tailieunhanh - Neurological Emergencies - part 9

Trung ảnh hưởng của rối loạn chuyển hóa Trung ương gốc transtentorial thoát vị não tổn thương nhồi máu xuất huyết ngoại sinh nén nội tại khối u Viêm não đa xơ cứng động cơ tế bào thần kinh bệnh Trung ương cầu não myelinolysis cột sống dây tổn thương dây nén động cơ tế bào thần kinh khối u bệnh nội tại đa xơ cứng bệnh viêm tủy ngang | ACUTE NEUROMUSCULAR RESPIRATORY PARALYSIS Box Central nervous system disorders causing respiratory failure Sedative drugs Secondary effects of metabolic disorders Central transtentorial herniation Brain stem lesions Infarction Haemorrhage Extrinsic compression Intrinsic tumour Encephalitis Multiple sclerosis Motor neuron disease Central pontine myelinolysis Spinal cord lesions Cord compression Motor neuron disease Intrinsic tumour Multiple sclerosis Transverse myelitis Poliomyelitis Rabies and on maximal inspiration measurement of the diaphragmatic EMG . Alternatively magnetic stimulation of the phrenic nerves may be used to assess diaphragmatic contractility. However neither of these tests is routinely performed outside research centres. Diagnosis of the cause Central nervous system causes Diseases of the nervous system can cause respiratory failure by damaging the respiratory centre in the medulla or its connections with the cervical and thoracic spinal cord Box . In practice the commonest causes are the secondary consequences of CNS depression by drugs metabolic abnormalities or primary cerebral or brain stem disease. These are important in differential diagnosis but this review is confined to disorders affecting the lower motor neuron peripheral nerves neuromuscular junction and muscles. The 381 NEUROLOGICAL EMERGENCIES localisation of the disease process to the brain stem or spinal cord does not usually present the neurologist with any difficulty because of the presence of symptoms and signs at the level of the lesion and involvement of the long tracts. Wild type poliomyelitis remains a common problem in the Indian subcontinent and south east Asia. Rare vaccine-associated cases still occur throughout the world. Poliomyelitis should still be considered in the differential diagnosis of acute flaccid paralysis when sensory deficit is absent the onset is asymmetrical and the CSF shows a pleocytosis especially in recent vaccine recipients or their .