Crumpy: causes, symptoms, diagnosis

In the literature one can find indications that approximately one third of the population experiences at least once a year spontaneous krampi - sudden involuntary and painful tonic muscular contraction that occurs spontaneously or provoked by movement and manifested by a visible muscular roller (cervical, knot ") dense at palpation.Crampi usually grasps one muscle or part of it.

I. Healthy people.

1. Excessive physical activity.
2. Loss of fluid with intense sweating or diarrhea.
3. Idiopathic.

II. Neurological diseases.

1. Family Crumpy.
2. Lateral amyotrophic sclerosis (krampi as a manifestation of pyramidal insufficiency and damage to the cells of the anterior horns of the spinal cord).
3. Other diseases of the anterior horn (progressive spinal amyotrophies).
4. Irritation of the spine or nerve (peripheral neuropathy: malignant tumors, injuries, compression lesions, polyneuropathies, multifocal motor neuropathy, late poliomyelitis effects).
5. Generalized hyperactivity of motor units (with or without peripheral neuropathy): Isaacs syndrome; paraneoplastic syndrome; hereditary forms of constant activity of motor units).
6. Mainly myogenic cramps (disorders of glycogen metabolism, disorders of lipid metabolism, local or diffuse myositis, endocrine myopathies, muscular dystrophy of Becker (Vecker)).
7. Myotonic disorders.
8. The syndrome of a rigid person.
9. SATOYOSHA'S SYNDROME.

III. Metabolic causes.

1. Pregnancy.
2. Tetany.
3. Other electrolyte disorders.
4. Hypothyroidism (myxedema).
5. Hyperparathyroidism.
6. Uremia.
7. Cirrhosis of the liver.
8. Gastrectomy.
9. Alcohol.

IV. Iatrogenic causes.

1. Diuretic therapy.
2. Hemodialysis.
3. Vincristine.
4. Lithium.
5. Salbutamol.
6. Nifidipine.
7. Other drugs (penicillamine, aminocaproic acid, etc.).

V. Other reasons.

1. Intermittent claudication.
2. Crumpy when overheating.
3. Syndrome of eosinophilia - myalgia.
4. Toxins (insecticides, strychnine, etc.).
5. Tetanus.

I. Healthy people

Excessive physical activity in a healthy person (especially in a detached person) can cause an episode (s) of a krampi. Prolonged and intense sweating or diarrhea, regardless of the cause of the latter, is also capable of provoking a krampi. Occasionally, random cramps occur, the cause of which remains unclear (idiopathic). Most often, such crimps are observed in the gastrocnemius muscles and can briefly fix the foot in a modified posture.

II. Neurological diseases

Family krampi have the same manifestations, but they are more resistant, more often they develop spontaneously and are more easily provoked (physical activity, use of diuretics or laxatives). The course of the disease is undulating; during exacerbations, it is possible to generalize the crump with periodic and alternate occurrence not only in the gastrocnemius muscles, but also in the thigh muscles (the posterior muscle group, the sartorius muscle), the anterior abdominal wall. It is possible to involve intercostal, pectoral muscles, as well as the muscles of the back. In the face area, the jaw-hyoid muscle is involved: after intensive yawning, usually one-sided spasm of this muscle develops with a characteristic painful compaction palpable from the side of the mouth's diaphragm. In some individuals, the crimps develop against the background of constant more or less generalized fasciculations (benign fasciculations and cramps); sometimes fasciculations are observed before and at the end of the fitsal cramps. Passive stretching of the muscle or active work (walking, etc.), as well as muscle massage, leads to cessation of the cramp.

Night cramps are very common, especially when you change the position of the body or limb, predominate in the population of the elderly. Diseases of peripheral nerves, muscles, veins and arteries contribute to their occurrence.

