Location via proxy:   [ UP ]  
[Report a bug]   [Manage cookies]                
Scribd Logo
Upload

Welcome to Scribd!

  • 4K views

    Approach To A Patient With Paraplegia

    Uploaded by

    Faisal Qureshi
    Paraplegia is paralysis of the lower part of the body that commonly affects both legs and sometimes internal organs below the waist. It can be caused by lesions of the upper motor neurons in the spinal cord or brain from conditions like transverse myelitis, spinal cord compression, or lower motor neuron lesions in the peripheral nerves, nerve roots or muscles from disorders such as polio, motor neuron disease or muscular dystrophies. Treatment involves management of symptoms, rehabilitation, and treating any underlying cause through methods such as surgery, steroids, or vitamin supplementation. Complications can include bedsores, incontinence, blood clots, and respiratory issues if not properly managed.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd

    Approach To A Patient With Paraplegia

    Uploaded by

    Faisal Qureshi
    4K views31 pages
    Paraplegia is paralysis of the lower part of the body that commonly affects both legs and sometimes internal organs below the waist. It can be caused by lesions of the upper motor neurons in the spinal cord or brain from conditions like transverse myelitis, spinal cord compression, or lower motor neuron lesions in the peripheral nerves, nerve roots or muscles from disorders such as polio, motor neuron disease or muscular dystrophies. Treatment involves management of symptoms, rehabilitation, and treating any underlying cause through methods such as surgery, steroids, or vitamin supplementation. Complications can include bedsores, incontinence, blood clots, and respiratory issues if not properly managed.

    Original Description:

    physiotherapy approache to treat paraplagia

    Original Title

    Approach to a Patient With Paraplegia

    Copyright

    © Attribution Non-Commercial (BY-NC)

    Available Formats

    PPT, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Paraplegia is paralysis of the lower part of the body that commonly affects both legs and sometimes internal organs below the waist. It can be caused by lesions of the upper motor neurons in the spinal cord or brain from conditions like transverse myelitis, spinal cord compression, or lower motor neuron lesions in the peripheral nerves, nerve roots or muscles from disorders such as polio, motor neuron disease or muscular dystrophies. Treatment involves management of symptoms, rehabilitation, and treating any underlying cause through methods such as surgery, steroids, or vitamin supplementation. Complications can include bedsores, incontinence, blood clots, and respiratory issues if not properly managed.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    4K views31 pages

    Approach To A Patient With Paraplegia

    Uploaded by

    Faisal Qureshi
    Paraplegia is paralysis of the lower part of the body that commonly affects both legs and sometimes internal organs below the waist. It can be caused by lesions of the upper motor neurons in the spinal cord or brain from conditions like transverse myelitis, spinal cord compression, or lower motor neuron lesions in the peripheral nerves, nerve roots or muscles from disorders such as polio, motor neuron disease or muscular dystrophies. Treatment involves management of symptoms, rehabilitation, and treating any underlying cause through methods such as surgery, steroids, or vitamin supplementation. Complications can include bedsores, incontinence, blood clots, and respiratory issues if not properly managed.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 31

    WHAT IS PARAPLEGIA?

    PARALYSIS OF LOWER PART OF BODY,COMMONLY AFFECTING BOTH LEGS AND OFTEN INTERNAL ORGANS BELOW WAIST.

    ETIOLOGY
    DIVIDED INTO 2 TYPES

    DUE TO UPPER MOTOR NEURON LESION DUE TO LOWER MOTOR NEURON LESION

    UMN LESIONS
    SPINAL LESIONS (common)

    Spinal cord compression( Potts disease,disc prolapse or fracture, tumors,epidural abscess,cervical spondylosis etc) VASCULAR Hemorrhage, Infarction SYSTEMIC DEGENERATION OF TRACTS Multiple sclerosis, MND, Sub acute combined degeneration of cord. INFECTION Transverse myelitis, Neurosyphilis

    UMN LESIONS
    CEREBRAL LESIONS (uncommon)
    Thrombosis of superior sagital sinus Tumor of falx-cerebri Hydrocephalus

    LMN LESIONS

    Anterior horn cells Poliomyelitis, Motor neuron disease Peripheral nerve Peripheral neuropathy Neuromuscular junction Myasthenia gravis Muscles Muscular dystrophies

    SPINAL CORD COMPRESSION

    It may be acute with trauma,metastasis or Arterial occlusion or it may be slow developing over weeks as in Potts disease,cervical spondylosis etc.

    POTTS DISEASE

    TB of spine often involves two or more adjacent vertebral bodies. Lower thoracic and upper lumber vertebrae are commonly involved.Intervertebral disc is also destroyed. With advanced disease paravertebral cold abscess , gibbus formation and PARAPLEGIA occur.

    TRANSVERSE MYELITIS

    It is an acute or subacute inflammation of spinal cord occuring after infection or recent vaccination. Many agents like influenza,measles,CMV,EBV and mycoplasma have been implicated.

    Guillain Barre Syndrome

    Acute inflammatory or post-infective demyelinating polyneuropathy. Develops 1-3 weeks after respiratoryinfection or diarrhea in >70% cases. Ascending polyneuropathy.

    MOTOR NEURON DISEASE


    Progressive degenerative disorder of upper and lower motor neurons in spinal cord,cranial motor neurons and pyramidal neurons in motor cortex. Cause- unknown. Patterns Progressive bulbar palsy Progressive muscular atrophy Amytrophic lateral sclerosis.

