The development of paralysis due to organic factors: due to physical damage, severe poisoning, metabolic or nutritional disorders, vascular pathology, cancer, infections, hereditary or congenital pathologies.

Central paralysis syndrome occurs after infections that have developed in the brain or spinal cord - syphilis, tuberculosis, viral encephalitis, meningitis, polio.

Paralysis due to intoxication means poisoning with derivatives heavy metals, alcoholic neuritis, vitamin B1 deficiency, nicotinic acid deficiency.

Multiple sclerosis, the nature of which has not been identified, causes dysfunction of movements varying 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 more often affects older people, but now there is a clear trend towards its “rejuvenation”. According to statistics, more than half of cases of paralysis are a consequence of a stroke. A blood clot, like hemorrhages, can lead to a disruption of blood supply by blocking blood vessels in the area of ​​the brain responsible for movement or pathways. Infantile paralysis usually occurs as a result of birth injuries or as a result of inherited spastic paraplegia.

Pathogenesis

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

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

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

There are no internal causes for paralysis of a psychogenic nature, so it disguises itself as any of the types, manifests general signs central and peripheral paralysis or any combination of them.

Central paralysis may combine symptoms of peripheral paralysis, or may exhibit exclusively pure symptoms; it is often accompanied by disturbances in vascular tone, sensitivity, and digestion. A common manifestation of peripheral paralysis is sensory disturbances.

In a body with paralysis, motor function often suffers entirely and does not selectively affect muscles. Paralyzed muscle tissue are in permanent tension and do not atrophy (this is possible solely due to complete inactivity). In immobilized limbs, deep tendon reflexes are maintained or exacerbated, and clonus (fast convulsive contractions) are often detected. On the side affected by paralysis, abdominal reflexes weaken or disappear completely.

Symptoms of central paralysis

We list the first signs of central paralysis:

• muscle hypertonicity;
• expanding the scope of reflective reactions;
• increased reflective reactions;
• rapid convulsive contractions of the muscles of the knees or feet (clonus).

With hypertonicity, the muscles are too dense. High muscle resistance is noted. High degree muscle tension is fraught with the appearance of contractures. Therefore, movements are limited partially or entirely. Contracture is characterized by an unnatural frozen position of the limb.

The most noticeable visible signs of paralysis are provoked by an expansion of the area of ​​​​action of reflex reactions. Convulsive rhythmic contractions of the muscles of the knees or feet appear due to stretching of the tendons. Typically, such contractions appear due to the intensification of tendon reflex reactions. The contraction of the feet is the result of accelerated dorsiflexion. Reflexive twitching of the leg is a response to such an impact. Clonus kneecap noticeable during rapid abduction of the limb. Pathological reflexes in the feet or hands are a visible symptom of pyramidal tract pathology. The most typical are the reflex reactions of Oppenheim, Rossolimo, Zhukovsky, Babinsky Gordon and Schaeffer.

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

Sykinensia is another symptom of paralysis. Synchronizations are reflexive simultaneous movements in the affected limb with conscious active movements. Like, say, waving your arms while walking, flexion - extension of the limbs simultaneously with directed movements on the half of the body that is not subject to paralysis. There are many types of synkinesia that indicate the development of paralysis.

Muscle spasms due to hypertonicity are often distributed unequally. More often, the left or right part of the body as a whole is affected; the arm is usually pressed down, the hand and fingers are twisted, the leg is straightened, and the foot is bent and turned inward.

With central paralysis, reflex reactions in the tendons are more pronounced, and abdominal, muscular and plantar reactions disappear completely or become noticeably weakened.

The most obvious symptoms central paralysis:

• Unnatural body position;
• Weakened or increased mobility;
• Weakening of facial muscles;
• Articulation and speech disorders;
• Convulsive contractions and trembling of muscles;
• Unnatural gait;
• Accidental opening of the mouth;
• Closing the eyes;
• Undirected shoulder movements;
• Random flexion and extension of the joints of the arms or legs;
• Muscular hypertonicity.

Symptoms accompanying central paralysis, help to accurately separate it from other types of motor dysfunction and even identify the area of ​​the pyramidal tract susceptible to pathological processes.

Central facial paralysis occurs due to disturbances in cortical processes or pathology 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 contract randomly due to the connection of the nerve with the extrapyramidal system. It looks like a tic or spasm. This type of paralysis may be accompanied by epileptic seizures.

The development of central paralysis of the limbs occurs due to pathological changes descending system of nerve fibers. A noticeable manifestation of pathology is reflex reactions in the tendons, muscle hypertonicity, and manifestations of pathological reflex reactions. Such symptoms may appear in conjunction with other signs of organic paralysis.

With paralysis of functional etiology, the reflex reactions of the tendons do not undergo changes and normal muscle tone is maintained.

Central spastic paralysis indicates that the area of ​​the brain in the hemisphere opposite to the affected limb is damaged.

Combined pathologies of the limbs are characteristic of disorders in the brain stem.

Cross paralysis refers to disturbances at the junction of the medulla oblongata and the spinal cord.

When the limbs are paralyzed only on the left or right, and the nerves of the skull have not been injured, this indicates a failure of the descending system of the nervous tissues of the cervical region.

Central paralysis of the legs means pathology or along the path of the lateral cord spinal cord, in the convolutions of the brain, the corona radiata.

Infantile central palsy

Infantile central paralysis unites a whole group of diseases characterized by damage to the central nervous system, motor dysfunction, slow development of the psyche. Infantile central palsy does not develop. This may indicate perinatal paralysis of the central nervous system or brain damage during childbirth, when lack of oxygen, birth trauma, or stroke causes the development of encephalopathy. Paralysis is often associated with impaired oxygen supply to brain cells. Complications of hypoxia are insufficient development of areas of the brain responsible for balance, coordination and ensuring the functioning of reflexes. This is why asymmetric muscle tone develops and pathological motor reactions appear.

