged side and paralysis of the opposite half of the body.

Injury to the brain: Causing paralysis of peripheral VII cord to the injured side (sometimes VI cord) and paralysis of the arm and leg on the opposite side called Millard-Gübler syndrome. Possible cause of Foville's syndrome is paralysis of a sideways glance to the affected side and paralysis of the limbs on the opposite side.

Injury to the medulla oblongata: Usually causes Babinski- Nageotte syndrome is cerebellar syndrome, Claude Bernard-Horner and paralysis of the paralysis of the paralysis of the paralysis of the paralysis with paralysis of the opposite limb.

Damage to high neck marrow (above C4)

Paralysis of limbs with lateral lesions and no cranial nerve palsy. Possible Brown - Sequard syndrome.

Differential diagnosis

Functional paralysis (dissociation disorder)

Usually occurs in special circumstances such as trauma. Clinical symptoms vary with external influences and under the influence of implications. There is no match between consecutive visits. Normal tendon reflex, normal abdominal and scrotum reflexes, no Babinski or equivalent signs.

Reduced movement in extrapyramidal semitoneum syndrome (Parkinson's syndrome)

Many cases of Parkinson's syndrome start on one side, especially those for which the hypertonic symptoms are primarily mistaken for hemiplegia. A careful physical examination will detect tremor at rest, signs of extrapyramidal hypertonia manifesting lead-tube spasticity, and serrated wheel signs. The symptoms of pyramidal spasticity have different characteristics: Spasticity of the folding muscles of the upper extremities and the extensors of the lower extremities, spasticity of elastic properties. Note that brain tumours can invade the Gray nuclei, so the first stage often presents with tremors and symptoms of lack of movement in the body.

Mobility deficiency after a local epilepsy (Todd paralysis)

In motor local epilepsy or a secondary generalized local epilepsy may develop residual paralysis within a few hours. Need to carefully ask the history and progress of paralysis, especially in cases that have occurred many times. EEG is important to help detect paroxysmal activities like epilepsy or unusual changes after the seizure.

Half-body inattention phenomenon

 Met in the parietal lobe injury syndrome of the non-dominant hemisphere This phenomenon is often combined with other symptoms of non-dominant hemisphere injury such as denial of the affected side, loss of seminary consciousness.

Diagnose the cause

Diagnosis is based on questioning, clinical examination and subclinical tests, especially brain scans, computed tomography or brain imaging ...

Hemiplegia appeared suddenly

Traumatic and traumatic brain injury:

Traumatic brain injury can cause brain crushing, hematoma, cerebral edema ... Diagnosis is based on clinical and cranial computed tomography.

Clinical manifestations include hemiplegia (sometimes only motor defects) with dilated pupils.

Cranial tomography without contrast injection will show a convex biconvex weight gain mass between the skull and the dura. This is an emergency neurosurgery.

If the CT scan of the brain is normal, it is necessary to carefully examine the arteries in the neck to detect the dissection aneurysms formed after the trauma, which may be the cause of the cerebral infarction that early stage can have not been seen on cranial tomography.

Stroke:

Includes two types of cerebral infarction and cerebral hemorrhage.

Cerebral infarction manifests itself as hemiplegia suddenly, usually without severe disorders of consciousness, and no meningeal syndrome. Cranial tomography showed an image of the reduced density area corresponding to the blood supply area of ​​the blocked artery. Brain scans that may be normal during the early hours also do not allow a new cerebral infarction to be ruled out.

Cerebral haemorrhage with hemiplegia appears suddenly accompanied by headache, vomiting, confusion and manifestations of meningeal syndrome. Cerebrospinal fluid may contain blood that is not clotting, evenly in all 3 tubes. Cranial tomography will show the image of the hematoma increasing density in the brain parenchyma, surrounded by brain oedema and squeezing the neighbouring organs; in addition, blood stagnation in the fissures in the base of the skull and blood flow into the ventricles can be seen.

Other causes:

Cerebral thrombophlebitis: Cerebral thrombophlebitis usually occurs in sites with systemic disease, postpartum, blood clotting disorders ... The clinical manifestations are persistent headache that may appear before or before. accompanied by paralysis. Hemiplegia may be accompanied by other symptoms such as epilepsy, increased intracranial pressure and reversible paralysis. Cranial CT scan showed a combined lesion of increased and decreased density of an infarct with bleeding in the nocte. When the contrast is injected, if the venous sinus obstruction can see an empty delta.

Post-subarachnoid cerebral spasm: Clinical manifestations are sudden onset of meningeal syndrome, usually without fever. Puncture of cerebrospinal fluid found no blood clots, evenly in all 3 tubes. Within the first 3 weeks, hemiplegia may also appear, rapid progression of paralysis accompanied by deteriorating patient consciousness. Brain computed tomography shows an increase in the density of the fissures of the base of the skull, the reservoirs, in the ventricles due to blood stagnation and or the loss in density, the position depends on the constriction of the artery.

Infectious endocarditis: Hemiplegia often appears suddenly in a patient presenting with persistent fever. Hear the heart's murmur and other heart symptoms. Other combined skin lesions such as pustules, septic ulcers ... Echocardiography has endocarditis images. Positive blood cultures.

Hemiplegia may be seen in atrophic endocarditis associated with some advanced cancers or some systemic diseases such as Liebman-Sacks endocarditis in lupus.

Hemiplegia appeared slowly

Blocks fill up:

The characteristic of hemiplegia in cases of displacement in general and in brain tumours in particular is progressive hemiplegia with progressive intracranial pressure syndrome. May present with epilepsy. Retarded hemiplegia develops slowly over days, months, usually benign tumours such as meningeal tumour, astrocytoma, less branched glioma ... Common weeks in malignant brain tumour, brain abscess.

Subacute encephalitis:

Patients often have septic syndrome and brain damage symptoms such as consciousness disturbances of varying degrees, epilepsy, severe muscle tone disturbances resulting in excessively twisted or twisted positions. The hemiplegic paralysis appears gradually, often manifested on both sides. In the early stages, there may be signs of a meningeal syndrome. Brain computed tomography showed scattered density reduction nipples accompanied by cerebral oedema. Diagnosis is confirmed by serological reactions such as anti-HSV-1 antibodies and finding HSV-1 DNA in the cerebrospinal fluid.

Some form of special progression

Malignant brain tumour:

May progress suddenly as a stroke due to bleeding in the tumour (pseudo-stroke).

Internal carotid artery occlusion:

Hemiplegia may be increased gradually due to the spread of brain tumour or cerebral oedema, which may be mistaken for a tumour (pseudotumor).

Transient hemiplegia:

The majority of these cases are transient ischemic events. Paralysis recovers within 24 hours, but requires careful examination, finding risk factors and preventive treatment because it will recur into a real cerebrovascular accident. There may be transient hemiplegia after a complication of seminal complications or transient hemiplegia after a local seizure (Todd paralysis).