Symmetrical quadriplegia

Introduction Periodic sputum is characterized by a periodic onset of delayed sputum. Muscle disease is often associated with abnormal potassium metabolism, and hypokalemia is most common with periodic paralysis. A group of diseases associated with potassium metabolism. The clinical features are recurrent skeletal muscle flaccid paralysis or weakness, ranging from a few hours to several weeks, all normal during the interictal period. Some cases have a family history. If accompanied by hyperthyroidism, kidney disease or other metabolic diseases, it is secondary periodic paralysis. According to the level of serum potassium at the time of onset, it can be divided into the following three types: 1 low potassium periodic sputum. It is an autosomal dominant inheritance, but it is more common in China. The causes of the disease are mostly overwork, full meal, cold and so on. More often at night, with flaccid paralysis of the limbs, rarely invading the respiratory muscles. The blood potassium level was lower than normal at the time of onset, and the U wave appeared on the electrocardiogram. For several hours to several days, the treatment can be supplemented with potassium salts. 2 high potassium type periodic enthalpy. Is an autosomal dominant inheritance, rare in China. 3 normal potassium type periodic sputum. Also known as sodium-reactive normal potassium-type periodic sputum, rare.

Cause

TCM pathogenesis

The disease is due to loss of righteousness, external causes induced by evil spirits, hindering the air machine, limb dystrophy and weakness. The incentives include unhealthy diet, overwork, nervousness, feeling cold and dampness, excessive sweat consumption, and so on. The specific pathological process can be summarized as follows.

Wet and evil accumulations are long and wet and turbid, or sitting in wetlands, or raining in the water, or sweating into the water, feeling the wind, water and moisture, water and turbid intrusion into the flesh veins, curbing gas The machine causes the yang to not replenish the tendons, so that the veins are not relieved. The dampness and sinfulness of the stagnation of heat, the consumption of gas and Tianjin, and the gas and Tianjin do not support the ribs, relax and not accept and cause convulsions. "The wetness tends to go down," and the disease usually occurs in the lower part. For example, "Su Wen·Paradox" said: "There is gradually getting wet, taking water as a matter. If you stay, you will be wet, muscles will be stained, and you will not be benevolent.

Spleen and stomach weak spleen and stomach is the foundation of the day after tomorrow, the source of qi and blood and fluid biochemistry, the main limbs, muscles. Thinking about fatigue and hurting the spleen, or the spleen is weak or the disease is long, the spleen and stomach are affected by the dysfunction of the spleen and stomach. On the one hand, the source of qi and blood and body fluids is insufficient, and it is not sufficient to replenish the muscles of the tendons; on the other hand, the spleen and stomach are imaginary, if the food is too thick and greasy, the diet is not good, it is easy to cause damp heat accumulation, stagnation, Affects the operation of blood and blood, so that the tendons are dying and the relaxation is not needed. Kidney yang is weak and kidney yang is insufficient, and it is cold, overworked or frightened. It is more harmful to kidney qi, so that yang can not warm the tendons, limbs are dying and soft and useless, or kidney yang can not warm water, Wet evil sputum does not use the veins.

Liver and kidney deficiency, spleen, dampness and heat, not flow, flow in the next, long time can also damage the liver and kidney, leading to the loss of vitality of the liver and kidney, can not fill the veins, the fascia is lost.

In short, the occurrence of this disease is related to the induction of exogenous six kinship or dietary internal injuries, excessive fatigue, etc., spleen and stomach deficiency, liver and kidney deficiency is an intrinsic factor. Its pathogenesis is wet turbid obstruction meridians, obstruction of air, visceral dysfunction, qi and blood deficiency, lack of muscle skin. The incidence is mainly related to liver, spleen and kidney.

an examination

Related inspection

Random motion examination CT examination

It can be diagnosed according to clinical symptoms.