Diagnosis of central paralysis

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

Differential diagnosis

Differential diagnosis includes assessment of the volume and severity of paralysis. A map of the affected muscle can indicate the area pathological processes CNS.

In case of paralysis of the limbs, it is necessary to assess its volume: immobility of four limbs means damage to the spinal cord in the area in the neck; paralysis of the limbs on one side is characteristic of the pathology of the internal capsule; paralysis of the legs - for spinal cord disorders in the chest or lower back; The cause of paralysis of one limb lies in peripheral nerve disorders.

It can paralyze other muscles. For example, dysfunction eye muscles- this is a pathology of the cranial nerves; immobility of facial muscles - pathology of the facial nerve or central motor neuron opposite hemisphere; laxity of the sternocleidomastoid and trapezius muscles means disturbances in the accessory nerve; lethargy of the tongue muscles - the hypoglossal nerve is damaged.

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

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

Treatment of central paralysis

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

In parallel with the prevention of contractures, they are treated with medications. The therapy intensifies metabolism in the nerves, circulation in small vessels, and improves nerve and synaptic conduction.

Conservative treatment brings results when the morphological substrate has survived, allowing muscle function to be regenerated. If it remains possible to resume muscle function, the goal is conservative treatment- avoidance of contractures and deformities and accelerated resumption of muscle function.

Physiotherapeutic treatment, balneotherapy, physical therapy, reflexology.

Physiotherapy for central paralysis is prescribed after some time. The timing of physical therapy depends on the factors causing the paralysis: inflammation, injury or stroke.

Electrophoresis of medications helps restore blood circulation to the affected area of ​​the brain. For inflammation, UHF and microwave treatment is used. Electrical stimulation in the area of ​​the immobilized limb is carried out at the motor points of the antagonist muscles. This helps relieve hypertonicity and reduce the reflex response of paralyzed muscles. Electrical stimulation is combined with taking muscle relaxing drugs and acupuncture. To reduce the risk of contractures, therapy is carried out with warm ozokerite or paraffin. Positive dynamics are possible when using cold, especially with spastic infantile central palsy.

Physical rehabilitation for central paralysis begins with massage, and after a week or a week and a half, physical therapy begins.

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

When the patient can already sit independently, the next stage of therapeutic exercises is learning to walk. First, the methodologist helps, and then the patient tries to move independently, using crutches and sticks. Then they begin to master more subtle movements: buttoning clothes, lacing shoes, controlling equipment using a remote control or keyboard.

Drug treatment for paralysis

The main drugs are benzodiazepines, baclofen, dantrolene. How these medications work has not been reliably established. Medicines are prescribed if disturbances in normal muscle activity occur every day. Medication therapy will give excellent results if you use two or more medications and combine them with other methods of therapy.

• Baclofen has an inhibitory effect, affecting gamma-aminobutyric acid receptors that are not susceptible to bicuculline. The dose is prescribed individually in each case in order to identify the minimum effective dosage that is not associated with side effects. Results are usually obtained with dosages ranging from 30 to 75 mg daily.

For the first 3 days, half a tablet is prescribed 3 times a day (if the dosage of the tablet is 10 mg); 4-6 days – a whole tablet; Days 7–9, 1.5 tablets 3 times a day; Days 10–12 - 2 tablets. A gradual increase in dosage ensures good tolerability of the drug. Abruptly stopping taking baclofen is fraught with hallucinations and exacerbation of signs of paralysis.

• Benzodiazepines enhance the postsynaptic effects of GABA by promoting presynaptic inhibition. Medicines also affect processes in the brain stem. The drug diazepam is very often used. Dosage – within 2–8 mg 2 times a day. The course of diazepam includes complete restriction alcohol. Among adverse reactions– disorders of the liver, disorders in the composition of the blood. Extreme care should be taken when administering diazepam and when discontinuing it for patients taking blood thinning medications.

Diazepam can cause drowsiness, dizziness, slow down the reaction, provoke allergies, nausea, and vomiting.

• Dantrolene inhibits the release of calcium in the muscles by dividing electromechanical coordination. That is, it reduces tone, increasing muscle weakness. For hypertonicity, the drug gives noticeable results, but it is usually prescribed to patients with plegia. For administration, it is prescribed in a dosage of 4-8 mg per day in 3 or 4 doses. Dantrolene is excreted through metabolism in the liver and is therefore limited for use in patients with unhealthy livers. Special care is also needed when prescribing dantrolene to people with problems with the lungs or heart.
• Sirdalud acts on the polysynaptic pathways of the spinal cord, reducing the production of excitatory signals to alpha motor neurons. The drug's effectiveness on muscle hypertonicity is similar to baclofen, but sirdalud has better tolerability. Sirdalud is prescribed to adults, starting with a dosage of 1 to 2 mg per day (in 2-3 doses) with a gradual increase in dosage to 12-14 mg, distributed over 3 or 4 doses. May cause a reaction in the form of weakness, dry mouth, and sleep disturbances.

Anticholinesterase drugs are also used to treat central palsy. Anticholinesterase drugs quickly enter the central nervous system, intensifies the transmission of signals to the muscles from the nerves and weakens the signs of central nervous system dysfunction.

Surgical treatment of paralysis

Before the operation, the functional capabilities of the muscles are identified, measures are taken to strengthen them, and measures to eliminate contractures that have arisen. After the operation, measures are developed to promote the growth and strengthening of the function of the implanted muscles, and then training of movements that are difficult in terms of coordination. Surgical intervention more often carried out with flaccid paralysis or cerebral palsy, when conservative therapy didn't improve the situation.

Surgery is advisable for neurogenic deformity, when the muscles of the limb are partially affected, changes in the mechanical axis, shape, and size are noticeable, for example, with complete paralysis of the muscular portion of the limb. Then surgical treatment– This is the preparatory stage before subsequent prosthetics.

