Central paralysis

Paralysis can not be linked to a single cause: the factors of its occurrence are very diverse.

Motor functions are able to suffer due to the most diverse damages of the nervous tissue.

[1], [2]

Causes of the central paralysis

It is known the development of paralysis due to organic factors: due to physical damage, severe poisoning, metabolic or nutritional disorders, vascular pathology, cancerous growths, infections, hereditary or congenital pathologies.

The syndrome of central paralysis occurs after infections that develop in the brain or spinal cord - syphilis, tuberculosis, viral encephalitis, meningitis, poliomyelitis.

Under paralysis due to intoxication means poisoning with heavy metals, alcoholic neuritis, lack of vitamin B1, a lack of nicotinic acid.

Multiple sclerosis, the nature of which is not detected, causes dysfunction of movements of different degrees. Wounds and fractures are fraught with similar consequences if motor centers or pathways are damaged.

Paralysis can occur even under the influence of psychogenic factors.

Central paralysis often affects the elderly, but now there is a clear tendency to its "rejuvenation". According to statistics, more than half of the cases of paralysis are the result of a stroke. A thrombus, like hemorrhage, is capable of causing blood flow disturbances, blocking the vessels in the area of the brain responsible for the movement, or conducting paths. Pediatric paralysis usually occurs as a result of birth trauma or as a result of the inherited spastic paraplegia.

[3], [4], [5],

Pathogenesis

The most common pathological states of the nervous system are destruction, degenerative, inflammatory processes, sclerotic changes, demyelination. Paralysis occurs because of the pathological states of the brain or due to damage to the peripheral nerves.

Separate two types of central paralysis: cerebral (cerebral) and spinal. The nature of spinal paralysis is a pathological change in the neurons responsible for movement. Cerebral palsy implies a capsular, bulbar, cortical or subcortical nature.

There are two types of neurons responsible for the movement. They differ in terms of their functional load and their structure. Therefore, if pathological changes occurred in them, two different types of signs are distinguished: the affected nerve cells responsible for the movements cause spastic paralysis, peripheral nerve cells - flaccid paralysis.

Internal causes are absent in psychic paralysis, therefore it disguises itself under any of the forms, exhibits common signs of central and peripheral paralysis or any combination thereof.

Central paralysis can combine signs of peripheral, and can exhibit exceptionally pure symptoms; often accompanied by violations of vascular tone, sensitivity, digestion. Frequent manifestations of peripheral paralysis are sensory disorders.

In the body with paralysis, the motor function often suffers entirely and does not touch the muscles selectively. Paralyzed muscle tissues are in permanent tension and do not atrophy (this is possible only because of total inactivity). In immobilized limbs, deep reflexes of the tendons are maintained or exacerbated, clonuses (fast convulsive contractions) are often found. On the side affected by paralysis, the abdominal reflexes weaken or disappear completely.

[6], [7], [8], [9], [10]

Symptoms of the central paralysis

Let's list the first signs of central paralysis:

• hypertonic musculature;
• expansion of the scope of reflective reactions;
• intensification of reflective reactions;
• fast convulsive contractions of the musculature of the knees or feet (clones).

With hypertension, the muscles are too tight. High resistance of muscles is noted. A high degree of muscle tension is fraught with the appearance of contractures. Therefore, movements are limited in part or entirely. For contracture is characterized by an unnatural frozen position of the limb.

The most visible visible signs of paralysis are provoked by the expansion of the range of reflex reactions. Convulsive rhythmic contractions of the muscles of the knees or feet appear due to the stretching of the tendons. Usually such contractions appear due to the intensification of tendon reflex reactions. Reduction of feet is the result of accelerated rear bending. Reflexive jerking of the foot is the answer to such an effect. The clonus of the knee cap is noticeable during the rapid withdrawal of the limb. Pathological reflexes in the feet or hands are a visible symptom of the pathology of the pyramidal path. The most typical are the reflex reactions of Oppenheim, Rossolimo, Zhukovsky, Babinsky Gordon and Scheffer.

Protective reflexes, manifested by the trembling of the affected limb, which reacts to mechanical irritation, is also a manifestation of the central paralysis syndrome.

Sickinensia is another symptom of paralysis. Sinnesia are reflexive simultaneous movements in the affected limb with conscious active movements. As, say, waving hands while walking, flexion - extension of limbs along with directed movements on half of the body, not prone to paralysis. There are many varieties of syciness, which speak of the development of paralysis.

Muscle cramps due to hypertension are often distributed unequally. Most often the left or right side of the body suffers entirely, the hand is usually pressed, the hand with the fingers is twisted, the leg is straightened, and the foot is bent and turned inward.

With central paralysis, reflective reactions in the tendons are more pronounced, and the abdominal, muscular and plantar fades completely or noticeably weaken.

