Lower extremity muscle paralysis

Introduction When the motor nerve is excited, acetylcholine in the synaptic vesicle breaks into the synaptic cavity through the membrane. The posterior part of the synaptic cavity is the posterior membrane of the motor endplate. Acetylcholine can cause a change in the intracellular balance of the membrane (depolarization), resulting in endplate potential and muscle contraction. Immediately after the acetylcholinesterase is decomposed, ions inside and outside the membrane are rebalanced (repolarized), and the muscles become slack. Muscle disease occurs when an obstacle occurs at the nerve-muscle junction or the muscle itself. Tumor is the most common cause of the disease.

Cause

Cause:

1. Tumor is the most common, accounting for more than 1/3 of the total number of spinal cord compression. Vertebral dislocation of the spinal injury, dislocation and hematoma of the fracture, inflammatory and parasitic granuloma, abscess, disc herniation, spinal vascular malformation and certain congenital spinal lesions can cause spinal cord compression.

2. Inflammation: bacterial infections in other parts of the body are disseminated by blood, direct spread of suppurative lesions adjacent to the spine, and direct implantation ("iatrogenic") can cause acute abscess or chronic spinal canal. True granuloma and oppression of the spinal cord are more common in the epidural, subdural and intraspinal abscesses are extremely rare. Non-bacterial infective spinal arachnoiditis, as well as injury, hemorrhage, chemical such as intrathecal injection of drugs and arachnoiditis caused by unknown causes, can cause spinal cord and inflammatory arachnoid adhesion, even cobweb The membrane forms a cyst that compresses the spinal cord. In addition, certain specific inflammations such as tuberculosis, parasitic granulomas, etc. can also cause spinal cord compression.

3. Injury: Spinal cord injury is often associated with spinal cord injury, and spinal cord injury can be caused by vertebral body, vertebral arch and lamina fracture, dislocation, facet joint staggering, disc herniation, and intraspinal hematoma formation.

4. Spinal vascular malformations: mostly due to abnormalities in the development of congenital embryos. Whether the acquired diseases such as inflammation, injury, atherosclerosis, etc. can cause spinal vascular malformation has not been confirmed by the data. The cause of spinal cord dysfunction caused by spinal cord vascular malformation, in addition to the expansion and expansion of deformed blood vessels has an oppressive effect, but also due to arterial short circuit, venous congestion leading to ischemic spinal cord injury.

5. Disc herniation: also known as nucleus pulposus, is also a common cause of spinal cord compression, often caused by excessive exertion or excessive flexion and flexion of the spine. It is rare that there is a disc herniation caused by sneezing or coughing. Disc herniation can also be caused by dehydration and aging of the nucleus pulposus itself. It can be seen in the lower neck of the neck without obvious damage factors. It can have more than one nucleus pulposus at the same time. The disease course is long and the symptoms progress slowly. This is a degenerative disease of the spine. portion.

6. Others: Some congenital spinal disorders, such as skull base depression, atlanto-occipital pillow, cervical fusion, spina bifida, meningeal spinal bulging, scoliosis and severe hypertrophic spinal osteoarthritis Can cause spinal cord compression.

an examination

Related inspection

EMG

diagnosis:

(1) Sensory disturbance: It is caused by stimulation or damage to various sensory conduction bundles in the posterior root of the spinal nerve and in the spinal cord. These include pain, hyperesthesia, loss or loss of sensation, sensory separation and paresthesia. Root pain is the most common and intense, as mentioned above. In addition, there is occasional sensation of conduction beam pain, which is caused by diffuse pain or burning of a certain limb or body, and needle-like pain. When the extramedullary pressure is applied to the spine, it can produce vertebral body pain, which is characterized by deep dull pain in the back muscles, often combined with local muscle spasm, increased in strength, cough or body position, or reduced in sitting position. Time is increased. Feeling allergic, often there is a lighter area above the flat surface where the feeling is reduced or disappeared, and there is often a narrow allergic zone above. The line between the lighter zone and the sensory allergy zone is reduced, representing the upper edge of the spinal cord compression segment. When the lesion is in the central region of the spinal cord, the crossed thalamic bundle fibers are often damaged, and a part of the uncrossed tactile fibers and deep sensory fibers are protected from the separation, resulting in a separation of sensory disturbances, namely pain, loss of sense of the sense of touch and joint muscles. Feel there. Common in syringomyelia, intramedullary tumors, and extramedullary tumors are rare. The damage associated with the pre-white matter lesions is accompanied by pain and loss of symmetry on the bilateral symmetry below the level of damage. Damage to the back cable results in loss of tactile, proprioceptive, and vibrational sensations below the plane. In addition, the extranodal compression of the corresponding segment of the spinous process tenderness and pain is more common. Sensory impairment is an important sign of spinal cord compression. It has important reference value for judging intramedullary or extramedullary compression, especially for the location diagnosis of compression.