Surgery for cerebral palsy seeks to remove deformation of the limb, distorting statics. Such intervention is advisable when conservative treatment methods have failed. It is also effective if areas with fixed deformation are found, which are caused by disorders of the tendon-muscular system and ligaments of the system. Sometimes operations are aimed at eliminating reflective contractures.

Operations are divided into three different types:

• operations on tendons and muscles;
• ligament surgeries;
• operations on bones and joints.

It happens that operations combine elements of all types.

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

Folk recipes

Traditional medicine advises patients to drink the juice of fresh celery, nettle or plantain.

If the cause of paralysis lies in pathologies of the blood circulation of the brain, feijoa will help. A noticeable improvement comes from taking the juice and the fruits themselves.

For paralysis, drink a tincture of cleft wolfberry. For 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. The ointment with the tincture is rubbed externally. To prepare, pour 20 ml of tincture into 50 g of heated lanolin, and, without stopping stirring, gradually pour in 50 g of Vaseline. The ointment is applied along the entire path of the nerve, and the treated area is wrapped in woolen cloth.

Baths can also help recovery from paralysis. To prepare a bath with a decoction of rosehip roots, take 4-6 teaspoons of crushed roots, add a liter of boiling water, and boil for 20-30 minutes. Then the broth is poured into the bath. For a bathroom, the water temperature should be moderate - 38 degrees is enough. You can also prepare a juniper decoction for the bath: 4 - 6 teaspoons of juniper branches or fruits, pour a liter of water, boil for 20-30 minutes. For baths, one plant is used up to 10 times, and then it must be replaced with some other one.

Brew 1 teaspoon of roots with a liter of boiling water, and after an hour strain through a sieve or cheesecloth. Take an infusion of peony roots, 1 tablespoon 3 times before meals. The roots infused with alcohol are drunk in a dosage of 30-40 drops 3 times a day.

• A decoction of sumac leaves.

1 tbsp. A spoonful of tinting sumac or tanning sumac is brewed in 0.5 liters of boiling water and left for an hour. Take 1 tablespoon of decoction 3-4 times a day.

• Tincture of pine cones

10-15 ripe pine cones are prepared for the tincture. The cones are filled with vodka (0.5-0.6 liters) and infused for a month. Drink 1 teaspoon of tincture 3 times a day.

Homeopathy

It is optimal to combine homeopathic medicines with classical medicine. Homeopathy does not replace primary treatment, but can complement a set of measures that stimulate the body to recover.

• The homeopathic drug Konium relieves seizures. Its basis is an extract from spotted hemlock, an extremely poisonous plant. Conium is indicated for paralysis accompanied by paresthesia, and the patient feels weak, suffers from insomnia, and often freezes. Dissolve 8 granules 5 times a day. Conium is taken for up to 2 months.
• Fibiaron – complex drug. Acts as a prevention of paralysis, in addition, it is indicated for treatment. Belladonna, white mistletoe, and ambergris in Fibiaron harmonize the excitation-inhibition mechanism and protect the central nervous system. Dosage - 5-7 granules 3 to 5 times a day. Fibirion is taken for 6 to 8 months.
• Barium aceticum is available in granules and drops. Prescribed for paralysis rising from the limb to the center. The drug is prescribed for absent-mindedness, hesitation before making decisions, a feeling of “pins and needles”, a feeling of cobwebs on the face, tingling and pain spreading along the left leg. Barium aceticum acts almost like Barita acetica.
• Bothrops is made from the venom of a spearhead snake and is produced in the form of granules or drops. Bothrops is prescribed for paralysis with signs of speech impairment, signs of paralysis right side bodies.
• CAUSTICUM (Caustic) is effective for paralysis caused by lead intoxication.

Rehabilitation after central paralysis may take months or perhaps years, the most important thing is to follow the recommendations, regularly practice independently, and try to expand motor functions, gradually move to sports loads: exercises in the pool, jogging, jumping.

Central paralysis occurs as a result of damage to the central motor neuron in any part of it. Since the arrangement of cells and fibers of the pyramidal bundles is quite close, central paralysis is usually diffuse, spreading to an entire limb or half of the body. Peripheral paralysis may be limited to damage to certain muscle groups or even individual muscles. There may, however, be exceptions to this rule. Thus, a small lesion in the cerebral cortex can cause the occurrence of isolated central paralysis of the foot, face, etc.; conversely, multiple diffuse lesions of the nerves or anterior horns of the spinal cord sometimes cause widespread paralysis of the peripheral type.

Minor diffuse muscle atrophy can sometimes be observed with central paralysis, but it never reaches such a significant degree as with peripheral paralysis, and is not accompanied by the degeneration reaction typical of the latter. This atrophy may result from lack of muscle activity, but sometimes it develops early after the lesion; in this case, it can be explained as a trophic disorder resulting from damage to the cortex (according to some data, more often than the parietal lobe). In cases of acute central paralysis (trauma, hemorrhage), muscle hypotonia and loss of reflexes are initially possible. At I.P. Pavlov, we find an indication that with thrombosis and hemorrhages in the cerebral hemispheres, accompanied by paralysis, and not “catalepsy” (i.e., not hypertension. - Author), there is even an absence of spinal reflexes.

The main features of central paralysis are muscle hypertonia, increased tendon reflexes, so-called accompanying movements, or synkinesis, and pathological reflexes.

Hypertension, or muscle spasticity, determines another name for central paralysis - spastic. The muscles are tense, dense to the touch; During passive movements, a clear resistance is felt, which is sometimes difficult to overcome. This spasticity is the result of increased reflex tone and is usually unevenly distributed, leading to typical contractures. With central paralysis, the upper limb is usually brought to the body and bent at the elbow joint: the hand and fingers are also in a flexed position. The lower limb is extended at the hip and knee joints, the foot is bent and the sole is turned inward (the leg is straightened and “elongated”). The gait in these cases is of a “circumducing” nature: due to the “lengthening” of the leg, the patient has to “circle” the affected leg (in order not to touch the floor with the toe).