    SUBACUTE COMBINED DEGENERATION OF SPINAL CORD

    Syndrome of combined spinal cord and peripheral nerve damage cause: Vit.B12 deficinency Changes start in posterior columnn (affecting vibration and position sense) then involve lateral column(pyramidal tracts)

    MYASTHENIA GRAVIS

    Acquired autoimmune disorder of NMJ. Causes skeletal muscle fatigubility and weakness, esp of proximal limb muscles,ocular anb bulbar muscles.

    DUCHENNES MUSCULAR DYSTROPHY


    X-linked recessive disorder Deficiency of protein dystrophin in muscles. Symptoms start in childhood,become severe in adolescence and death occurs by age 20 years.

    MANAGEMENT OF PARAPLEGIA
    HISTORY EXAMINATION INVESTIGATIONS TREATMENT

    HISTORY

    AGE AND SEX Young age: Inherited disorders,muscle dis.,infections Old age: malignancies r common. DURATION ACUTE:GBS,transverse myelitis, cord compression. CHRONIC:MND,polyneuropathies,muscle dis. SPHINCTER DISTURBANCES (INITIALLY URGENCY OR HESITENCY OF MICTURATION,THEN URINARY RETENTION) Seen in UMN lesions.

    HISTORY

    SENSORY SYMPTOMS

    Numbness,tingling and hyperesthesias in neuropathy. ROOT PAIN In cord compression. BACKACHE In cord compression,transverse myelitis. HEADACHE,VOMITING Intracranial lesions PRECEDING FEVER,URTI In GBS

    EXAMINATION

    MOTOR SYSTEM FEATURES Muscle waisting Muscle tone Power Deep reflexes Superficial reflex Planters Fasciculations UMNL LMNL absent present

    +++ _ absent present

    absent present

    SENSORY SYSTEM
    Sharp sensory level in transverse myelitis differentiates it from GBS. Neuropathy:glove and stocking distribution. Romberg sign +ve if posterior column is involved.

    SIGNS OF SPINAL CORD COMPRESSION

    CERVICAL,ABOVE C5 UMN signs and sensory loss in all 4 limbs CERVICAL,C5 TO T1 LMNsigns and segmental sensory loss in arms,and UMN signs in legs THORACIC CORD Spastic paraplegia with a sensory level on trunk. CONUS MEDULLARIS Sensory loss in sacral area and extensor plantar response CAUDA EQUINA LMN signs in lower limbs.

    EXAMINATION

    EXAMINATION OF SPINE For deformity and tenderness. SPHINCTERS:Look for incontinence or retention of urine or faeces. OTHER FEATURES: Anemia-B12 deficiency Stiff neck in cervical spondylosis Site of malignancy.

    INVESTIGATIONS

    X-RAY SPINE: May show collapse or erosion of vertebrae,herniated interverteberal disc,mets.,# or dislocation of vertebra etc. MRI: Investigation of choice CT SCAN BLOOD CP: Megaloblastic anemia in subacute combined degeneration of spinal cord.

    INVESTIGATIONS

    CSF examination:

    Inflammatory lesions, both cells and proteins are increased. In malignancy,malignant cells may be present. In transverse myelitis ,proteins are increased and upto 50 lymphocytes/cmm are present. In MS,monoclonal IgG is increased. In GBS,protein cell dissociation is seen.

    INVESTIGATIONS

    MYELOGRAPHY: Site of cord compression is demonstrated. NERVE CONDUCTION STUDIES: Helpful in diagnosis of neuropathies. FUNDOSCOPY: For papilloedema due to intracranial tumor or MS. BONE SCAN: Mets and inflammatory vertebral lesions r detected.

    TREATMENT
    GENERAL MEASURES SKIN CARE: Change posture every 2-4 hrly to avoid bed sores. Keep skin dry and clean. BLADDER CARE: CATHETERIZATION for urinary retention. BOWEL CARE: Avoid constipation by suitable diet and laxatives.

    TREATMENT

    PREVENTION OF CONTRACTURES By regular passive movements. REHABILITATION By using wheel chair,standing frames,vocational training etc.

    SPECIFIC TREATMENT

    POTTS DISEASE
    Immobilization ATT Surgery:Anterior transthoracic decompression.

    TRANSVERSE MYELITIS
    Glucocorticiods are given.Initially I/V methylprednisolone,then oral prednisolone.

    TREATMENT

    MND Symptomatic T/M like physiotherapy,walking aids,splints and speech therapy. Glutamate antagonist,RILUZOLE ? SUBACUTE COMBINED SPINALCORD DEGENERATION Injection vit.B12 1000 ug I/M daily for 7-10 days,then weekly for a month and then monthly for whole life.

    TREATMENT
    GBS
    Plasma pharesis(effective only in first 2 weeks) i/v immunoglobulins(2g/kg in 5 days) No role of steriods. SPINAL CORD TUMORS Radiotherapy Surgical decompression.

    COMPLICATIONS

    BEDSORES BOWEL AND BLADDER INCONTINENCE DVT PULMONARY EMBOLISM PSYCHIATRIC LAYOUT HYPOSTATIC PNEUMONIA DISEASE RELATED COMLICATIONS

    THANK YOU

    You might also like