LANDRY THE ASCENDING PARALYSIS (J. Century O. of Landry, fr. doctor, 1826 — 1865; grech, paralysis relaxation; synonym paralysis ascendens acuta) — the symptom complex which is characterized by development of flaccid paralyzes which cover the lower extremities in the beginning, then upper, and for several days all any muscles, including muscles of a thorax, a diaphragm, the person, language. Landry in 1859 is for the first time described. As at such development of paralyzes function of respiratory muscles is often switched off and bulbar symptoms develop, it is considered to be L. accusative manifestation of especially heavy disease, against the background of a cut it developed.
Etiology and pathogeny
L. accusative is the symptom complex reflecting only a distributional pattern of paralyzes. It can be the cause: 1) infectious diseases with the known activator (acute poliomyelitis; the poliomiyelitopodobny diseases caused by viruses of intestinal group — ECHO, Koksaki; paralytic forms of rage; tick-borne encephalitis; shingles; inf. parotitis; measles; chicken pox, etc.); 2) infectious and allergic diseases which causative agent is unknown (acute primary idiopathic polyradiculoneuritis, acute disseminated encephalomyelitis, collagenoses, a nodular periarteritis, Postvaccinal myelites, entsefalomiyeloradikulonevrita, etc.); 3) polyneuropathies at toxic processes (alcoholic, medicamentous, blastomatous, etc.); 4) enzymatic defects (the polyneuropathy connected with the acute alternating hepatic porphyria, diabetes, etc.). L. accusative can develop at localization of process in peripheral nerves (polyradiculoneurites, polyneuropathies) or in a spinal cord (acute poliomyelitis, myelites). In hard cases perhaps combined defeat of peripheral nerves, a spinal cord and its roots, and also bulbar department of a brain.
Pathological anatomy it is various and is defined by a disease, against the background of to-rogo paralysis developed.
The current and symptoms
Is characteristic the following development of symptoms: originally there are paralyzes of muscles of feet, then function of all muscles of legs, trunks, hands, a neck, mimic muscles, muscles of a throat, a throat, language is switched off. The heaviest current of L. accusative is observed at switching off or sharp weakening of function of respiratory muscles: comes acute or incremental respiratory insufficiency (see), the mechanism of a tussive reflex falls apart, arises hypoxia (see) and hypercapnia (see). Paralysis of muscles of a throat, throat and language (bulbar paralysis) can lead to obstruction of respiratory tracts contents of a digestive tract and has all signs of a flaccid paralysis (see. Paralyses, paresis ): hypotonia of muscles, an areflexia, later 2 — 3 weeks in muscles arises reaction of degeneration. Paresthesias, painful siidry can precede paralyzes. Frustration sensitivity (see) are observed at a polyneuropathy, a polyradiculoneuritis (on peripheral type in the form of gloves and socks), at myelites (on segmented or conduction type). Disorders of function of pelvic bodies are noted at L. accusative caused by a myelitis or encephalomyelitis; at defeat of peripheral nerves they arise seldom.
Terms of development of L. accusative fluctuate from 3 — 6 days to one month. So, e.g., at acute poliomyelitis development of L. accusative happens within 3 — 6 days, and at an acute idiopathic polyradiculoneuritis — over 3 — 4 weeks. Depending on an etiology of L. by accusative in an onset of the illness fever, an indisposition and all-brain symptoms can be observed. In cerebrospinal liquid at L. accusative inf. genesis the pleocytosis at normal protein content or its small increase is noted. At toxic processes cerebrospinal liquid is not changed.
Main diagnostic criteria of L. accusative following: the beginning of paralyzes from muscles of legs, steady progressing of paralyzes with distribution on overlying muscles of a trunk, a thorax, hands, necks, faces, language, a throat, symmetric expressiveness of paralyzes, hypotonia of muscles, an areflexia, objective disturbances of sensitivity are minimum.
Treatment depends on a basic disease, against the background of to-rogo the L developed. accusative. At all forms therapy is shown by vitamins B 1 , In 6 , In 12 (at a porphyria polyneuramin 1 it is contraindicated). Hormonal therapy is more effective at secondary poly-neuropathies (collagenoses, enzymatic defects, etc.). At primary idiopathic polyneurites which caused L. accusative, hormonal therapy not always gives effect. Doses select according to age. In the recovery period the gymnastics, massage, electrostimulation of muscles, use of antikholinesterazny drugs are necessary. At emergence of respiratory insufficiency apply respiratory resuscitation. Previously provide free passability of respiratory tracts for air (suction of a secret from respiratory tracts, isolation of respiratory tracts from a digestive tract, the Tracheostomy). Artificial ventilation of the lungs is carried out by means of devices of various systems and designs (see. Artificial respiration ). Importance at L. accusative has maintenance of somatic functions: food via the probe (at an aphagia) the balanced nutritious mixes, elimination of a paralytic hypokinesia for what early use of passive movements in joints of the paralyzed extremities, frequent turns, massage mattresses, etc. is recommended. Rational use of antibiotics according to sensitivity of flora of respiratory tracts and a bladder is necessary.
the Forecast concerning life is defined by extent of switching off of respiratory muscles and depth of bulbar frustration. Introduction to therapy of methods of resuscitation considerably lowered number of lethal outcomes. At polyradiculoneurites recovery of function happens full approximately at 90% of patients. After the postponed L. accusative caused by heavy damage of motive nervous cells of front horns of a spinal cord, and also extensive demyelinating process persistent paresis and paralyzes can be observed.
Bibliography: Brusilovsky L. Ya. To the doctrine about the acute ascending paralysis of Landry, in book: Nevrol., it is put. psikhonevrol., prikladn. psikhol., Works wedge, nervn. Bol. I MSU, Saturday. 2, page 3, M., 1928; Martulis M. S. Guide to neurology, t. 5, century 1, page 208, M., 1940; Popova L. M. Clinic and treatment of severe forms of a polyradiculoneuritis, M., 1974; Haymaker W. a. Kernohan J.W. Landry — Guillain — Vaggyo of syndrome, Medicine (Baltimore), v. 28, p 59, 1949; Landry J. B. Note sur la paralysie ascendante aigue, Gaz. hebd. Med. Chir., t. 6, p. 472, 486, 1859; Leneman F. The Guil-lain — Barre syndrome, Arch, intern. Med., v. 118, p. 139, 1966.
L. M. Popova.