Increased tendon reflexes (hyperreflexia) are also a manifestation of increased, disinhibited, automatic activity of the spinal cord. Reflexes from the tendons and periosteum are extremely intense and are easily evoked as a result of even minor irritations: the reflexogenic zone expands significantly, i.e. the reflex can be evoked not only from the optimal area, but also from neighboring areas. An extreme degree of increase in reflexes leads to the appearance of clonus (see above).

In contrast to tendon reflexes, skin reflexes (abdominal, plantar, cremasteric) do not increase with central paralysis, but disappear or decrease.

Concomitant movements, or synkinesis, observed with central paralysis, can occur in the affected limbs reflexively, in particular when healthy muscles are tense. Their occurrence is based on the tendency to irradiate excitation in the spinal cord to a number of neighboring segments of its own and opposite sides, which is normally moderated and limited by cortical influences. When the segmental apparatus is disinhibited, this tendency to spread excitation is revealed with particular force and causes the appearance of “additional” reflex contractions in the paralyzed muscles.

There are a number of synkinesis characteristic of central paralysis. Here are some of them:

• 1) if the patient, according to the instructions, resists with his healthy hand the extension in the elbow joint produced by the examiner, or strongly shakes his hand with his healthy hand, then a concomitant reflex flexion occurs in the paralyzed arm;
• 2) the same flexion of the affected arm occurs when coughing, sneezing, or yawning;
• 3) under the mentioned conditions, involuntary extension is observed in the paralyzed leg (if the patient is sitting with his legs hanging over the edge of the couch or table);
• 4) the patient lying on his back with his legs extended is asked to adduct and abduct his healthy leg, in which he is resisted. In this case, an involuntary corresponding adduction or abduction is observed in the paralyzed leg;
• 5) the most constant of the accompanying movements with central paralysis is the symptom of combined flexion of the hip and trunk. When the patient tries to move from a horizontal position to a sitting position (the patient lies on his back with his arms crossed on his chest and straightened legs apart), the paralyzed or paretic leg is raised (sometimes adducted).

Pathological reflexes are a group of very important and constant symptoms of central paralysis. Of particular importance are pathological reflexes on the foot, which are observed, of course, in cases where the affected area is lower limb. The most sensitive symptoms are Babinski (perverted plantar reflex), Rossolimo and Bekhterev. The remaining pathological reflexes on the foot (see above) are less constant. Pathological reflexes in the hands are usually weakly expressed and of great importance were not acquired in clinical trial practice. Pathological reflexes on the face (mainly a group of “oral” reflexes) are characteristic of central paralysis or paresis of muscles innervated by cranial nerves, and indicate bilateral supranuclear lesions of the tractus cortico-bulbaris in the cortical, subcortical or brainstem regions.

The methodology for studying movements consists of

• 1) studying the general appearance, facial expressions, speech, posture and gait of the patient,
• 2) determining the volume and strength of active movements,
• 3) studies of passive movements and muscle tone,
• 4) studies of movement coordination
• 5) checking the electrical excitability of nerves and muscles

Just one external examination of the patient can reveal a lot of significant information and direct the investigator’s attention to one or another defect in the state of muscles and motor function.

Thus, muscle atrophy and limb contractures can be immediately detected. Sometimes the patient’s posture, low or, conversely, excessive mobility attracts attention. In a conversation with a patient, paresis of facial muscles, speech disorders, and phonation disorders may be noticed. Trembling, convulsive twitching, etc. are noticeable. Be sure to examine the patient's gait, which may be disordered. In particular, with hemiparesis of the central type, a “hemiplegic, circumducing” gait, Wernicke-Mann posture, is noted, as mentioned above. With spastic lower paraparesis, a “spastic” or “spastic-paretic” gait is observed, when the patient walks with straightened legs, without lifting the soles from the floor; When you move your legs, the tension in them is noticeable. With flaccid paraparesis, the feet usually hang down, and the patient, in order not to touch the floor with his toe, is forced to raise his leg high (the so-called “cock” or peroneal gait).

Active movements are examined in order from top to bottom; usually the volume of only some basic movements is determined.

On the face, the wrinkling of the forehead upward, the closing of the eyelids, and movements eyeballs, opening the mouth and pulling the corners of the mouth outward, sticking out the tongue.

The volume of head rotation to the sides is determined. The subject is asked to make a shoulder-raising movement (“shrug”). The arms are raised to the horizontal and higher; flexion and extension in the elbow, wrist and finger joints; pronation and supination of the hands; bringing and spreading fingers; to determine mild degree paresis and disorders of fine movements, it is advisable to ask the subject to make quick flexion and extension movements with his fingers, moving them in the air with his arms extended forward.

Flexion and extension are performed in the joints of the hip, knee, ankle, and toes, walking on the heels and on the toes.

In necessary cases, it is necessary to check more subtle and isolated movements relating to individual muscles during the study.

The presence of a full range of active movements does not always exclude the possibility of mild paresis, which in such cases may be limited by a weakening of muscle strength. Therefore, the study of the range of active movements of the limbs is usually accompanied by a simultaneous study of muscle strength, for which the subject provides a certain counteraction to the movement being performed. The grip force of the hand is determined, which can be measured with a dynamometer.

Passive movements, of course, will not be limited if there is a full range of active movements. Their study is necessary when establishing the absence or limitation of active movements in a particular muscle group. It may turn out that movements are limited not because of paresis, but because of damage to the joints, due to pain, etc. The study of passive movements is also carried out to determine muscle tone.

Tone is determined primarily by feeling the muscle at rest. With atony or hypotension, the muscles feel flabby and sluggish; with hypertension - dense, tense. With passive movements in the case of atony, excursions in the joints are completely free, even excessive; joints are “loose.” As tone increases, passive movements encounter significant resistance, to overcome which a certain amount of tension is necessary. With spasticity of the muscles that accompanies central paralysis, a phenomenon is observed that is called the “jackknife symptom”: if we make a fast passive movement, then the resistance provided by the rigid muscles is not the same throughout the entire movement; it is especially felt at the beginning and decreases later.