First, hypokalemia periodic paralysis: the most common. Young adults are more common, may have a family history, often induced by cold, full meal, fatigue, etc.; often in the middle of the night, early morning or after a nap acute onset, manifested as a sputum from the lower extremities, gradually involving the upper limbs; limb paralysis symmetry The proximal end is heavier than the far end and reaches a peak within a few hours. Very few muscles that can accumulate the neck, sacral and cranial nerves. Each episode lasts for hours to days and then gradually recovers. At the beginning of the attack, there are symptoms such as thirst, sweating, sore limbs, and abnormal feeling. The sputum reflexes diminished during the attack, and the electrical stimulation of the iliac muscle did not excite. It feels normal.

Second, hyperkalemia periodic paralysis: very rare. The disease often occurs in children before the age of 10, with more men. After hunger and vigorous exercise, rest and rest, wet or cold environment or take potassium salt, spiral lactone can be induced. Clinical manifestations are similar to hypokalemic periodic paralysis. Each episode lasts from a few minutes to tens of minutes, rarely more than an hour. Often accompanied by eyelids and rigidity.

Third, normal blood potassium peripheral paralysis: also known as sodium reactive periodic paralysis, rare. I got sick before I was 10 years old. Patients with halophilic diseases are often induced after reducing the amount of salt. The clinical manifestations are the same as hypokalemia and periodic paralysis, and the duration can be as long as 10 days or more.

Differential diagnosis

1. Primary aldosteronism: often with recurrent limb weakness and hypokalemia, but the initial onset is older, the duration of each episode can last for several months, the symptoms are slower and often difficult to recover To normal; in addition, there are characteristics such as increased blood pressure and nocturia.

2. Acute infectious polyneuritis: Most patients have a history of upper respiratory tract or digestive tract infection from several days to several weeks before the onset of symptoms. The symptoms gradually increase after onset, reaching a peak within 1 to 2 weeks, after the condition is stable 2~ Recovery began in 4 weeks, cerebrospinal fluid examination can be found in the phenomenon of protein cell separation; and the periodic peak or recovery time is shorter, accompanied by a decrease or increase in serum potassium, generally without obvious sensory loss.

3. Myasthenia gravis: Mainly characterized by partial or all skeletal muscle susceptibility to fatigue, increased during activities, improved after rest, effective for cholinesterase inhibitors, 90% of patients with blood AchR-Ab positive.

4. Acute sputum poisoning: There may be quadriplegia, drooping eyelids, pronunciation and difficulty in swallowing, gastrointestinal symptoms such as muscle tremor, nausea and vomiting, diarrhea, and history of eating salt or drugs with excessive bismuth.

5. Polymyositis: Slow onset, with fever, muscle pain, Raynaud's phenomenon, increased blood CPK, duration is rarely shorter than weeks or months.

6. Hypokalemia: Most patients with a history of cotton production and eating cottonseed oil, in addition to paroxysmal limb weakness, often accompanied by gastrointestinal symptoms, effective for potassium chloride treatment.

7. Hyperthyroidism combined with low-potassium periodic sputum: with clinical manifestations of hyperthyroidism, elevated T3, T4, and periodic sputum cessation after normal thyroid function.

Other hypokalemia

(1) renal tubular acidosis: the distal defects of the distal convoluted tubule can not be acid and potassium, low potassium and high chlorine, urine pH increased.

(2) hypokalemia caused by diuretics, vomiting and diarrhea.

8. Caries: Most of them are stimulated by mental factors. There are more episodes during the day, and there are no obvious features of the distal and distal tendons of the extremities. The tendon reflexes are not weakened, and the myoelectric stimulation response is normal.

9. Hypokalemia Periodic paralysis should be differentiated from Guillain-Barré syndrome. The disease is faster onset, recovery is faster, limbs are delayed, no respiratory muscle paralysis and cranial nerve damage, no sensory disturbances and nerve irritations, cerebrospinal fluid examination is normal, blood potassium is low, potassium supplementation is effective There is a history of recurrent episodes; while Guillain-Barré syndrome has a history of pre-infection and autoimmune reactions, acute or subacute onset, no more than 4 weeks of progression, and may have varying degrees of respiratory muscle paralysis and cranial nerve damage. Cerebrospinal fluid examination showed protein-cell separation, electrophysiological examination of early F wave or H reflex delay, blood potassium test results were normal, no history of recurrent episodes.

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