Tonic

Introduction Tonic brain, also called brain rigidity, is due to lesion damage, the connection between the brain and the midbrain and pons, interrupted the function of the upper brain stem. Common in severe cerebral hemorrhage coma, late Tianzhu sputum, ventricular hemorrhage, midbrain, cerebral hemorrhage and other causes of severe brain stem injury. Its main performance is the extension of the limbs, the upper arm is adducted and rotated, the forearm is straight and excessively pre-rotated, the hip is adducted, the internal rotation is extended, the knee is straight, and the back of the neck is angulated. The patient is often in a deep coma with irregular breathing and muscle twitching.

Cause

It is caused by lesion damage, which interrupts the connection between the brain and the midbrain and pons, which affects the function of the upper brain stem.

Denervation of the brain is mainly a reflex extensor hypertonic hyperextension, which is an excessive stretch reflex. Excessive strong stretch reflex, mainly due to the interruption of the connection between the red nucleus and the inferior structure of the midbrain, the downward inhibitory effect from the upper part of the red nucleus is blocked, the activity of the reticular inhibition system is reduced, and the central nervous system is above the spinal cord. The inhibitory impulse of neurons is weakened, and the impulses of the cerebellum, vestibular nuclei and reticular formation on motor neuron are still present, which leads to tonic paralysis of the extremities of the extremities.

an examination

Related inspection

Blood routine CT examination

The main manifestations are the tonic extension of the extremities, the upper arm adducted and the inner rotation, the forearm straightened and over-spinned, the hips adducted, the internal rotation, the knees straightened, and the neck back was angulated.

The disturbance of consciousness manifests itself as a wake-up coma. The patient looks awake, but has no conscious activity, does not respond to verbal stimuli, and has incontinence, similar to the cortical tonic.

Differential diagnosis

Differential diagnosis

Peeling

1. Definition: It is a kind of awake coma. It is a special consciousness disorder in which the "awakening state" exists and the "consciousness content" is lost. The clinical manifestation is the serious loss of language and motor response.

2. Common diseases: hypoxic ischemic encephalopathy, cerebrovascular diseases and trauma caused by extensive damage to the cerebral cortex.

3. Typical signs: upper limb flexion, lower extremity straightening "bending elbow, shoulder adduction, leg and ankle straight".

4. The basis of the disease:

Cerebral cortical function or loss of certain functions under the cortex, while most of the function of the subcortex and the autonomic function of the medulla oblongata have been preserved or restored.

The mid-brain and pons are not damaged, and there may be unconscious swallowing movements, such as awakening-sleep cycle.

5 common performance:

Can unconsciously blink and close your eyes, the eye can move. The pupil has light reflection and corneal reflex, the muscle tension of the limbs is increased, the pathological reflex is positive, the sucking reflex and the strong grip reflex, and the cervical reflex can occur. Feeding can occur unconsciously, but there is no spontaneous movement. There is no conscious response to external stimuli, incontinence and incontinence, and there is an awakening-sleep cycle.

Go to the brain

1. Common diseases: damage to the midbrain, posterior fossa lesions, hypoxia or hypoglycemia.

2. Typical signs: angulation of the angle, rigidity of the limbs, increased muscle tone. "Extension of the elbow, shoulder and forearm, and straightening of the lower limbs."

3. The basis of the disease: Degenerative brain is mainly a kind of reflex extensor hypertonic hyperthyroidism, which is an excessive stretch reflex. Caused excessive stretch reflex, mainly due to the interruption of the connection between the red nuclei of the midbrain and the subordinate structure. The descending inhibitory effects from the upper part of the red nucleus were blocked, the activity of the reticular inhibition system was reduced, the inhibitory impulse of the motor neurons was weakened by the central nervous system, and the cerebellum, vestibular nuclei and reticular formation were facilitating motor neurons. Sexual impulses still exist, causing tonic paralysis of the extremities of the extremities.

4. Common performance:

The disturbance of consciousness manifests itself as a wake-up coma. The patient looks awake, but has no conscious activity, does not respond to verbal stimuli, and has incontinence, similar to the cortical tonic.

The dyskinesia is characterized by straightness and straightness of the extremities, and the torso is angulation, irregular breathing, accompanied by systemic muscle tonic.

5. Disease outcome:

Better: stretchy tonic gradually becomes upper limb flexion, adduction, internal rotation. It indicates that the lesion is gradually confined to the level of the midbrain and the condition is improved.

Deterioration: The disturbance of consciousness is in a coma, and the extensional rigidity gradually becomes a stagnation, indicating that the lesion has spread below the pons, and the condition gradually develops into a state of sudden death.

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