High paraplegia

Introduction High paraplegia refers to a transverse lesion that occurs at a higher level in the spinal cord. Medically, paraplegia caused by transverse spinal cord lesions above the second thoracic vertebra is generally referred to as high paraplegia, and paraplegia caused by spinal cord injury below the third thoracic vertebra is called lower limb paraplegia. High paraplegia usually has quadriplegia, and the prognosis is poor. Others are the same as paraplegia of the lower extremity. The spine or accessory fracture of the spine, the displaced vertebral body or the bone piece protruding into the spinal canal, may oppress the spinal cord or the horsetail, causing it to occur to varying degrees. The injury, the injured spinal cord is below the plane, the sensory movement and reflex of the limb disappear completely, and the bladder and anal sphincter function are completely lost, which is called complete paraplegia. After cervical spinal cord injury, the upper limbs have neurological dysfunction, which is quadriplegia.

Cause

Paraplegia caused by transverse spinal cord lesions above the second thoracic vertebra. Most paraplegic patients are suddenly injured in normal labor and accidents (such as car accidents, work injuries, natural disasters).

1, traumatic type: mostly caused by spinal trauma, fractures and spinal cord injury.

2, spinal cord compression type: bone hyperplasia caused by bone hyperplasia, spinal stenosis, disc herniation surgery injury.

3, spinal degeneration type: including spinal cord softening, cavities, atrophy caused by inflammation and compression-type transformation.

an examination

Related inspection

Magnetic resonance plain EEG examination random exercise examination

Inspection and diagnosis of high paraplegia:

(1) Spinal shock: a complete flaccid paralysis secondary to the injury segment after spinal cord injury, accompanied by various clinical phenomena of loss of reflex, sensation, and sphincter function. In the case of minor injuries, this performance can be restored within hours or days without leaving sequelae. If the degree of injury is heavier, this performance may last for a long time. It usually takes 3 to 6 weeks before the spontaneous activity of the spinal cord below the injury segment gradually appears.

(b) Sensory impairment: All kinds of sensations are lost below the damage plane. After the recovery of spinal cord shock, the feeling can gradually appear. Sometimes there may be some sensory retention in the anus and perineum during the spinal shock period, indicating that the spinal cord injury is incomplete.

(3) Motor function: After the loss of the spinal cord in the transverse injury, the motor function below the injury segment disappears completely, but the muscle tension is gradually increased and the reflex is filled. Partially injured people may gradually develop muscle autonomic activity after recovery from the spinal cord shock stage, but the muscle group under the jurisdiction of the damaged segment may exhibit tension relaxation, atrophy, and disappearance of tendon reflex.

(4) Reflection: After the disappearance of the shock period, the reflection of the limbs gradually becomes hyperthy, and the muscle tension changes from relaxation to sputum.

(5) Bladder function: Different types of neuronal bladder may occur in spinal cord injury at different stages. In the spinal cord shock phase, it shows a tension-free bladder, and when the shock gradually recovers, it manifests as reflex bladder and intermittent urinary incontinence. When the spinal cord returns to reflex, stimulating the skin of the lower extremities can produce involuntary reflex urination. In the advanced stage, it is characterized by contracture and bladder.

(6) autonomic nervous system dysfunction: such as high fever, no sweat, slowing of bowel movements, constipation and so on.

Differential diagnosis

Differential diagnosis of high paraplegia:

1. Todd (defective temporary local limb paralysis or weakness): This disease was first described by the London physiologist Robert Bentley Todd in 1849 and named after him. Todd's paralysis is an abnormality of the nervous system that occurs in patients with epilepsy, that is, a transient paralysis that occurs in epileptic seizures. The tendon can be local or whole body, but usually only occurs on one side of the body. It is most common after a full-body tonic-clonic attack (large episode) and may last for several hours or occasionally for a few days after the epileptic seizure.

2, hemiplegia: Hemiplegia, also called hemiplegia, refers to the movement disorders of the upper and lower limbs, the facial muscles and the lower part of the tongue. It is a common symptom of acute cerebrovascular disease. Although mild hemiplegia patients can still move, but when they walk, they tend to flex their upper limbs, straighten their lower limbs, and take a half circle in the lower limbs. This special walking posture is called hemiplegic gait. Severe cases are often bedridden and lose their ability to live. According to the degree of hemiplegia, it can be divided into sputum, incomplete sputum and sputum. Flick: manifested as weak muscle strength, muscle strength in 4-5, generally does not affect daily life, incomplete sex is lighter and heavier, the range is larger, muscle strength is 2-4, full : muscle strength 0- Level 1, the limbs are completely inactive.

3, contralateral limb hemiplegia: the clinical manifestations of the lateral pons syndrome have contralateral limb hemiplegia, pons lateral syndrome (Millard-Gubler syndrome): the lesion is located in the lateral part of the pons, is a common lesion of the pons.

4, spastic paraplegia: hereditary spastic paraplegia, is a genetic disease, there is no special treatment, so the focus should be on prevention. Avoid close marriage, do a good job before marriage, patients with this disease should not marry or do not give birth after marriage, should strengthen physical exercise during the course of the disease, prevent premature bed and cause disability, the disease develops slowly, as long as care, can be maintained for decades life.

5, the limbs are symmetrical under the motor neuron sputum: the lower motor neuron sputum, also known as peripheral sputum. It is the result of damage to the motor fibers of the anterior horn cells (or cranial nerve motor cells), the anterior spinal cord, the peripheral nerves, and the peripheral nerves of the brain. The motor neuron spasm of the limbs is symmetrical. It is caused by motor neuron disease, which is characterized by the lower motor neuron symmetry of the limbs. Motor neuron disease (MND) is a group of neurodegenerative diseases that are unexplained and selectively damage the anterior horn of the spinal cord and the motor nucleus of the brainstem. The clinical manifestations are the coexistence of upper and lower motor neurons of the limbs, without affecting the sensory system, autonomic nerves, and cerebellar function.

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