(2) Muscle dyskinesia and tendon reflex changes: Muscle strength, muscle tone and reflex changes occur when the lesion involves the anterior root, anterior horn and corticospinal tract. In the early stage, fatigue, difficulty in movement, difficulty in walking, etc., followed by decreased muscle strength until complete paralysis. The damage of the anterior root and anterior horn was mainly caused by muscle weakness, low muscle tone, muscle atrophy and fasciculation, and disappearance of tendon reflex. Performance, the so-called lower motor neuron. The lesion is particularly evident in the cervical and lumbosacral segments. When the corticospinal tract and other descending conduction bundles related to exercise are damaged, the muscle weakness, increased muscle tone, hyperreflexia, and pathological reflexes are the main manifestations, so-called upper motor neuron spasm. If the lesion is in the enlarged part of the cervical spinal cord, it involves both the anterior root and anterior horn of the upper limb and the corticospinal bundle that innervates the lower limb, thus producing the lower motor neuron of the upper limb and the upper motor neuron of the lower limb. The sputum caused by spinal cord compression is usually paraplegia or quadriplegia, and single limb paralysis is rare, and hemiplegia is less common. Slow progressive progressive paraplegia, the early two lower extremities are extensatory spasm, stimulating the skin below the level of the lesion, can lead to the lower limbs straight, increased muscle tone. Reflex buckling can also occur, known as flexion paralysis. Clinically, the upper boundary of the defensive reflection zone can be extracted as the lower edge of the spinal compression plane. In the late stage, it becomes slack. The disappearance of shallow reflexes below the level of compression, hyperreflexia and pathological reflexes are caused by simultaneous damage to the descending corticospinal tract. In the early stage, only the affected side was involved, and then the healthy side gradually changed.

(3) sphincter dysfunction: early manifestations of urinary urgency, dysuria, usually appear after sensory, dyskinesia, then become urinary retention, intractable constipation, and ultimately incontinence. When the lesion is in the conus of the spinal cord, sphincter dysfunction often occurs earlier. When the lesion is above the cone, the bladder is often in a paralyzed state, its volume is reduced, the patient has frequent urination, urgency, can not control autonomously, and has constipation. When the lesion is below the cone, urinary retention occurs, and the bladder is slack. When the bladder is filled with urine, it automatically overflows and is filled with urinary incontinence. The anal sphincter relaxes, the thin feces flow out by itself, and the stool is incontinent.

(4) Nutritional disorders: secondary to the feeling of the limbs, dyskinesia, dry skin, easy to desquamation, thinning, loss of elasticity, subcutaneous tissue relaxation, prone to pressure ulcers (pressure sores). The nails lose their luster, thicken and fall off. The joint is stiff.

(5) Autonomic dysfunction: There are sympathetic nerve cells in the gray matter side of the spinal cord 1 to the waist 2, and parasympathetic nerve cells in the sacral section. When under pressure or loss of contact with the high-level center, there are changes such as excessive sweating, no sweat, vasomotor and abnormal hair reflexes, often accompanied by edema of both lower extremities, abdominal distension and fever (large body when the level of compression is high) Table sweating disorder). The gray matter side of the neck 8 to chest 1 has a ciliary spinal cord center, which produces Horner syndrome when damaged, which is a valuable localization sign.

Differential diagnosis

Differential diagnosis of lower extremity muscle spasm:

1, lower limb weakness: lower limb weakness is caused by cervical spondylotic myelopathy, manifested as lower limb weakness, numbness, tightness, heavy lifting and other symptoms, gradually appearing limp, trembling, gait shaking, easy to fall, etc. . Cervical spondylotic myelopathy is a type of cervical spondylosis. Cervical spondylosis can be roughly divided into four types: cervical cervical spondylosis, radiculous cervical spondylosis, vertebral artery type cervical spondylosis, and cervical spondylotic myelopathy. Cervical spondylosis, also known as cervical vertebra syndrome, is a general term for cervical osteoarthritis, proliferative cervical spondylitis, cervical nerve root syndrome, and cervical disc herniation. It is a disease based on degenerative pathological changes. Mainly due to long-term cervical vertebrae strain, bone hyperplasia, or disc herniation, ligament thickening, resulting in cervical spinal cord, nerve root or vertebral artery compression, a series of clinical syndromes of dysfunction. The manifestations of cervical disc degeneration and its secondary pathological changes, such as vertebral instability, loosening; nucleus protruding or prolapse; spur formation; ligament hypertrophy and secondary spinal stenosis, etc., stimulated or oppressed Adjacent nerve roots, spinal cord, vertebral artery, and cervical sympathetic nerves, and cause a variety of symptoms and signs of the syndrome.

2, lower limb swelling and fatigue: lower limb swelling and fatigue is one of the symptoms of deep vein thrombosis.

3, lower limbs or soft body of the whole body: lower limbs or soft palate in the whole body is a symptom of the water and salt metabolism disorder in Barth Syndrome.

4, sudden lower limbs sputum: sputum refers to the loss or disappearance of random movements, sudden paralysis of both lower limbs is a kind of sputum.

5. Muscle spasm below the thigh or below the knee: Diagnosis of sciatic nerve injury: history of trauma or history of injection, muscle spasm below the thigh or below the knee; muscle spasm in the branch of the nerve branch. The area below the calf is partially lost. Electromyography can confirm the diagnosis.

6, amyotrophic lateral sclerosis: a degenerative disease. The lesion mainly involves the spinal cord anterior horn cells, the medullary motor nucleus and the pyramidal tract. Therefore, the main obstacles are dyskinesia, and there is generally no sensory disturbance. There may be root pain in the early stage, which is characterized by atrophy of the upper limb hand muscles and atrophy of the tongue muscle. In severe cases, there is difficulty in constructing sound. When the motor neurons above the lesion are predominant, the tendon reflex is hyperthyroidism. There was no obstruction in the spinal cord, and the cerebrospinal fluid was normal and biochemical examination was normal.

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