The most obvious symptoms of central paralysis are:

• The unnatural position of the body;
• Weakened or strengthened mobility;
• Weakening of the muscles of the face;
• Violations of articulation and speech;
• Convulsive contractions and muscle shaking;
• Unnatural gait;
• Accidental opening of the mouth;
• Closing the eyes;
• Non-directional movements of the shoulders;
• Accidental flexion-extension of the joints of the hands or feet;
• Hypertonus musculature.

Symptoms that accompany central paralysis help to unmistakably separate it from other types of motor dysfunction and even determine the area of the pyramidal pathway that is prone to pathological processes.

Central paralysis of the facial nerve is manifested due to violations of cortical processes or pathology of the nerve pathways leading to the facial nerve. Facial paralysis appears opposite the affected area and is usually located in the lower region.

The facial muscles are accidentally contracted due to the connectivity of the nerve to the extrapyramidal system. It looks like a tick or a spasm. Paralysis of this type may be accompanied by epileptic seizures.

The development of central paralysis of the limbs is due to the pathological changes in the descending system of nerve fibers. Noticeable manifestation of pathology - reflex reactions in the tendons, hypertonic muscles, manifestations of pathological reflex reactions. Such symptoms can manifest themselves in combination with other signs of organic paralysis.

With paralysis of functional etiology reflex tendon reactions are not subject to changes and normal muscle tone is maintained.

Central spastic paralysis says that the brain region is broken in the hemisphere opposite from the affected limb.

The combined pathology of the limbs is characteristic of disorders in the brainstem.

Cross paralysis refers to disorders in the contiguous area of the medulla oblongata and spinal cord.

When the extremities are only paralyzed on the left or on the right, and the nerves of the skull were not injured, this indicates a failure of the descending system of the nerve tissues of the cervical region.

Central legs paralysis means pathology or along the path of the side cord of the spinal cord, in the convolutions of the brain, the radiant crown.

[11], [12], [13]

Children's central paralysis

Children's central paralysis unites a whole group of diseases characterized by CNS damage, motor dysfunction, delayed development of the psyche. Children's central paralysis does not develop. This, perhaps, speaks of perinatal paralysis of the central nervous system or brain damage in childbirth, when oxygen shortage, birth trauma, stroke causes the development of encephalopathy. Often paralysis is associated with impaired supply of brain cells with oxygen. Complications of hypoxia - inadequate development of brain areas responsible for the balance, coordination and ensuring the work of reflexes. That is why asymmetric muscle tone develops, pathological motor reactions appear.

[14], [15], [16]

Diagnostics of the central paralysis

Instrumental diagnosis of central paralysis includes: neuroimaging (CT and MRI), radiography of the bones of the spine and skull, electromyography, spinal cord puncture, histology and histochemistry of the biopsy of the affected muscles.

Differential diagnosis

Differential diagnosis includes assessment of the volume, severity of paralysis. The map of the affected musculature can indicate the area of CNS pathological processes.

When paralysis of the extremities, an assessment should be made of its volume: immobility of the four limbs means damage to the spinal cord at the site in the neck region; paralysis of the extremities of one side is characteristic of the pathology of the inner capsule; paralysis of the legs - for violations of the spinal cord on the chest or lower back; the cause of paralysis of one limb lies in disorders of the peripheral nerve.

Other muscles can paralyze. For example, dysfunction of the eye muscles is a pathology of the cranial nerves; immobility of mimic muscles - pathology of the facial nerve or central motor neuron of the opposite hemisphere; lethargy of the sternocleidomastoid and trapezius muscles means abnormalities in the accessory nerve; lethargic muscles of the tongue - the sublingual nerve suffered.

For the diagnosis it is necessary to clarify the circumstances of the appearance of paralysis: how it began, whether it was accompanied by trauma, impaired consciousness, fainting, fever, signs of an infectious disease. It is important to analyze whether other neurological symptoms have manifested: sensory disorders, ataxia, vision problems, bladder emptying, bowel cleansing.

For differential diagnosis of central and peripheral paralysis, electromyography is effective, which marks pathologies inherent in damaged neurons of the anterior horn of the spinal cord, emerging neuropathies. These violations of central paralysis are not inherent. With central paralysis, the H-reflex changes. It manifests itself in all affected muscles, when it is normally defined exclusively in the lower leg.

Treatment of the central paralysis

Patients are treated with the main disease with the treatment of paralysis itself. If the vessels are injured, the immobilized limb is given a position that does not interfere with the normal supply of blood.

In parallel with the prevention of contractures, medicines are treated. Therapy intensifies exchange in nerves, circulation in small vessels, improvement of nervous and synaptic conductivity.