Coordination of movements is impaired as a result of damage to the cerebellar system and the loss of the “sense of position and movement” (articular-muscular sense).

central paralysis muscle atrophy

Central paralysis is a pathology in which there is a lack of muscle strength in a separate part of the body. The disease predominantly affects the upper and lower extremities.

With central (spastic) paralysis, muscle hypertension occurs. The peculiarity of the disease is that there is an increase in tendon reflexes and muscle tone.

In addition, there is involuntary motor activity. Whenever characteristic symptoms disease, you will need to contact a medical specialist for diagnosis.

A treatment regimen is individually selected for each patient, thanks to which it will be possible to maintain and improve the condition of the body.

In healthy people, when irritants are applied to the skin, impulses are transmitted through the spinal cord to the cranial cavity. The process involves nerve fibers through which signals are sent.

With central paralysis, certain muscle groups are toned all the time. Reflexes do not pass through the tendons, and even the pain impulse does not enter the brain. A person has muscle spasm and uncontrolled movements.

Central paralysis prevents a person from assuming certain postures. If the face is affected, then the patient notes a deterioration in his emotional state. A temporary decrease in muscle tone is achieved through special massage, therapeutic exercises and warming up the problem area.

Over time, sick people learn to independently determine the nature of impulses that have external and internal type. Patients may feel discomfort and pain, depending on the degree of spasticity. Those citizens who have a moderate level of spasticity have the opportunity to move with slow steps or independently change their body position.

When central paralysis occurs, a person often has problems with coordination and difficulty eating. Respiratory and digestive system. Tactile sensitivity can become dull or worsen. Might fall visual function. Ballroom people demand special care, they must be handled with care. Any change in body posture causes significant problems.

Main reasons

With central paralysis, a person loses the ability to control certain parts of the body. The causes are related to damage to the nervous system. Basically, pathology develops in disorders that arise in the motor centers.

Various provoking factors can lead to such a condition. Among them are dangerous diseases that a person has. In such a situation, you will need to identify them and, if possible, eliminate them.

Reasons:

• Heredity. If close relatives have had central palsy, then the person will be significantly more likely to experience the disease. In most cases, the first signs of damage can be observed within 1 year of the child’s life.

• Infections. They can affect the spinal cord and brain. Because of this, they are observed various disorders in the motor center. It is important to treat all infections in a timely manner so that you do not have to deal with their complications.
• Developmental defects. In this situation, paralysis is diagnosed at an early age.
• Poor nutrition. Directly if you overuse fatty foods, a person may experience central paralysis.
• Metabolic disorders. Because of them, brain function significantly deteriorates.
• Malignant neoplasms in the brain. They compress the organ and lead to disruption of its functions. In particular, due to tumors, motor activity may deteriorate.

• Severe intoxication. In case of poisoning toxic substances and medications, a person may experience central paralysis.
• Congenital pathologies. In some children, even during intrauterine development, the central nervous system is formed incorrectly. This can happen due to hypoxia, infectious diseases, difficult childbirth. In such a situation, a child is born with central paralysis.

Central paralysis often occurs due to dysfunction of the circulatory system. Vascular stenosis, hemorrhage or blood clot formation leads to the destruction of neural connections.

The disease often acts as a complication after suffering an ischemic or hemorrhagic type. When diagnosing, a medical specialist must determine the root cause of the disease. In this case it will be easier to choose correct scheme treatment and improve the patient's condition.

Symptoms

Central paralysis has characteristic manifestations, by which pathology can be recognized. If several signs appear, you should visit a doctor. A medical specialist will be able to make an accurate diagnosis and determine the form of the disease.

Symptoms:

• Mobility abnormalities: Mobility may be decreased or increased.
• Speech disorders. A person may have difficulty pronouncing words and may completely lose the ability to speak.
• Muscle paresis. In this case, muscle strength and reflexes are significantly weakened, although they are preserved to some extent.
• Change in gait. It becomes much more difficult for a person to move. He may stop walking altogether.
• Muscle hardening. This condition occurs due to muscle hypertonicity.
• . The patient often experiences trembling of the limbs.
• Convulsive states. They can be temporary or permanent.
• Uncontrolled movement of limbs. A person can bend or straighten his arms and shrug his shoulders.
• Unnatural position of arms and legs. With central paralysis, it is impossible to keep the limbs in a relaxed and natural state.
• Uncontrolled downward abduction of the lower jaw.

It is important to take into account that symptoms depend on the affected area. With facial nerve paralysis, the pathology will affect the facial muscles. The person will experience distortion of facial expressions and unnatural muscle contraction. Speech function may deteriorate significantly due to the disease.

If characteristic symptoms occur, it is not allowed to make a diagnosis on your own. Negative manifestations may indicate other diseases, for example, synkinesis, hyperreflexia, clonus and other pathologies. Only a doctor, after conducting examinations, will be able to clearly say what we are dealing with.

If left untreated, further impairment of brain function will occur. New tissue will be affected and cannot be restored. For this reason, if you notice signs of central paralysis, it is important to go to the hospital immediately. In this situation, it will be possible to improve the condition of the body and prevent further spread of paralysis.

Diagnostics

If paralysis is suspected, a differentiated diagnostic method is used. With it, the disease is determined by excluding other pathologies that do not relate to humans. Ultimately, one disease remains, which is the cause of spastic paralysis.

Diagnostics consists of three stages:

• First, the doctor finds out what diseases the patient has suffered. Some of them could cause complications in the form of impaired motor function.
• In the second stage, a medical specialist will examine the patient and find out the symptoms. It will be possible to roughly understand what you have to deal with.
• At the third stage you will need to study everything laboratory tests, on the basis of which the conclusion is made. Neuroimaging is used, for this purpose it is used CT And MRI. The person is also sent for x-rays of the bones of the skull and spine. A cerebrospinal fluid tap may need to be performed. Based on the research results, it will be possible to generally judge the state of the body. If a person has any pathologies that provoked central paralysis, they will be identified.

