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Paralysis

Paralysis is a neurological disorder which is associated with the impairment of voluntary functions of the muscles. The important cause for paralysis is metabolic disorders of the neuromuscular functionalities. The attack of paralysis in the body is categorized into various types such as paraplegia (lower body), hemiplegic (one side of the body) and quadriplegia which is localized only to the legs. The motor and sensory activities are impaired at respective regions where the onset of paralysis takes place.


Causes of paralysis

The onset of paralysis has many predisposing factors and medical conditions. Thorough understanding and evaluation of these conditions paves the way for comprehensive diagnosis and treatment.

Ischemic cerebral stroke: Stroke is one of the fatal causes for paralysis. It happens because of the lack of blood supply to the cerebral region. The neuromuscular junctions are subjected to damage because of oxygen deficiency and hence the nerve cells associated with the efferent and afferent functions are impaired.


Trauma: Injuries to the head and spinal cord result in blood vessel and neural cell damage. In some cases paralysis associated with trauma can be localized and affects one region of the body. This phenomenon depends upon the site of the head injury and the peripheral neuromuscular fibre associations.

Infections and other causes: Paralytic occurrences can happen in patients who have a history of meningitis and abscesses present in the brain because of bacterial infections. Other causes of paralysis include Guillian Barre syndrome, cerebral palsy and multiple sclerosis.


Diagnosis and treatment

The definitive diagnosis of paralysis depends upon the source of its onset and progression. Paralysis neuromuscular dysfunction for which many causes are possible. Pathologically, paralytic sites indicate appearances of tissue necrosis caused because of gangrene associated hypoxia and ischemia. Cellular pathology often indicates dead cells and tissue debris because of necrosis. Surgical intervention is recommended in order to remove the necrotic tissue present in the regions like central nervous system.

Diagnostic interventions to paralysis include radiological examinations of the necrotic sites, nerve conduction studies in order to understand the myogenic and neurogenic abnormalities along with sensory and motor functions of a respective region. If malignancies are suspected, fine needle aspiration, cytology and biopsy tests are recommended to understand cellular pathology.


Treat of paralysis is mostly therapeutic in origin. It is necessary to identify the cause of the paralytic disease and to treat it appropriately with antimicrobial drugs in case of infections. Physiotherapy is advised to facilitate motor and sensory functions.

Andersen Tawil Syndrome

Andersen Tawil syndrome or ATS is a rare disease characterized by three distinct features that include: periodic paralysis or episodes of muscle weakness, cardiac arrhythmia and distinct facial and skeletal features. However all the three features may not be present in a single patient. Most ATS cases are caused by a mutation in the KCNJ2 gene; other cases result from unknown causes. KCNJ2 gene forms a channel that is responsible for transporting potassium ions into muscle cells. The movement of these ions is essential for maintaining the normal function of muscles. KCNJ2 gene mutations disrupt the structure of the potassium ions and leads to periodic paralysis and irregular heart rhythm.


Periodic paralysis: Anderson Tawil syndrome patients may experience episodes of flaccid paralysis. The lower and the upper limbs normally get affected and the paralysis may remain for short duration or continue for days. The severity and frequency varies from person to person and from episode to episode.

Heart arrhythmia: Anderson Tawil syndrome patients typically present with long QT interval, a disorder of the heart's electrical activity. It can cause sudden, uncontrollable, dangerous arrhythmia in response to exercise or stress.

Distinct Facial or skeletal features: Patients with ATS commonly develop physical abnormalities such as a small lower jaw, dental abnormalities, widely spaced eyes, short stature and curvature of the spine.


Diagnosis and treatment

Examining the clinical features, serum test to assess potassium levels, electrocardiogram to test the heart's electric activity and molecular genetic testing together help in establishing the diagnosis of Anderson Tawil syndrome.

There are no standard protocols laid out for treating ATS because of the rarity of the condition. Treatment of the Anderson Tawil syndrome depends upon the symptoms of the patient. If the patient is suffering from potassium sensitive periodic paralysis, potassium supplements are prescribed to rectify the levels.

However periodic paralysis caused by higher potassium levels resolve on their own in a short while. Of late, drugs known as carbonic anhydrase inhibitors are being used successfully to treat periodic paralysis in individuals with Andersen-Tawil syndrome. Cardiac arrhythmia is normally treated with beta adrenergic blockers and more complicated cases might need pacemakers and implantable defibrillator to prevent sudden cardiac deaths.



Polio

Polio or Poliomyelitis or infantile paralysis is a viral disease caused by poliovirus that spread as a worldwide epidemic in the early twentieth century. But after the polio vaccine was introduced in 1955, the cases have drastically reduced. The polio virus spreads from contact and rapidly spreads within the blood and lymph system. The virus spreads through contaminated water, food and human waste. Polio tends to affect young children most often.


Polio can manifest as Paralytic, non-paralytic and subclinical polio, which is most common. Subclinical polio might result in symptoms such as headache, fever, vomiting and headache. With non-paralytic polio, the person would notice back pain, leg pain, muscle stiffness and tenderness, headache and pain in the legs, hands and abdomen. But with paralytic polio, the symptoms would also include muscle spasms, fever, difficulty in breathing and stiffness and sensitivity. Routine test of Cerebrospinal fluid or viral culture of CSF can help diagnose polio. Heat packs can reduce muscle cramps and pain. Physical therapy can help recover lost muscle strength. No treatment can reverse polio paralysis.

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Bibliography / Reference

Collection of Pages - Last revised Date: November 17, 2019