Paralysis

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Paralysis
Specialty Neurology, neurosurgery, psychiatry

Paralysis (pl.: paralyses; also known as plegia) is a loss of motor function in one or more muscles. Paralysis can also be accompanied by a loss of feeling (sensory loss) in the affected area if there is sensory damage. In the United States, roughly 1 in 50 people have been diagnosed with some form of permanent or transient paralysis. [1] The word "paralysis" derives from the Greek παράλυσις, meaning "disabling of the nerves" [2] from παρά (para) meaning "beside, by" [3] and λύσις (lysis) meaning "making loose". [4] A paralysis accompanied by involuntary tremors is usually called "palsy". [5] [6]

Contents

Causes

Paralysis is most often caused by damage in the nervous system, especially the spinal cord. Other major causes are stroke, trauma with nerve injury, poliomyelitis, cerebral palsy, peripheral neuropathy, Parkinson's disease, ALS, botulism, spina bifida, multiple sclerosis, and Guillain–Barré syndrome. Temporary paralysis occurs during REM sleep, and dysregulation of this system can lead to episodes of waking paralysis. Drugs that interfere with nerve function, such as curare, can also cause paralysis.

Pseudoparalysis (pseudo- meaning "false, not genuine", from Greek ψεῦδος [7] ) is voluntary restriction or inhibition of motion because of pain, incoordination, orgasm, or other cause, and is not due to actual muscular paralysis. [8] In an infant, it may be a symptom of congenital syphilis. [9] Pseudoparalysis can be caused by extreme mental stresses, and is a common feature of mental disorders such as panic anxiety disorder. [10]

Variations

Paralysis can occur in localised or generalised forms, or it may follow a certain pattern. Most paralyses caused by nervous-system damage (e.g., spinal cord injuries) are constant in nature; however, some forms of periodic paralysis, including sleep paralysis, are caused by other factors. [11] [12]

Paralysis can occur in newborns due to a congenital defect known as spina bifida. Spina bifida causes one or more of the vertebrae to fail to form vertebral arches within the infant, which allows the spinal cord to protrude from the rest of the spine. In extreme cases, this can cause spinal cord function inferior to the missing vertebral arches to cease. [12] This cessation of spinal cord function can result in paralysis of lower extremities. Documented cases of paralysis of the anal sphincter in newborns have been observed when spina bifida has gone untreated. [11] While life-threatening, many cases of spina bifida can be corrected surgically if operated on within 72 hours of birth.

Ascending paralysis presents in the lower limbs before the upper limbs. It can be associated with:

Ascending paralysis contrasts with descending paralysis, which occurs in conditions such as botulism.

Other animals

Many animal species use paralyzing toxins to capture prey, evade predation, or both. In stimulated muscles, the decrease in frequency of the miniature potentials runs parallel to the decrease in postsynaptic potential, and to the decrease in muscle contraction. In invertebrates, this clearly indicates that, e.g., Microbracon (wasp genus) venom causes paralysis of the neuromuscular system by acting at a presynaptic site. Philanthus venom inhibits both the fast and slow neuromuscular system at identical concentrations. It causes a decrease in the frequency of the miniature potentials without affecting their amplitude significantly.[ citation needed ]

Invertebrates

In some species of wasp, to complete the reproductive cycle, the female wasp paralyses a prey item such as a grasshopper and places it in her nest. In the species Philanthus gibbosus , the paralysed insect (most often a bee species) is coated in a thick layer of pollen. The adult P. gibbosus then lays eggs in the paralysed insect, which is devoured by the larvae when they hatch. [14]

Vertebrates

A well-known example of a vertebrate-produced paralyzing toxin is the tetrodotoxin of fish species such as Takifugu rubripes , the famously lethal pufferfish of Japanese fugu. This toxin works by binding to sodium channels in nerve cells, inhibiting the cells' proper function. A non-lethal dose of this toxin results in temporary paralysis. This toxin is also present in many other species ranging from toads to nemerteans.

Paralysis can be seen in breeds of dogs that are chondrodysplastic. These dogs have short legs, and may also have short muzzles. Their intervertebral disc material can calcify and become more brittle. In such cases, the disc may rupture, with disc material ending up in the spinal canal, or rupturing more laterally to press on spinal nerves. A minor rupture may only result in paresis, but a major rupture can cause enough damage to cut off circulation. If no signs of pain can be elicited, surgery should be performed within 24 hours of the incident, to remove the disc material and relieve pressure on the spinal cord. After 24 hours, the chance of recovery declines rapidly, since with continued pressure, the spinal cord tissue deteriorates and dies.

