Symmetric flaccid paralysis of the veloglossopharyngeal respiratory muscles

Introduction The sputum, tongue, pharynx, and respiratory muscles are symmetrically flaccid, and have cranial nerve damage such as difficulty in chewing, difficulty in swallowing, difficulty in language, and difficulty in breathing. Typical symptoms such as sagging of the eyes and neurological problems of the eyes may occur. Therefore, the symptoms of facial nerve must be understood to facilitate the timely detection of the disease. It is caused by the activation of herpes zoster (VZV), which is latent in the dormant state of the facial nerve sensory ganglia. Other inflammatory diseases and infections can also trigger this symptom.

Cause

Botulism poisoning. Herpes zoster (VZV), which is latent in the dormant state of the facial nerve sensory ganglia, is activated. In addition, meningitis, mumps, influenza, scarlet fever, malaria, multiple cranial neuritis, local infections, etc. can be caused, such as otitis media, labyrinthitis, mastoiditis, supracondylar inflammation of the humerus, paralysis due to fatigue and facial, It is cold after the ear and is caused by the wind. Both the tumor itself and surgical removal of the tumor can be caused. Tumors include: basal aneurysms, skull base tumors, acoustic neuromas, and adenomas.

an examination

Related inspection

Neutralization test electromyogram

According to the history of special diet and the incidence of the same meal, combined with the clinical manifestations of symptoms and signs such as dry throat, constipation, blurred vision and central nervous system damage, it is generally not difficult to make a diagnosis. The detection of bacteria can only be used as an auxiliary basis. The toxin was cultured and confirmed. The diagnosis of infant botulism is mainly based on the detection of Clostridium botulinum or Clostridium botulinum toxin in the stool of the child, because the blood toxin may have been combined and not easily detected. Traumatic botulism, mainly to detect Clostridium botulinum or serum toxins.

Laboratory inspection:

1. Pathogen examination After suspicious food, vomit or excretion is heated and boiled for 20 minutes, blood agar is inoculated as an anaerobic culture to detect pathogenic bacteria.

2. Toxin test

(1) Animal test: the test specimen leaching solution is fed to the animal, or the guinea pig and the white mouse are injected intraperitoneally, and the control group is set at the same time, and the sample treated by heating at 80 ° C for 30 min or the mixed botulinum antitoxin is added to the specimen, such as The limbs of the experimental group died of limb paralysis, while the control group did not, the diagnosis of the disease was established.

(2) Neutralization test: 0.5 ml of each type of antitoxin serum was injected into the peritoneal cavity of the mouse, and then 0.5 ml of the specimen was inoculated, and a control group was set at the same time to judge the toxin and the stereotype.

(3) Avian eye inoculation test: The toxin containing toxin is injected into the lower eyelid of the poultry's eye from 0.1 to 0.3 ml depending on the size of the bird. The eyelids are closed, or paralytic convulsions and dyspnea appear. Death to several hours can be used as a quick diagnosis.

3. Other auxiliary examinations: EMG examination has muscle fiber fibrillation, single stimulation response is reduced, multiple repeated stimulation potentials are increased, short-term duration wavelet amplitude multi-phase movement, potential increase, etc., which is helpful for the diagnosis of this disease.

Differential diagnosis

1. Bronchial smooth muscle spasm: Asthma, the main pathological change is bronchial smooth muscle spasm, which is one of the common respiratory diseases in pediatrics. It is currently believed that bronchial asthma is a chronic airway inflammatory disease, and many cells play important roles in it, such as lymphocytes, eosinophils, mast cells, etc., accompanied by a significant increase in non-specific airway response. Airway hyperresponsiveness (BHR) is a multifactorial disease with major clinical features. Clinically, it mainly manifests as reversible wheezing and coughing episodes, chest tightness, and difficulty in breathing. These symptoms are often reversible, but they can also cause death.

2. Abnormal breathing refers to the frequency of breathing and the change in rhythm concept. When the patient feels that the air is insufficient, the breathing is laborious, objectively, the patient has strong breathing, the respiratory muscles and the auxiliary respiratory muscles all participate in the respiratory movement, the ventilation increases, the respiratory rate, the depth and the rhythm change, which is called dyspnea.

3. Respiratory failure is a serious disorder of lung ventilation or ventilation due to various reasons, so that effective gas exchange cannot be performed, resulting in hypoxia with or without carbon dioxide retention, resulting in a series of physiological functions and metabolic disorders. Clinical syndrome. Respiratory failure is an important part of respiratory physiology research, an important cause of death from respiratory diseases, and the application of various types of mechanical breathing devices and respiratory physiology devices in the respiratory failure care unit (RUCU) to achieve significant therapeutic effects. Respiratory failure relies solely on clinical diagnosis of arterial blood gas analysis.

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