If after diagnosis the disease is confirmed, the doctor will prescribe complex treatment. You will need to simultaneously combat the symptoms of paralysis, improve the functioning of the central nervous system and eliminate the root cause. In this situation, it will be possible to achieve good results in treatment.

The prognosis depends on the degree of damage to the body, the person’s age and concomitant diseases. For this reason, it is impossible to say unambiguously how successful the chosen treatment regimen will be.

Treatment methods

Therapy is carried out exclusively under the supervision of a medical specialist. During treatment it is necessary to remove painful sensations and spasms, reduce muscle spasticity. IN mandatory therapy is aimed at improving the patient’s quality of life, as well as developing his abilities to perform everyday tasks. Doctors will need to make it easier for the citizen to perform controlled movements. The desired result achieved thanks to comprehensive measures, which are prescribed individually for the patient.

Drug treatment consists of at least two drugs. Drugs such as Baclofen, Dantrolene or Gabaleptin are often used. A group of benzodiazepines is also used good result provides Botox. The last remedy is injected into the damaged muscles, after which they relax. The pain disappears and the patient may feel relief. One injection will last up to 16 weeks on average.

Surgical treatment may be required, in such a situation in cerebrospinal fluid Baclofen is administered. The ampoule is implanted into the skin of the abdomen.

Additionally, the person will need physical therapy; specific procedures are prescribed depending on the patient’s condition. They give good results with regular use. Doctors recommend that people with central palsy perform therapeutic exercises; specific options are selected depending on the patient's condition. Muscle condition can be improved with massage and water procedures. Homeopathy may be prescribed as a supplement.

Exceptionally comprehensive measures can achieve good results. It is important to strictly follow the doctor’s recommendations, otherwise the desired effect will not be achieved. The rehabilitation process is long and difficult, because how to restore motor activity not easy. The rate of improvement is influenced by how advanced the disease is. If a person for a long time is not treated, then muscle tissue atrophy will occur.

With timely treatment there is a chance of full recovery. brain activity and return the person to full life. Naturally, we are talking about mild forms of central paralysis. IN difficult situations The main goal of therapy is to reduce the symptoms of the pathology and teach a person to live with movement disorders. A citizen will need to do therapeutic exercises throughout his life and, if necessary, take medications. To monitor the condition, you need to be observed by a doctor to prevent the progression of central paralysis.

Central paralysis occurs when the central nutrient neuron is damaged in any part of it (motor cortex cerebral hemispheres, brain stem, spinal cord). A break in the pyramidal tract removes the influence of the cerebral cortex on the segmental reflex apparatus of the spinal cord; his own apparatus is disinhibited.

In this regard, all the main signs of central paralysis are in one way or another associated with increased excitability of the peripheral segmental apparatus. The main signs of central paralysis are muscle hypertension, hyperreflexia, expansion of the zone of evoking reflexes, clonus of the feet and kneecaps, pathological reflexes, protective reflexes and pathological synkinesis. The difference between central and peripheral paralysis is characterized by the data presented in table. 1 (see p. 170).

With muscular hypertension, the muscles are tense and dense to the touch; Their resistance during passive movement is felt more at the beginning of the movement. Severe muscle hypertension leads to the development of contractures - a sharp limitation of active and passive movements in the joints, and therefore the limbs can “freeze” in an incorrect position. Hyperreflexia is accompanied by an expansion of the zone of evocation of reflexes. Clonus of the feet, kneecaps and hands are rhythmic muscle contractions in response to stretching of the tendons. They are a consequence of a sharp increase in tendon reflexes. Foot clonus is caused by rapid dorsiflexion of the feet. In response to this, rhythmic twitching of the feet occurs. Sometimes foot clonus is also noted when inducing a reflex from the heel tendon. Patella clonus is caused by sudden downward abduction of the kneecap.

Pathological reflexes appear when the pyramidal tract is damaged at any of its levels. There are hand and foot reflexes. Pathological reflexes on the foot are of greatest diagnostic importance: reflexes of Babinsky, Oppenheim, Gordon, Schaeffer, Rossolimo, Zhukovsky.

When studying reflexes, it should be taken into account that in a newborn and children early age These reflexes are normally detected.

The Babinski reflex is caused by line irritation of the foot closer to its outer edge. In this case, a fan-shaped spread of the fingers and extension occurs thumb(perverted plantar reflex) (see Fig. 42). A distinct extension of the thumb and a fan-shaped spread of all other fingers occurs when the hand is vigorously drawn from top to bottom along the inner edge of the tibia (Oppenheim reflex) (Fig. 59), pressing calf muscle(Gordon reflex) (Fig. 60), compression of the Achilles tendon (Schaeffer reflex) (Fig. 61). Listed pathological symptoms are an extensor group of pathological reflexes.

There are also flexion reflexes. When the flesh of the tips of the toes is abruptly struck, they bend (Rossolimo reflex) (Fig. 62). The same effect is observed when hitting a hammer with a hammer. back surface foot in the area of ​​the base of the II-IV fingers (Bechterev reflex) (Fig.

63) or in the middle of the sole at the base of the fingers (Zhukovsky reflex) (Fig. 64).

Protective reflexes occur in response to pain or temperature stimulation of a paralyzed limb. At the same time, she involuntarily withdraws.

Synkinesis - involuntary friendly movements that occur, accompanied by active movements (for example, waving your arms while walking). With central paralysis, pathological synkinesis is observed. So, when the muscles of a healthy limb on the paralyzed side are tense, the arm is bent at the elbow and brought to the body, and the leg is extended.