Another type of paralysis is caused by a fibrocartilaginous embolism. This is a microscopic piece of disc material that breaks off and becomes lodged in a spinal artery. Nerves served by the artery will die when deprived of blood.

The German Shepherd Dog is especially prone to developing degenerative myelopathy. This is a deterioration of nerves in the spinal cord, starting in the posterior part of the cord. Affected dogs will become gradually weaker in the hind legs as nerves die off. Eventually, their hind legs become useless. They often also exhibit faecal and urinary incontinence. As the disease progresses, the paresis and paralysis gradually move forward. This disease also affects other large breeds of dogs. It is suspected to be an autoimmune problem.

Cats with a heart murmur may develop blood clots that travel through arteries. If a clot is large enough to block one or both femoral arteries, there may be hind leg paralysis because the major source of blood flow to the hind leg is blocked.

Many snakes exhibit powerful neurotoxins that can cause non-permanent paralysis or death. Also, many trees contain neurotoxins.

See also

Related Research Articles

Hemiparesis, also called unilateral paresis, is the weakness of one entire side of the body. Hemiplegia, in its most severe form, is the complete paralysis of one entire side of the body. Either hemiparesis or hemiplegia can result from a variety of medical causes, including congenital conditions, trauma, tumors, traumatic brain injury and stroke.

<span class="mw-page-title-main">Tetraplegia</span> Paralysis of all four limbs and torso

Tetraplegia, also known as quadriplegia, is defined as the dysfunction or loss of motor and/or sensory function in the cervical area of the spinal cord. A loss of motor function can present as either weakness or paralysis leading to partial or total loss of function in the arms, legs, trunk, and pelvis. The paralysis may be flaccid or spastic. A loss of sensory function can present as an impairment or complete inability to sense light touch, pressure, heat, pinprick/pain, and proprioception. In these types of spinal cord injury, it is common to have a loss of both sensation and motor control.

<span class="mw-page-title-main">Spina bifida</span> Birth defect of the spinal cord

Spina bifida is a birth defect in which there is incomplete closing of the spine and the membranes around the spinal cord during early development in pregnancy. There are three main types: spina bifida occulta, meningocele and myelomeningocele. Meningocele and myelomeningocele may be grouped as spina bifida cystica. The most common location is the lower back, but in rare cases it may be in the middle back or neck.

<span class="mw-page-title-main">Brachial plexus</span> Network of nerves

The brachial plexus is a network of nerves formed by the anterior rami of the lower four cervical nerves and first thoracic nerve. This plexus extends from the spinal cord, through the cervicoaxillary canal in the neck, over the first rib, and into the armpit, it supplies afferent and efferent nerve fibers to the chest, shoulder, arm, forearm, and hand.

In medicine, paresis, compund word from greek Ancient Greek: πάρεσις,, is a condition typified by a weakness of voluntary movement, or by partial loss of voluntary movement or by impaired movement. When used without qualifiers, it usually refers to the limbs, but it can also be used to describe the muscles of the eyes (ophthalmoparesis), the stomach (gastroparesis), and also the vocal cords.

<span class="mw-page-title-main">Phrenic nerve</span> Nerve controlling the diaphragm

The phrenic nerve is a mixed motor/sensory nerve that originates from the C3–C5 spinal nerves in the neck. The nerve is important for breathing because it provides exclusive motor control of the diaphragm, the primary muscle of respiration. In humans, the right and left phrenic nerves are primarily supplied by the C4 spinal nerve, but there is also a contribution from the C3 and C5 spinal nerves. From its origin in the neck, the nerve travels downward into the chest to pass between the heart and lungs towards the diaphragm.

<span class="mw-page-title-main">Paraplegia</span> Impairment of motor and sensory functions in the lower limbs

Paraplegia, or paraparesis, is an impairment in motor or sensory function of the lower extremities. The word comes from Ionic Greek (παραπληγίη) "half-stricken". It is usually caused by spinal cord injury or a congenital condition that affects the neural (brain) elements of the spinal canal. The area of the spinal canal that is affected in paraplegia is either the thoracic, lumbar, or sacral regions. If four limbs are affected by paralysis, tetraplegia or quadriplegia is the correct term. If only one limb is affected, the correct term is monoplegia. Spastic paraplegia is a form of paraplegia defined by spasticity of the affected muscles, rather than flaccid paralysis.

