Paraplegia

Paraplegia (gr. paraplegie, from para - around, close and plege a shot, defeat)- paralysis of both lower (paraplegia inferior) or both upper (paraplegia superior) of the limbs. Paraplegia arises from organic lesions of the nervous system (organic P.) or psychogenic disorders (psychogenic, mostly hysterical P.). Organic paraplegia can develop as a result of bilateral lesions of the Central or peripheral nervous system. In the first case, P. mostly (but not always) has a spastic nature, the second is sluggish.
The symptomology. Spastic paraplegia, in addition to the effects of paralysis is characterized first of all by the increased tone, development spastic hypertonia.
More often hypertension affects leading muscles, the extensors of the femur and tibia, and plantar flexor tendons of the foot. Lower extremity when stretched. Less common P., in which the lower limbs constantly bent due
development of contractures of the femur and tibia (flexor paraplegia Babinski). P. flexion type occurs in cases of particularly voluminous lesions of the spinal cord, as well as the very debilitated patients and in patients with severe bedsores. In prognostic against it less favourable than P. extension type. When extensor paraplegia observed a sharp increase tendon and subperiosteal reflexes, fading skin and pathological reflexes (see) as extensor (Babinski reflex and similar)and flexion (reflex Rossolimo and similar) type, appear protective reflexes (see) And friendly movements like global and coordinatory of Cincinnati (see).
Paraplegia, developing at defeat of the Central motor neurons, can be sluggish or permanent, or in the well-known phase of its development (the beginning of the disease or the end of it). P. flowing all the time in the flaccid form with atony, fading, tendon and subperiosteal reflexes, always a sign of a complete or almost complete transection of the spinal cord (mainly traumatic cases) and is accompanied by decrease of sensitivity, deep functional disorders of the urinary bladder and rectum, bedsores. The sudden emergence of a sluggish P. after injury does not always speak about a complete break of the spinal cord, it can be a consequence only of deschisa (see). In such cases, decreasing deschisa symptoms flaccid paraplegia begin to give way to the symptoms spastic., In the final phase of sluggish P. develops in those cases when the process that caused the first development spastic P., increasingly spreading across the spinal cord or more of its squeezes. This usually occurs by tumors of the spinal cord.
Paraplegia arising from bilateral lesions of the peripheral motor neurons [poliomyelitisa processes, analgesia appearances in those of syringomyelia (see), the defeat of the cauda equina, especially its traumatic injuries and tumors, deep radiculitis, plexitis, polyneuritis, especially alcohol, but also other toxic and infectious origin], always be sluggish, that is characterized by atony and the fading of the tendon and subperiosteal reflexes. From sluggish village center of origin of peripheral P. differ in the development of muscle atrophy with the qualitative changes of elektrovozoremontnij (reaction rebirth).
Finally, there may be cases where affected are at the same time and peripheral and Central conditioners. This may occur, for example, when meningomyelitis with the involvement of the front roots, extramedullary tumors, amyotrophic lateral sclerosis. The clinical picture is thus composed of the symptoms of spasmodic and sluggish P. peripheral type in various combinations.
The diagnosis. When paraplegia it should be borne in mind compression (especially in tuberculous spondylitis and extramedullary tumors and infectious mality and meningomyelitis, multiple sclerosis, traumatic lesions of the spinal cord, intramedullary tumors, syringomyelia, diseases of the spinal cord (amyotrophic lateral sclerosis, lateral sclerosis, the so-called combined scleroses). When cerebral lesions in most cases there is a bilateral softening of the brain (specific Takayasu, arteriosclerosis). The diagnosis should be based on the aggregate of all symptoms and analysis of disease. Great importance is the determination of the level of destruction. The upper boundary of the anaesthetic corresponds to the top level of the hearth, top border of the zone with which called protective reflexes,the lower its level.
The treatment should be aimed first of all at the underlying disease; favorable effect and symptomatic treatment. When paraplegia peripheral origin shown electrotherapy, in spastic P. it cannot be used, as can increase contracture. Good help massage, active and passive exercises. In some cases, good dirt and sulphur bath, but remember that mud is contraindicated in patients with multiple sclerosis, systemic sclerosis, tuberculous spondylitis. Drug treatment - see Paralysis, paresis.