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SUDDEN INFANT DEATH SYNDROME SYMPTOMS |
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Paralysis and loss of sensation The extent to which movement and sensation are damaged depends on the level of the spinal cord injury. Nerves leaving the spinal cord at different levels control sensation and movement in different parts of the body. The distribution is roughly as follows: C1-C4: head and neck. C3-C5: diaphragm (chest and breathing). C5-T1: shoulders, arms and hands. T2-T12: chest and abdomen (excluding internal organs). L1-L4: abdomen (excluding internal organs), buttocks, genitals, and upper legs. L4-S1: legs. S2-S4: genitals and muscles of the perineum. Damage below T1, which lies at the base of the rib cage, causes paralysis and loss of sensation in the legs and trunk below the injury. Injury at this level usually does no damage to the arms and hands. Paralysis of the legs is called paraplegia. Damage above T1 involves the arms as well as the legs. Paralysis of all four limbs is called quadriplegia or tetraplegia. Cervical or neck injuries not only cause quadriplegia but also may cause difficulty in breathing. Damage in the lower part of the neck may leave enough diaphragm control to allow unassisted breathing. Patients with damage at C3 or above, just below the base of the skull, require mechanical assistance to breathe. Symptoms also depend on the extent of spinal cord injury. A completely severed cord causes paralysis and loss of sensation below the wound. If the cord is only partially severed, some function will remain below the injury. Damage limited to the front portion of the cord causes paralysis and loss of sensations of pain and temperature. Other sensation may be preserved. Damage to the center of the cord may spare the legs but paralyze the arms. Damage to the right or left half causes loss of position sense, paralysis on the side of the injury, and loss of pain and temperature sensation on the opposite side. Deep venous thrombosis Blood does not flow normally to a paralyzed limb that is inactive for long periods. The blood pools in the deep veins and forms clots, a condition known as deep vein thrombosis. A clot or thrombus can break free and lodge in smaller arteries in the brain, causing a stroke, or in the lungs, causing pulmonary embolism. Pressure ulcers Inability to move also leads to pressure ulcers or bed sores. Pressure ulcers form where skin remains in contact with a bed or chair for a long time. The most common sites of pressure ulcers are the buttocks, hips, and heels. Spasticity and contracture A paralyzed limb is incapable of active movement, but the muscle still has tone, a constant low level of contraction. Normal muscle tone requires communication between the muscle and the brain. Spinal cord injury prevents the brain from telling the muscle to relax. The result is prolonged muscle contraction or spasticity. Because the muscles that extend and those that bend a joint are not usually equal in strength, the involved joint is bent, often severely. This constant pressure causes deformity. As the muscle remains in the shortened position over several weeks or months, the tendons remodel and cause permanent muscle shortening or contracture. When muscles have permanently shortened, the inner surfaces of joints, such as armpits or palms, cannot be cleaned and the skin breaks down in that area. Heterotopic ossification Heterotopic ossification is an abnormal deposit of bone in muscles and tendons that may occur after injury. It is most common in the hips and knees. Initially heterotopic ossification causes localized swelling, warmth, redness, and stiffness of the muscle. It usually begins one to four months after the injury and is rare after one year. Autonomic dysreflexia Body organs that regulate themselves, such as the heart, gastrointestinal tract, and glands, are controlled by groups of nerves called autonomic nerves. Autonomic nerves emerge from three different places: above the spinal column, in the lower back from vertebrae T1-L4, and from the lowest regions of the sacrum at the base of the spine. In general, these three groups of autonomic nerves operate in balance. Spinal cord injury can disrupt this balance, a condition called autonomic dysreflexia or autonomic hyperreflexia. Patients with injuries at T6 or above are at greatest risk. In autonomic dysreflexia, irritation of the skin, bowel, or bladder causes a highly exaggerated response from autonomic nerves. This response is caused by the uncontrolled release of norepinephrine, a hormone similar to adrenaline. Uncontrolled release of norepinephrine causes a rapid rise in blood pressure and a slowing of the heart rate. These symptoms are accompanied by throbbing headache, nausea, anxiety, sweating, and goose bumps below the level of the injury. The elevated blood pressure can rapidly cause loss of consciousness, seizures, cerebral hemorrhage, and death. Autonomic dysreflexia is most often caused by an over-full bladder or bladder infection, impaction or hard impassable fecal mass in the bowel, or skin irritation from tight clothing, sunburn, or other irritant. Inability to sense these irritants before the autonomic reaction begins is a major cause of dysreflexia. Loss of bladder and bowel control Bladder and bowel control require both motor nerves and the autonomic nervous system. Both of these systems may be damaged by SCI. When the autonomic nervous system triggers an urge to urinate or defecate, continence is maintained by contracting the anal or urethral sphincters. A sphincter is a ring of muscle that contracts to close off a passage or opening in the body. When the neural connections to these muscles are severed, conscious control is lost. In addition, loss of feeling may prevent sensations of fullness from reaching the brain. To compensate, the patient may help empty the bowel or bladder by using physical maneuvers that stimulate autonomic contractions before they would otherwise begin. However, the patient may not be able to relax the sphincters. If the sphincters cannot be relaxed, the patient will retain urine or feces. Retention of urine may cause muscular changes in the bladder and urethral sphincter that make the problem worse. Urinary tract infection is common. Retention of feces can cause impaction. Symptoms of impaction include loss of appetite and nausea. Untreated impaction may cause perforation of the large intestine and rapid overwhelming infection. Sexual dysfunction Men who have sustained SCI may be unable to achieve an erection or ejaculate. Sperm formation may be abnormal too, reducing fertility. Fertility and the ability to achieve orgasm are less impaired for women. Women may still be able to become pregnant and deliver vaginally with proper medical care. |
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| SUDDEN INFANT DEATH SYNDROME RELATED ITEMS | ||