<span class="mw-page-title-main">Monoplegia</span> Paralysis of a single limb

Monoplegia is paralysis of a single limb, usually an arm. Common symptoms associated with monoplegic patients are weakness, numbness, and pain in the affected limb. Monoplegia is a type of paralysis that falls under hemiplegia. While hemiplegia is paralysis of half of the body, monoplegia is localized to a single limb or to a specific region of the body. Monoplegia of the upper limb is sometimes referred to as brachial monoplegia, and that of the lower limb is called crural monoplegia. Monoplegia in the lower extremities is not as common of an occurrence as in the upper extremities. Monoparesis is a similar, but less severe, condition because one limb is very weak, not paralyzed. For more information, see paresis.

Polyneuropathy in dogs and cats is a collection of peripheral nerve disorders that often are breed-related in these animals. Polyneuropathy indicates that multiple nerves are involved, unlike mononeuropathy. Polyneuropathy usually involves motor nerve dysfunction, also known as lower motor neuron disease. Symptoms include decreased or absent reflexes and muscle tone, weakness, or paralysis. It often occurs in the rear legs and is bilateral. Most are chronic problems with a slow onset of symptoms, but some occur suddenly.

<span class="mw-page-title-main">Foot drop</span> Gait abnormality

Foot drop is a gait abnormality in which the dropping of the forefoot happens out of weakness, irritation or damage to the deep fibular nerve, including the sciatic nerve, or paralysis of the muscles in the anterior portion of the lower leg. It is usually a symptom of a greater problem, not a disease in itself. Foot drop is characterized by inability or impaired ability to raise the toes or raise the foot from the ankle (dorsiflexion). Foot drop may be temporary or permanent, depending on the extent of muscle weakness or paralysis and it can occur in one or both feet. In walking, the raised leg is slightly bent at the knee to prevent the foot from dragging along the ground.

Tethered cord syndrome (TCS) refers to a group of neurological disorders that relate to malformations of the spinal cord. Various forms include tight filum terminale, lipomeningomyelocele, split cord malformations (diastematomyelia), occult, dermal sinus tracts, and dermoids. All forms involve the pulling of the spinal cord at the base of the spinal canal, literally a tethered cord. The spinal cord normally hangs loose in the canal, free to move up and down with growth, and with bending and stretching. A tethered cord, however, is held taut at the end or at some point in the spinal canal. In children, a tethered cord can force the spinal cord to stretch as they grow. In adults the spinal cord stretches in the course of normal activity, usually leading to progressive spinal cord damage if untreated. TCS is often associated with the closure of a spina bifida. It can be congenital, such as in tight filum terminale, or the result of injury later in life.

Vocal cord paresis, also known as recurrent laryngeal nerve paralysis or vocal fold paralysis, is an injury to one or both recurrent laryngeal nerves (RLNs), which control all intrinsic muscles of the larynx except for the cricothyroid muscle. The RLN is important for speaking, breathing and swallowing.

Flaccid paralysis is a neurological condition characterized by weakness or paralysis and reduced muscle tone without other obvious cause. This abnormal condition may be caused by disease or by trauma affecting the nerves associated with the involved muscles. For example, if the somatic nerves to a skeletal muscle are severed, then the muscle will exhibit flaccid paralysis. When muscles enter this state, they become limp and cannot contract. This condition can become fatal if it affects the respiratory muscles, posing the threat of suffocation. It also occurs in the spinal shock stage in complete transection of the spinal cord occurring in injuries such as gunshot wounds.

Synkinesis is a neurological symptom in which a voluntary muscle movement causes the simultaneous involuntary contraction of other muscles. An example might be smiling inducing an involuntary contraction of the eye muscles, causing a person to squint when smiling. Facial and extraocular muscles are affected most often; in rare cases, a person's hands might perform mirror movements.

<span class="mw-page-title-main">Central nervous system disease</span> Disease of the brain or spinal cord

Central nervous system diseases or central nervous system disorders are a group of neurological disorders that affect the structure or function of the brain or spinal cord, which collectively form the central nervous system (CNS). These disorders may be caused by such things as infection, injury, blood clots, age related degeneration, cancer, autoimmune disfunction, and birth defects. The symptoms vary widely, as do the treatments.