Rice. 63. Study of the ankylosing spondylitis reflex

Rice. 64. Study of the Zhukovsky reflex

Rice. 59. Study of the Oppenheim reflex

Rice. 60. Gordon's reflex study

Rice. 61. Study of the Schaeffer reflex

Rice. 62. Study of the Rossolimo reflex

Lesion of the pyramidal tract in the lateral column of the spinal cord causes central paralysis of the muscles below the level of the lesion. If the lesion is localized in the area of ​​the upper cervical segments of the spinal cord, then central hemiplegia develops, and if in thoracic region spinal cord, then central leg plegia.

Damage to the pyramidal tract in the area brain stem leads to central hemiplegia on the opposite side. At the same time, the nuclei or roots may be affected cranial nerves. In this case, cross syndromes may occur: central hemiplegia on the opposite side and peripheral paralysis of the muscles of the tongue, face, and eyeball on the affected side (Fig. 65). Cross syndromes make it possible to accurately determine the location of the lesion. Lesion of the pyramidal tract in the internal capsule is characterized by central hemiplegia on the opposite side with central paralysis of the muscles of the tongue and face on the same side (Fig. 66, 67). Damage to the anterior central gyrus most often leads to monoplegia on the opposite side.

Rice. 67. Characteristic pose patient with capsular paralysis (Wernicke-Mann position)

Central paralysis of the facial muscles differs from the peripheral paralysis observed with neuritis of the facial nerve or with the Miyaoa-Gublep cross syndrome in that only the muscles of the lower half of the face are affected. The patient cannot extend his lips forward and grin his teeth on the affected side. His nasolabial fold is smoothed and the corner of his mouth is lowered. However, the forehead muscles remain intact, and the palpebral fissure closes completely. There is no lacrimation, hyperacusis or taste disorder.

With central paralysis of the tongue muscles, tongue atrophy does not develop.

Central paralysis occurs as a result of damage to the central motor neuron in any part of it. Since the arrangement of cells and fibers of the pyramidal bundles is quite close, central paralysis is usually diffuse, spreading to an entire limb or half of the body. Peripheral paralysis may be limited to damage to certain muscle groups or even individual muscles. There may, however, be exceptions to this rule. Thus, a small lesion in the cerebral cortex can cause the occurrence of isolated central paralysis of the foot, face, etc.; conversely, multiple diffuse lesions of the nerves or anterior horns of the spinal cord sometimes cause widespread paralysis of the peripheral type.

As mentioned above, the symptomatology of central paralysis differs sharply from that of peripheral paralysis: pronounced muscle atrophy is not characteristic here and there is no degeneration reaction, neither muscle atony nor loss of reflexes is observed.

Minor diffuse muscle atrophy can sometimes be observed with central paralysis, but it never reaches such a significant degree as with peripheral paralysis, and is not accompanied by the degeneration reaction typical of the latter. This atrophy may result from lack of muscle activity, but sometimes it develops early after the lesion; in this case, it can be explained as a trophic disorder resulting from damage to the cortex (according to some data, more often than the parietal lobe). In cases of acute central paralysis (trauma, hemorrhage), muscle hypotonia and loss of reflexes are initially possible. At I.P. Pavlov we find an indication that with thrombosis and hemorrhages in the cerebral hemispheres, accompanied by paralysis, and not “catalepsy” (i.e., not hypertension. - Auth.), There is even an absence of spinal reflexes.

“It is clear that the retarding (inhibitory) effect of the destruction that has occurred has descended even on the spinal cord...” This phase is usually short-lived and in most cases is soon replaced by a typical picture of central paralysis (with muscle hypertonia and increased reflexes).

The absence of disorders characteristic of flaccid paralysis is understandable, since the peripheral motor neuron (and segmental reflex arc) remains intact in central paralysis; therefore, there are no symptoms depending on its defeat. The segmental apparatus of the spinal cord that remains intact not only retains its reflex activity, but also increases it, freed during central paralysis (damage to the pyramidal system) from the inhibitory (subordinate) influences of the cerebral cortex.

The main features of central paralysis are muscle hypertonia, increased tendon reflexes, so-called accompanying movements, or synkinesis, and pathological reflexes.

Hypertension, or muscle spasticity, defines another name for central paralysis - spastic. The muscles are tense, dense to the touch; During passive movements, a clear resistance is felt, which is sometimes difficult to overcome. This spasticity is the result of increased reflex tone and is usually unevenly distributed, leading to typical contractures. With central paralysis, the upper limb is usually brought to the body and bent at the elbow joint: the hand and fingers are also in a flexed position. The lower limb is extended at the hip and knee joints, the foot is bent and the sole is turned inward (the leg is straightened and “elongated”). This position of the limbs with central hemiplegia creates a peculiar Wernicke-Mann position, the interpretation of the patterns of its occurrence from the point of view of the history of the development of the nervous system was given by M.I. Astvatsaturov.

The gait in these cases is of a “circumducing” nature: due to the “lengthening” of the leg, the patient has to “circle” the affected leg (in order not to touch the floor with the toe).

Increased tendon reflexes(hyperreflexia) is also a manifestation of increased, disinhibited, automatic activity of the spinal cord. Reflexes from the tendons and periosteum are extremely intense and are easily caused by even minor irritations: the reflexogenic zone expands significantly, i.e. the reflex can be caused not only from the optimal area, but also from neighboring areas. An extreme degree of increase in reflexes leads to the appearance of clonus (see above).

In contrast to tendon reflexes, skin reflexes (abdominal, plantar, cremasteric) do not increase with central paralysis, but disappear or decrease.

Associated movements or synkinesis, observed with central paralysis, can occur in the affected limbs reflexively, in particular when healthy muscles are tense. Their occurrence is based on the tendency to irradiate excitation in the spinal cord to a number of neighboring segments of its own and opposite sides, which is normally moderated and limited by cortical influences. When the segmental apparatus is disinhibited, this tendency to spread excitation is revealed with particular force and causes the appearance of “additional” reflex contractions in the paralyzed muscles.

