20. Central paralysis. Flaccid paralysis

Central paralysis

Definition

• Paralysis occurs following damage to the central or peripheral nervous system that interferes with the communication between the motor cortex, limbs and the torso
• Results in lack of control and a change in muscle tone and often a loss of senses

Etiology

• Organic factors
• Physical damage
• Severe poisoning
• Metabolic or nutritional disorders
• Vascular pathology
• Cancerous growths

Symptoms

• Intentional motion loss
• Hyperreflexia
• Appearance of pathological reflexes
• Upper motor neuron dysfunction reflects an interruption in the pyramidal tract and consequent decreased activation of the lower motor neurons innervating one or more areas of the body
• Usually affects more than one muscle grou

Poliomyelitis

Defintion

• Infectious disease transmitted by fecal-oral contamination with lymphatic replication

Etiology

• Poliovirus:
• Member of the Picornaviridae family and belongs to the Enterovirus C species
• There are 3 serotypes- types 1, 2, and 3

Symptoms

Pre-paralytical stage

• Also called the acute stage
• Fever, angina, headache, nausea, vomiting, pain in the sacrum.

Paralytic stage

• Palsy usually develops on 3rd or 4th day under bulbar and spinal palsy

Recovery phase

• Improvement depends on the degree of damage to grey matter

Residual stage

• Paralyses in this stage are definitive
• No further recovery is expected

Diagnosis

• Blood
• CSF
• Stool viral cultures
• Polymerase chain reaction to detect poliovirus or other viruses
• EMG
• MRI

DD

• Flaccid paresis due to other viruses (like enterovirus)
• Spinal cord infarctions
• Acquired axonal neuropathies
• Myasthenia gravis
• Rhabdomyolysis

Treatment

• Supportive care is the mainstay of treatment
• Orthopaedic treatment is aimed at eliminating the deforming trends at the very beginning
• Patient simply takes a comfortable position in bed
• Special orthopaedic treatment is conducted in the residual period and is aimed at:
• Improving the available joint contracture
• Avoiding malformations
• Improving function through tendon transposition and stabilizing operations
• Correcting length of lower extremities and their thickness