STUDY - Technical - New Dacian's Medicine
Paralysis
(Classical / Allopathic Medicine)
Paralysis
- the total loss of voluntary motor function - results
from severe cortical or pyramidal tract damage. It can
occur with a cerebrovascular disorder, degenerative
neuromuscular disease, trauma, tumors, or a central
nervous system infection. Acute paralysis may be an early
indicator of such life-threatening disorders as
Guillain-Barré syndrome. Paralysis may also be caused by a
psychological disorder.
Paralysis
can be local or widespread, symmetrical or asymmetrical,
transient or permanent, and spastic or flaccid. It's
commonly classified according to location and severity as
paraplegia (sometimes transient paralysis of the legs),
quadriplegia (permanent paralysis of the arms, legs, and
body below the level of the spinal lesion), or hemiplegia
(unilateral paralysis of varying severity and permanence).
Incomplete paralysis with profound weakness (paresis) may
precede total paralysis in some patients. (See
Understanding spinal cord syndromes.)
Understanding
spinal cord syndromes
When a patient's spinal cord is incompletely severed, he experiences partial motor and sensory loss. Most incomplete cord lesions fit into one of the syndromes described below.
When a patient's spinal cord is incompletely severed, he experiences partial motor and sensory loss. Most incomplete cord lesions fit into one of the syndromes described below.
Anterior
cord syndrome, usually resulting from a flexion injury,
causes motor paralysis and loss of pain and temperature
sensation below the level of injury. Touch,
proprioception, and vibration sensation are usually
preserved
Brown-Séquard's
syndrome can result from flexion, rotation, or penetration
injury. It's characterized by unilateral motor paralysis
ipsilateral to the injury and loss of pain and temperature
sensation contralateral to the injury.
Central
cord syndrome is caused by hyperextension or flexion
injury. Motor loss is variable and greater in the arms
than in the legs; sensory loss is usually slight.
Posterior
cord syndrome, produced by a cervical hyperextension
injury, causes only a loss of proprioception and light
touch sensation. The motor function remains intact.
ALERT:
If paralysis has developed suddenly:
- determine the patient's level of consciousness, and assess vital signs
- make sure that the patient's neck is immobilized, especially if trauma is suspected
- institute emergency measures, if necessary.
If the patient's condition permits, perform a focused assessment.
ALERT:
If paralysis has developed suddenly:
- determine the patient's level of consciousness, and assess vital signs
- make sure that the patient's neck is immobilized, especially if trauma is suspected
- institute emergency measures, if necessary.
If the patient's condition permits, perform a focused assessment.
HISTORY:
Ask the patient or family about the onset, duration, intensity, and progression of the paralysis as well as the events preceding its development.
Review the patient's medical history for incidence of degenerative neurologic or neuromuscular disease, recent infectious illness, sexually transmitted disease, cancer, recent injury, and hypertension.
Ask the patient about associated signs and symptoms, such as fever, headache, visual disturbances, dysphagia, nausea and vomiting, bowel or bladder dysfunction, muscle pain or weakness, and fatigue.
Ask the patient or family about the onset, duration, intensity, and progression of the paralysis as well as the events preceding its development.
Review the patient's medical history for incidence of degenerative neurologic or neuromuscular disease, recent infectious illness, sexually transmitted disease, cancer, recent injury, and hypertension.
Ask the patient about associated signs and symptoms, such as fever, headache, visual disturbances, dysphagia, nausea and vomiting, bowel or bladder dysfunction, muscle pain or weakness, and fatigue.
PHYSICAL
ASSESSMENT:
Perform a complete neurologic examination, testing cranial nerve, motor, and sensory function as well as deep tendon reflexes.
Assess strength in all major muscle groups, noting muscle atrophy.
Document all findings to serve as a baseline.
Perform a complete neurologic examination, testing cranial nerve, motor, and sensory function as well as deep tendon reflexes.
Assess strength in all major muscle groups, noting muscle atrophy.
Document all findings to serve as a baseline.
SPECIAL
CONSIDERATIONS:
Because a paralyzed patient is particularly susceptible to complications of prolonged immobility, provide frequent position changes, meticulous skin care, and frequent chest physiotherapy.
Because a paralyzed patient is particularly susceptible to complications of prolonged immobility, provide frequent position changes, meticulous skin care, and frequent chest physiotherapy.
PEDIATRIC
POINTERS:
Besides the obvious causes - trauma, infection, and tumors - children may develop paralysis from a hereditary or congenital disorder, such as Tay-Sachs disease, Werdnig-Hoffmann disease, spina bifida, or cerebral palsy.
Besides the obvious causes - trauma, infection, and tumors - children may develop paralysis from a hereditary or congenital disorder, such as Tay-Sachs disease, Werdnig-Hoffmann disease, spina bifida, or cerebral palsy.
PATIENT
COUNSELING:
Instruct the patient on what to expect from diagnostic testing, which may include a computed tomography scan and magnetic resonance imaging. Arrange for physical, speech, occupational, or psychological therapy as appropriate.
Instruct the patient on what to expect from diagnostic testing, which may include a computed tomography scan and magnetic resonance imaging. Arrange for physical, speech, occupational, or psychological therapy as appropriate.
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common symptoms,
Edition V, McGraw - Hill, 2002.