Conservative treatment brings results when the morphological substrate that allows the regeneration of muscle functions has survived. If there is still an opportunity to resume muscle work, the goal of conservative treatment is to avoid contractures and deformations and to accelerate the resumption of muscle work.

Widely used physiotherapy, balneotherapy, exercise therapy, reflexology.

Physiotherapy with central paralysis is prescribed after some time. The timing of the introduction of physiotherapy depends on the factors that led to paralysis: inflammation, trauma or stroke.

Electrophoresis of medicines helps to restore blood circulation of the affected area of the brain. When inflammation is used UHF and microwave treatment. Electrostimulation in the region of the immobilized limb is carried out along the motor points of the antagonist muscles. This helps to remove hypertonia and reduce the response reflex response of paralyzed muscles. Electrostimulation is combined with the use of relaxing muscle drugs and acupuncture. To reduce the risk of contractures, they perform warm ozokerite or paraffin therapy. Possible positive dynamics in the use of cold, especially in spastic children's central paralysis.

Physical rehabilitation with central paralysis begins with a massage, and a week or a half later they begin to introduce physical therapy.

The first exercises involve working to maintain the occupied position of the limb. Working on the development of conscious movements, use special equipment: frames with blocks and various ropes attached to the bed, balls, expanders.

When the patient can already sit on his own, the next stage of therapeutic gymnastics is learning to walk. At first the methodologist helps, and then the patient tries to move independently using crutches and sticks. Then they start to master more subtle movements: fastening of clothes, shoe lacing, control of technology with the help of the remote, the keyboard.

Medication for paralysis

The main drugs are benzodiazepines, baclofen, dantrolene. How these drugs work is not reliably established. Medications are prescribed if violations of normal muscle activity occur every day. Therapy with medicines will give an excellent result if you use two or more medications and combine them with other therapies.

• Baclofen has a retarding effect, affecting the bicuculline receptors not susceptible to hamaaminobutyric acid. The dose is administered individually in each case to reveal a minimum effective dosage that is not associated with adverse events. The result is usually obtained at a dosage in the range of 30 to 75 mg daily.

The first 3 days are prescribed on a half-tablet 3 times a day (if the dosage is 10 mg); 4-6 day - for the whole tablet; 7-9 day for 1.5 tablets 3 times a day; 10-12 days - 2 tablets each. Gradual increase in dosage ensures good drug tolerance. A sharp discontinuation of baclofen is fraught with hallucinations and exacerbations of signs of paralysis.

• Benzodiazepines enhance the postsynaptic effects of gammaaminobutyric acid, promoting presynaptic inhibition. Medications also affect the processes in the brain stem. Very often, diazepam is used. Dosage - within 2-8 mg 2 times a day. The course of diazepam provides for a complete alcohol restriction. Among the side effects - violations of the liver, violations in the blood. Extremely accurate should be with the introduction of diazepam and cancellation of admission for patients taking medications that dilute blood.

Diazepam may cause drowsiness, dizziness, slow reaction, provoke allergies, nausea, vomiting.

• Dantrolen stops the release of calcium in the musculature, separating electromechanical consistency. That is, it lowers the tone, increasing muscle weakness. With hypertension, the drug gives noticeable results, but it is usually prescribed to patients with plegia. For reception appoint at a dosage of 4-8 mg per day for 3 or 4 reception. Dantrolene is excreted by exchange in the liver, so it is restricted for admission to patients with unhealthy liver. Also, special care is needed when administering dantrolene to people with lung or cardiac problems.
• Sirdalud affects the polysynaptic pathways of the spinal cord, reducing the generation of stimulating signals to alpha-motor neurons. The drug on the effectiveness of influencing hypertension of muscles is similar to baclofen, but in sirdaluda it is better tolerated. Sirdalud is prescribed to adults, starting at a dosage of 1 to 2 mg per day (in 2-3 doses) with a phased increase in dosage to 12-14 mg divided into 3 or 4 doses. May cause a reaction in the form of weakness, a feeling of dryness in the mouth, sleep disorders.

Anticholinesterase drugs are also used to treat central paralysis. Anticholinesterase drugs quickly enter the central nervous system, intensify the transmission of signals to the musculature from the nerves and weaken the signs of central nervous system dysfunction.

Operative treatment of paralysis

Before the operation, the functional capabilities of the muscles are revealed, measures are taken to strengthen them, measures to eliminate the contractures that have arisen. After the operation, measures are developed to promote the growth and strengthening of the function of implanted muscles, and then - training difficult, in terms of coordination, movements. Surgical intervention is more often performed with flaccid paralysis or cerebral palsy, when conservative therapy has not improved the situation.