There are a number of synkinesis characteristic of central paralysis. Here are some of them:

1) if the patient, according to the instructions, resists with his healthy hand the extension in the elbow joint produced by the examiner, or strongly shakes his hand with his healthy hand, then a concomitant reflex flexion occurs in the paralyzed arm;

2) the same flexion of the affected arm occurs when coughing, sneezing, or yawning;

3) under the mentioned conditions, involuntary extension is observed in the paralyzed leg (if the patient is sitting with his legs hanging over the edge of the couch or table);

4) the patient lying on his back with his legs extended is asked to adduct and abduct his healthy leg, in which he is given resistance. In this case, an involuntary corresponding adduction or abduction is observed in the paralyzed leg;

5) the most constant of the accompanying movements with central paralysis is the symptom combined flexion of the hip and trunk. When the patient tries to move from a horizontal position to a sitting position (the patient lies on his back with his arms crossed on his chest and straightened legs apart), the paralyzed or paretic leg is raised (sometimes adducted).

Pathological reflexes are a group of very important and persistent symptoms of central paralysis. Of particular importance are pathological reflexes on the foot, which are observed, of course, in cases where the lower limb is affected. The most sensitive symptoms are Babinski (perverted plantar reflex), Rossolimo and Bekhterev. The remaining pathological reflexes on the foot (see above) are less constant. Pathological reflexes in the hands are usually weakly expressed and have not acquired much significance in the practice of clinical research. Pathological reflexes on the face (mainly a group of “oral” reflexes) are characteristic of central paralysis or paresis of muscles innervated by cranial nerves, and indicate bilateral supranuclear lesions of the tractus cortico-bulbaris in the cortical, subcortical or brainstem regions.

Symptoms such as increased tendon reflexes of the extremities, weakened abdominal reflexes and Babinski's sign are very subtle and early signs integrity violations pyramid system and can be observed when the lesion is not yet sufficient to cause paralysis or even paresis. Therefore, their diagnostic value is very great. E.L. Venderovich described a symptom of “ulnar motor defect,” indicating a very mild degree of pyramidal lesion: on the affected side, the patient’s resistance to forced abduction of the little finger as far as possible toward the fourth finger is weaker.

The table is given. 6 (according to M.I. Astvatsaturov) symptoms of peripheral and central paralysis.

The methodology for studying movements consists of 1) studying the general appearance, facial expressions, speech, posture and gait of the patient, 2) determining the volume and strength of active movements, 3) studying passive movements and muscle tone, 4) studying the coordination of movements and 5) checking the electrical excitability of nerves and muscles.

Already alone external inspection the patient can give a lot of significant information and direct the investigator’s attention to one or another defect in the state of muscles and motor function.

Table 6

Thus, muscle atrophy and limb contractures can be immediately detected. Sometimes the patient’s posture, low or, conversely, excessive mobility attracts attention. In a conversation with a patient, paresis of facial muscles, speech disorders, and phonation disorders may be noticed. Trembling, convulsive twitching, etc. are noticeable. Be sure to examine the patient's gait, which may be disordered. In particular, with hemiparesis of the central type, a “hemiplegic, circumducing” gait, Wernicke-Mann posture, is noted, as mentioned above. With spastic lower paraparesis, a “spastic” or “spastic-paretic” gait is observed, when the patient walks with straightened legs, without lifting the soles from the floor; When you move your legs, the tension in them is noticeable. With flaccid paraparesis, the feet usually hang down, and the patient, in order not to touch the floor with his toe, is forced to raise his leg high (the so-called “cock” or peroneal gait).

Active movements are examined in order from top to bottom; usually the volume of only some basic movements is determined.

On the face, we examine the wrinkling of the forehead upward, the closing of the eyelids, the movements of the eyeballs, the opening of the mouth and the pulling of the corners of the mouth outward, and the protrusion of the tongue.

The volume of head rotation to the sides is determined. The subject is asked to make a movement of raising the shoulders (“shrug” the shoulders). The arms are raised to the horizontal and higher; flexion and extension in the elbow, wrist and finger joints; pronation and supination of the hands; bringing and spreading fingers; For definition of mild degree of paresis and disorder of fine movements, it is advisable to ask the subject to make quick flexion and extension movements with his fingers, moving them in the air with his arms extended forward.

Flexion and extension are performed in the joints of the hip, knee, ankle, and toes, walking on the heels and on the toes.

In necessary cases, it is necessary to check more subtle and isolated movements relating to individual muscles during the study.

The presence of a full range of active movements does not always exclude the possibility of mild paresis, which in such cases may be limited by a weakening of muscle strength. Therefore, the study of the range of active movements of the limbs is usually accompanied by a simultaneous study of muscle strength, for which the subject provides a certain counteraction to the movement being performed. The grip force of the hand is determined, which can be measured with a dynamometer.

Passive movements It is clear that they will not be limited if there is a full range of active movements. Their study is necessary when establishing the absence or limitation of active movements in a particular muscle group. It may turn out that movements are limited not because of paresis, but because of damage to the joints, due to pain, etc. The study of passive movements is also carried out to determine muscle tone.

Tone determined primarily by palpation of the muscle at rest. With atony or hypotension, the muscles feel flabby and sluggish; with hypertension - dense, tense. With passive movements in the case of atony, excursions in the joints are completely free, even excessive; joints are “loose.” As tone increases, passive movements encounter significant resistance, to overcome which a certain amount of tension is required. With spasticity of the muscles that accompanies central paralysis, a phenomenon is observed that is called the “jackknife symptom”: if we make a fast passive movement, then the resistance provided by the rigid muscles is not the same throughout the entire movement; it is especially felt at the beginning and decreases later.

Coordination of movements is disrupted as a result of damage to the cerebellar system and the loss of the “sense of position and movement” (articular-muscular sense). The ataxic disorders that arise in this case will be discussed further.