<span class="mw-page-title-main">Spinal cord</span> Part of the vertebral column in animals

The spinal cord is a long, thin, tubular structure made up of nervous tissue that extends from the medulla oblongata in the lower brainstem to the lumbar region of the vertebral column (backbone) of vertebrate animals. The center of the spinal cord is hollow and contains a structure called the central canal, which contains cerebrospinal fluid. The spinal cord is also covered by meninges and enclosed by the neural arches. Together, the brain and spinal cord make up the central nervous system.

<span class="mw-page-title-main">Spinal disease</span> Disease involving the vertebral column

Spinal disease refers to a condition impairing the backbone. These include various diseases of the back or spine ("dorso-"), such as kyphosis. Dorsalgia refers to back pain. Some other spinal diseases include spinal muscular atrophy, ankylosing spondylitis, scoliosis, lumbar spinal stenosis, spina bifida, spinal tumors, osteoporosis and cauda equina syndrome.

<span class="mw-page-title-main">Smile surgery</span> Surgical procedure to restore smile

Smile surgery or smile reconstruction is a surgical procedure that restores the smile for people with facial nerve paralysis. Facial nerve paralysis is a relatively common condition with a yearly incidence of 0.25% leading to function loss of the mimic muscles. The facial nerve gives off several branches in the face. If one or more facial nerve branches are paralysed, the corresponding mimetic muscles lose their ability to contract. This may lead to several symptoms such as incomplete eye closure with or without exposure keratitis, oral incompetence, poor articulation, dental caries, drooling, and a low self-esteem. This is because the different branches innervate the frontalis muscle, orbicularis oculi and oris muscles, lip elevators and depressors, and the platysma. The elevators of the upper lip and corner of the mouth are innervated by the zygomatic and buccal branches. When these branches are paralysed, there is an inability to create a symmetric smile.

References

  1. ↑ "Paralysis Facts & Figures - Spinal Cord Injury - Paralysis Research Center". Christopherreeve.org. Archived from the original on 2016-03-24. Retrieved 2013-02-19.
  2. ↑ Liddell, Henry George; Scott, Robert (1940). "παράλυσις". A Greek-English Lexicon. Oxford: Clarendon Press. on Perseus
  3. ↑ Liddell & Scott 1940 , παρά
  4. ↑ Liddell & Scott 1940 , λύσις
  5. ↑ "Palsy". Lexico. Archived from the original on July 24, 2012. Retrieved 27 May 2015.
  6. ↑ "Palsy". Merriam-Webster . Retrieved 27 May 2015.
  7. ↑ Liddell & Scott 1940 , ψεῦδος
  8. ↑ TheFreeDictionary > pseudoparalysis, in turn citing The American Heritage Medical Dictionary 2007, 2004
  9. ↑ Workowski KA, Berman SM (August 2006). "Sexually transmitted diseases treatment guidelines, 2006". MMWR Recomm Rep. 55 (RR–11): 1–94. PMID   16888612. ... evidence of congenital syphilis (e.g., nonimmune hydrops, jaundice, hepatosplenomegaly, rhinitis, skin rash, and/or pseudoparalysis of an extremity).
  10. ↑ "anxiety-panic.com". anxiety-panic.com. Archived from the original on 2018-07-30. Retrieved 2017-06-06.
  11. 1 2 Hutchinson, Jonathan (1877). "Clinical Lecture On Cases Of Spina Bifida, With Paralysis Of Sphincters". The British Medical Journal. 1 (830): 767–768. doi:10.1136/bmj.1.860.767. JSTOR   25244879. PMC   2220916 . PMID   20748563.
  12. 1 2 Saladin, Kenneth (2012). Anatomy and Physiology: Form and Function. McGraw Hill. ISBN   978-0-07-337825-1.
  13. ↑ MedlinePlus Encyclopedia : Tick paralysis
  14. ↑ Colman, D. R.; Toolson, E. C.; Takacs-Vesbach, C. D. (2012-10-01). "Do diet and taxonomy influence insect gut bacterial communities?". Molecular Ecology. 21 (20): 5124–5137. doi:10.1111/j.1365-294X.2012.05752.x. ISSN   1365-294X. PMID   22978555. S2CID   23740875.
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