Crumpy at rest can be the earliest manifestation of amyotrophic lateral sclerosis; the clinical symptoms of progressive defeat of upper and lower motoneurons are joined later. Cramps in BAS can be observed in the muscles of the lower leg, hip, abdomen, back, arms, neck, lower jaw and even in the tongue. Some fascinations and cramps without EMG signs of denervation can not serve as a basis for the diagnosis of amyotrophic lateral sclerosis. Progressive spinal amyotrophies can be accompanied by fasciculations and krampi, but the main manifestation of this group of diseases are symmetrical amiotrophies with benign course. Progressive spinal amyotrophies, as a rule, have neither clinical nor electromyographic signs of the defeat of the upper motoneuron.

Crumpi can be observed with radiculopathies and polyneuropathies (as well as plexopathies) of very different origin. Patients who have experienced poliomyelitis in the past sometimes notice the appearance of cramps and fasciculations.

A number of diseases of the nervous system, which have a common neurophysiological basis in the form of so-called hyperactivity of motor units, is manifested in addition to other clinical manifestations of the crimpial syndrome: idiopathic (autoimmune) syndrome of constant activity of muscle fibers (Isaacs syndrome); paraneoplastic syndrome (clinically similar to idiopathic Isaacs syndrome) can be observed with bronchogenic carcinoma, lymphoma and other malignant neoplasms with or without peripheral neuropathy; syndrome "krampi-fasciculation" (syndrome "muscle pain-fascination"); some hereditary diseases: hereditary miokimiya with krampi, miokimiya with paroxysmal dyskinesias. In most of these forms of neurological diseases, crimps are not a leading clinical syndrome and are most often observed in the context of progressive stiffness, and electromyographically reveals constant spontaneous activity in the affected muscles.

Cramps are found in some myotonic disorders. The Lambert-strongrody syndrome develops in the first or second decade of life and is manifested by progressive muscular pain induced by physical exertion; muscular tension (stiffness) and krampi. Another rare disease is congenital myotonia with painful and krampi. Some researchers consider this version of myotonia as a variant of Thomsen's myotonia. Crumpis are observed in the picture of chondrodystrophic myotonia (Schwartz-Jampel syndrome). The latter is characterized by an autosomal dominant type of inheritance and begins to manifest itself in infants myotonia, osteochondroplasia, growth retardation, hypertrophic musculature and a characteristic face with blepharophimosis, micrognathia and low-set ears. Muscular tension and osteochondrodysplasia often limit mobility in the joints and lead to a rigid walking pattern.

The syndrome of the rigid person (Stiff-Person syndrome) is characterized by a gradual onset of symmetrical tension of the proximal and especially axial muscles of the trunk (characterized by a fixed lumbar hyperlordosis that does not disappear in the lying position) with stony muscle density and painful spasms that are provoked by many factors and sometimes accompanied by vegetative reactions. Sometimes this pattern is superimposed on a spontaneous or reflex ("stimulus-sensitive") myoclonus, provoked by various sensory stimuli. On EMG, constant increased activity at rest. With progression, dysbasia develops. Hypertension disappears or decreases during sleep (especially in the phase of fast sleep), during the sedative effect of diazepam, general anesthesia, blockage of the root or nerve, and when curare is administered.

The Satoyoshi syndrome begins in childhood or adolescence with periodic painful muscle spasms, because of which limbs and trunk often take pathological poses (myospasm gravis). Spasms are provoked by voluntary movements and are usually not observed at rest and in sleep. Many patients develop alopecia, diarrhea with malabsorption, endocrinopathy with amenorrhoea and multiple secondary skeletal deformations. The pathogenesis of this syndrome is not completely known; involvement of autoimmune mechanisms is implied.

Mostly myogenic cramps are typical for such hereditary diseases as glycogenoses (glycogenases V, VII, VIII, IX, X and XI types); deficiency of carnitine-palmitoyltransferase I (autosomal recessive type of inheritance, early debut, often neonatal, episodes of non-ketone hypoglycemic coma, hepatomegaly, hypertriglyceridemia and mild hyperammonia, decreased carnitine-palmitoyltransferase I activity in fibroblasts and liver cells) and carnitine palmitoyl transferase II deficiency the age of the manifestations of the disease is variable, the most frequent complaint is muscle pain (myalgia) and spontaneous krampi, is characterized by myoglobulinuria, a biopsy of skeletal muscles reveals de itsit above enzyme). Local or diffuse myositis may be accompanied by a krampi, as well as endocrine myopathies; the appearance of the crump is described in Becker's muscular dystrophy (differs from Duchenne's muscular dystrophy by a later onset and benign course). Pronounced myalgias in the legs, often in combination with a krampi, are the earliest symptoms of this disease in about a third of patients.

