Upper limb weakness

Introduction Early amyotrophic lateral sclerosis is mostly upper limb weakness. Amyotrophic lateral sclerosis involves the upper motor neurons (brain, brainstem, spinal cord) and affects the lower motor neurons (cranial nucleus, spinal cord anterior horn cells) and their dominating trunk, limbs and head and face muscles. A chronic progressive degenerative disease. Clinically, it is often characterized by mixed upper and lower motor neurons with impaired mixed sputum. More than 40 to 60 years of insidious onset, single / double upper limb / lower limb weakness, muscle contracture, fasciculation and atrophy. In the early stage, it was mostly weak in the upper limbs. At the same time, it can affect the symptoms of bulbar palsy in the neck, tongue, throat and throat. Finally, the trunk and respiratory muscles are involved and life-threatening. Even if the course of the disease is very long, the condition is very serious and the patient has no sensory disturbance.

Cause

Because the cause is not clear, the etiology is more. Recent studies have supported the immunological mechanisms of onset, and there are a variety of immunological theories. Other causes include poisoning, trace elements, amino acid metabolism disorders, and viral infections. Some cases have genetic characteristics. The incidence rate in Guam is 50 to 100 times higher than in other parts of the world, but there is no evidence of environmental toxicants and abnormal diet.

an examination

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X-ray lipiodol angiography CT examination magnetic resonance scan

More than 40 to 60 years of insidious onset, single / double upper limb / lower limb weakness, muscle contracture, fasciculation and atrophy. In the early stage, it was mostly weak in the upper limbs. It has the characteristics of typical upper and lower neuron damage, and can affect the symptoms of bulbar palsy in the neck, tongue, pharynx and larynx. Finally, the trunk and respiratory muscles are involved, which is life-threatening. Even if the course of the disease is very long, the condition is very serious and the patient has no sensory disturbance.

Differential diagnosis

Differential diagnosis of upper limb weakness:

1. Upper limb numbness: The problem of upper limbs is related to cervical spondylosis. Upper limb numbness is one of the main manifestations of cervical spondylosis. Cervical spondylosis refers to the clinical manifestations caused by the deformation or stenosis of the cervical spinal canal or intervertebral foramen caused by cervical degeneration, which stimulates and compresses the cervical spinal cord, nerve roots and sympathetic nerves to cause structural or functional damage. This disease is more common in patients over 40 years old.

2, peripheral paralysis of the upper limbs: peripheral sputum, also known as motoneurons, or flaccid paralysis, soft palate. It is caused by the damage of the anterior horn cells of the spinal cord and the brain to the motor nucleus, and the fibers of the anterior root, spinal nerve, and cranial nerves. Peripheral paralysis of the upper extremity refers to the peripheral paralysis of the upper limb in the affected part.

3, upper extremity abduction lifting difficulty: polymyositis manifested as upper extremity abduction and lifting difficulties. The skeletal muscle pain and atrophy usually start from the proximal end. For example, the pelvic belt muscles are affected by dysplasia and it is difficult to go upstairs; the shoulder swelling is affected by the development of two arms and the difficult lesions can accumulate the whole body; the muscle and neck muscles are affected and the head is exhausted. In pharyngeal muscle involvement, dysphagia and dysarthria may cause dyspnea in a small number of patients; acute muscle involvement often has muscle atrophy in the late stage; some patients may have arrhythmia and heart block.

4, the upper limbs are delayed paralysis: one of the symptoms of brachial plexus injury, total brachial plexus injury: early all upper limbs are delayed paralysis. Brachial plexus is a common type of peripheral nerve injury.

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