Surgical operation is suitable for neurogenic deformation, when the muscles of the limb are partially affected, changes in the mechanical axis, shape, and size are noticeable, for example, in the case of continuous paralysis of the muscular part of the limb. Then surgical treatment is a preparatory stage before the subsequent prosthetics.

Surgical operation in cerebral palsy tries to remove the deformity of the limb, which distorts the statics. Such intervention is advisable when the methods of conservative treatment have not yielded results. It is also effective if areas with fixed deformations that are caused by violations of the tendon-muscular system and ligaments of the system are detected. Sometimes, operations aim to eliminate reflective contractures.

Subdivide operations into three different types:

• surgery on tendons and muscles;
• operations on bundles;
• surgery on the bones and joints.

It happens that the operations combine elements of all types.

The success of the operation and the recovery time depend on a set of conservative therapy measures.

Alternative recipes

Alternative medicine to patients advises to use juice of fresh celery, nettle or plantain.

If the cause of paralysis lies in the pathologies of the blood circulation of the brain, feijoa will help. A noticeable improvement is given by the reception and juice, the fruits themselves.

When paralysis, drink tincture from the wolf normal. At 5 grams of bark or roots, you need to take 0.5 liters of vodka or alcohol. Take a two-week course of 1 - 2 drops three times a day. Ointment with tincture is rubbed externally. To prepare 50 grams of heated lanolin, pour in 20 ml of tincture, and, without stopping the stirring, gradually pour 50 g of Vaseline. Ointment is applied throughout the nerve pathway, and the treated area is wrapped in wool tissue.

Baths can also help restore paralysis. To prepare a bath with a decoction on the roots of the dog rose, take 4-6 teaspoons of ground roots, add a liter of boiling water, boil for 20-30 minutes. Then the broth is poured into the bath. For a bath, the water temperature should be moderate - enough 38 degrees. You can also prepare for the bath and juniper broth: 4 - 6 teaspoons of branches or juniper fruit pour a liter of water, boil for 20-30 minutes. For baths, one plant is used up to 10 times, and afterwards it is replaced by some other one.

Baths and the reception of herbal infusions are recommended to combine with the treatment of mummies. Twice a day, a piece of pinhead is stirred with 20-30 ml of water and drunk before eating.

[17], [18], [19], [20]

Herbal treatment for paralysis

• Infusion based on the roots of the pion. He also meets under the name marjin root.

1 teaspoon of roots are brewed with a liter of boiling water, after an hour, they are fed through a sieve or gauze. Take infusion of peony roots for 1 tablespoon 3 times before meals. Alcoholic roots are drunk in a dosage of 30-40 drops 3 times a day.

• Decoction on the leaves of sumac.

1 tbsp. Spoonful of sumac dyeing or sumache tanning is brewed in 0.5 liters of boiling water and defended for an hour. Take a decoction of 1 tablespoon 3-4 times a day.

• Tincture on pine cones

For the tincture, 10-15 mature pine cones are prepared. The cones are poured with vodka (0.5-0.6 liters) and the month is insisted. Tincture is taken 1 teaspoonful 3 times a day.

Homeopathy

Optimal combination of homeopathic preparations with medicines of classical medicine. Homeopathy does not replace the basic treatment, but it can complement the set of measures that stimulate the body to recover.

• The homeopathic preparation Conium relieves convulsions. Its basis is an extract from the hemlock of a spotted, extremely poisonous plant. Conium is shown with paralysis accompanied by paresthesia, and the patient feels weak, suffers from insomnia, often freezes. Dissolve 8 granules 5 times a day. Conium take up to 2 months.
• Fibiaron is a complex preparation. Acts as a prophylaxis of paralysis, in addition, is indicated for treatment. Belladonna, mistletoe is white, ambergris in the composition of Fibiaron harmonizes the excitation - inhibition mechanism, protects the central nervous system. Dosage - 5-7 granules from 3 to 5 times a day. Fibirion take from 6 to 8 months.
• Barium aceticum (Barium aceticum) is available in granules and drops. It is prescribed for paralysis, which rises from the limb to the center. The drug prescribes absent-mindedness, hesitation before making decisions, a sensation of "goosebumps", a feeling of cobwebs on the face, tingling and pain that spreads on the left leg. Acts Barium aceticum almost like Barita Acetica (Barita acetica).
• Botrops (Botrops) is made from the poison of a spearhead snake, is made in the form of granules or drops. Botrops is prescribed for paralysis with signs of speech impairment, signs of paralysis of the right side of the body.
• CAUSTICUM (Caustic) is effective in paralysis, which is due to intoxication with lead.

For rehabilitation after central paralysis, it may take months or perhaps years, the most important thing is to follow the recommendations, the regularity of independent studies, the efforts to expand the motor functions, and gradually move to sports loads: swimming pool exercises, jogging, jumping.