III. Metabolic causes

Crimpi during pregnancy is usually associated with a hypo-calcicemic condition. Crumpis are characteristic for tetany, which can carry endocrinopathic (insufficiency of parathyroid glands) and neurogenic character (in the picture of hyperventilation syndrome). Soft forms of tetany without hyperventilation disorders are quite common. Hidden tetany in children is sometimes called spasmophilia.

Thetania is manifested by distal paresthesias, carpo- pedal spasms, typical krampi and attacks of the laryngeal stridor. The tetanic syndrome in the picture of psycho-vegetative disorders usually serves as an indicator of the presence of hyperventilation disorders, which is often accompanied by symptoms of increased neuromuscular excitability (the symptom of Khvostek, Trusso, etc.).

Crumpy can also be caused by other electrolyte disorders. These include: hypokalemia (the most common causes are diuretics, diarrhea, hyperaldosteronism, metabolic acidosis), acute hyponatremia (accompanied by fasciculations and krampi), a decrease in the magnesium content in the blood (weakness, krampi, fasciculation and tetany). Studies of electrolytes in the blood can easily detect these disorders.

Hypothyroidism in infants and children often leads to hypothyroid myopathy with generalized muscle tension (stiffness), hypertrophy of gastrocnemius muscles (Kocher-Debre-Semelaigne syndrome). In adults, hypothyroid myopathy is accompanied by a moderate weakness in the muscles of the shoulder and pelvic girdle; with 75% of patients complaining of muscle pain, krampi or muscle tension (stiffness). If these symptoms are associated with muscle hypertrophy, the entire symptom complex in adults is called Hoffman's syndrome. For all forms of hypothyroid myopathy, slowness of muscle contraction and relaxation is characteristic. The level of creatine kinase in the serum can be increased.

Muscle pain and cramps are often observed with hyperparathyroidism; they are also observed in the picture of various manifestations of uremia. Metabolic causes are the basis for the cramp in diseases such as cirrhosis, state after gastrectomy, nutritional disorders in alcoholism.

IV. Iatrogenic causes

Typical causes of iatrogenic foci include: diuretic therapy, hemodialysis, treatment with vincristine, lithium, salbutamol, nifidipine, and some other drugs (penicillamine, aminocaproic acid, isoniazid, blood cholesterol lowering drugs, hypervitaminosis E, azathiaprine, corticosteroid withdrawal, interferon and others ).

V. Other reasons

Among other causes of the crump, mention should be made of the intermittent claudication (claudicatio intermittens), in which ischemia of the soft tissues of the shin may exhibit, in addition to the typical symptoms of intermittent claudication, characteristic periodic crampial cramps.

The high temperature of the environment, especially with prolonged physical work in it, can provoke a crump.

The syndrome of eosinophilia-myalgia is described in the US as an epidemic outbreak in people taking L-tryptophan (eosinophilia, pneumonia, edema, alopecia, skin manifestations, myopathy, arthralgia and neuropathy, severe agonizing cramps, especially in axial muscles, are characteristic of late stages of this syndrome).

Some toxins (scorpion poisons, spider "black widow" and some fish, insecticides, etc.) cause intoxication, in the clinical manifestations of which an important place is occupied by the crump.

Tetanus is an infectious disease, the cardinal manifestations of which are progressive trisus, dysphagia, rigidity of the muscles of the back, abdomen and whole body (generalized form). In the first three days, severe painful muscle spasms are developed, provoked by sensory and emotional stimuli, as well as by movements. Consciousness is almost always preserved in patients.

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