Neuromuscular symptoms

Introduction Mild neuromuscular symptoms are only paresthesia, stinging, numbness, stiffness of the hands, feet, and feet are easily overlooked or misdiagnosed. When the blood calcium is reduced to a certain level (80mg/L or less), there is often a seizure of the hand and foot. The bilateral symmetry wrist and the knuckle of the palm are flexed, the interphalangeal joint is straight, the thumb is adducted, and the eagle claw is formed. Both feet often have tonic stretching, knee and hip flexion; severe cases of systemic skeletal muscle and smooth muscle spasm, can occur throat and bronchospasm, asphyxia and other crises; myocardial fatigue in time tachycardia, ECG QT prolonged, mainly For the ST segment extension, with abnormal T wave; tendon tendon when there is hiccup; children with more convulsions, mostly systemic, like unexplained epileptic seizures without coma, incontinence and other performance. The above symptoms can be induced by factors such as infection, overwork and mood. Women are more likely to attack before and after menstruation.

Cause

Neuromuscular symptoms are caused by increased neuromuscular stress.

(A) secondary is more common: the most common cause of parathyroidectomy or injury caused by thyroid surgery. If most or all of the glands are removed, permanent hypoparathyroidism often occurs, accounting for about 1% to 1.7% of thyroid surgery. Excessive glandular thyroid hyperplasia can also cause this disease. As for thyroid inflammation, hyperthyroidism is less common after receiving radioactive iodine or due to malignant tumor invasion of the parathyroid gland.

(2) Idiopathic is less common: it is an autoimmune disease. Can be combined with thyroid and adrenal cortical hypofunction, diabetes, such as multiple endocrine gland hypofunction; some patients can detect autoantibodies against gastric parietal cells, parathyroid glands, adrenal cortex and thyroid.

an examination

Related inspection

Cerebrospinal fluid neuropeptide urine routine electromyography

It is easy to diagnose after thyroid surgery. Idiopathic and symptomatic submersibles are easily overlooked, and it is not uncommon for people with neurosis or epilepsy to be mistaken. However, if multiple tests of blood and urine can be performed, most of them can detect hypocalcemia in time. The above induced test can help diagnose. The main diagnosis basis is: 1 no thyroid surgery or anterior neck radiotherapy and other medical history; 2 chronic seizures; 3 blood calcium is too low, blood phosphorus is too high; 4 other causes can cause plasma calcium hypoxia, such as Renal insufficiency, fatty sputum, chronic diarrhea, vitamin D deficiency and alkalosis; 5 serum iPTH is significantly lower than normal or absent; 6Ellsworth-Howard test has phosphorus reaction; 7 no body deformity, such as short stature, refers to Short toes and malformations or cartilage development disorders.

Differential diagnosis

Need to be differentiated from symptomatic symptoms:

Torsional dystonia: The disease is a group of more common extrapyramidal diseases. It is characterized by continuous involuntary contraction of active and antagonistic muscles at the beginning of active exercise, showing a special torsional posture or position. It can be autosomal dominant or recessive or X-linked. Neurochemical examination revealed abnormal distribution of neurotransmitters in the brain. The disease is chronic progressive, and the onset age varies with heredity. Early symptoms often begin with a certain localized dystonia. In the early stage, the abnormal posture of the mid-axis muscle, especially the torticollis, and the twisted posture of the trunk or pelvic muscle are the main features. The recessive hereditary type is characterized by abnormal gait on one side of the lower limb or abnormal posture of the hand. When walking, it is inversion of the position of the foot, difficult to write, and finally progresses to systemic dystonia. The identification point with cerebral palsy is a family history of the disease, normal perinatal period, no mental retardation, no seizures, no pyramidal signs, no sensory disturbances.

Progressive spinal muscular atrophy: the disease is an autosomal recessive disorder caused by the degeneration of the anterior horn cells of the spinal cord and the motor nucleus of the brainstem, causing atrophy of the secondary nerve roots and muscles. Most children The activity at birth is normal, and symptoms appear only after 3 to 6 months or later. The trunk, scapula, pelvic girdle and lower extremities are symmetrical and weak, with a proximal end. Hip abduction in supine, knee flexion, such as frog leg posture, the course of the disease is progressive, and finally showed complete flaccid paralysis, which may involve respiratory muscles and die.

Central nerve cavernous degeneration: the disease is autosomal recessive. Lack of aspartate acyltransferase in fibroblasts. Pathological changes are mainly found in the white matter of the brain, which is filled with cystic spaces containing liquid, which resembles a sponge. The child is normal at birth, and mental retardation begins to appear 2 to 4 months after birth. The muscle tension is low and the head cannot be vertical. The head circumference is enlarged, and the muscle tension is gradually increased after the cerebrospinal fluid is normal.

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