China
Africa
Explore chapters and articles related to this topic
Neurotoxicology
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Sean D. McCann, Trevonne M. Thompson
Intermediate syndrome (IMS) can occur 24–96 hours after exposure to OP poisons and presents with weakness of the facial, neck flexor, and respiratory musculature with preserved consciousness. The exact etiology is not well understood, but the syndrome is thought to arise from dysfunction at the neuromuscular junction following severe or prolonged exposure to an OP poison, possibly due to downregulation of ACh receptors following overstimulation during the acute toxicity. Given the impairment of respiratory muscles, patients may require mechanical ventilation. IMS typically resolves over the course of several weeks. Organophosphate-induced delayed polyneuropathy (OPIDP) is a late finding in some patients with severe OP exposure. Symptoms typically start with shooting pains in the legs and can progress to include ataxia and paralysis, with quadriplegia rarely observed in only the most severe cases. Onset is typically 3–6 months after exposure and etiology is unclear; however, the syndrome has been associated with OP poisoning resulting in high rates of enzyme ageing. Chronic behavioral changes including irritability, psychosis, depression, and fatigue have also been reported following OP toxicity, although the incidence and pathophysiology of these changes are not well described. IMS and OPIDP will not improve with the standard treatment used in acute OP toxicity.
Paediatric Orthopaedic Surgery
Published in Timothy W R Briggs, Jonathan Miles, William Aston, Heledd Havard, Daud TS Chou, Operative Orthopaedics, 2020
Jonathan Wright, Russell Hawkins, Aresh Hashemi-Nejad, Peter Calder
Adductor psoas and gracilis release is commonly indicated for the classic flexion adduction contracture and scissoring gait seen in cerebral palsy. Muscle imbalance combined with infrequent weightbearing causes structural changes at the hip (increased anteversion, posterolateral acetabular dysplasia) leading to posterolateral migration, pelvic obliquity and scoliosis. This is more commonly seen in quadriplegic patients and releases are performed early (3–4 years) to prevent deterioration. Muscles should be released sequentially during the procedure and performed bilaterally to prevent a windswept deformity. Releases are also commonly combined with proximal varus femoral osteotomy at age 5 years.
The patient with acute neurological problems
Published in Peate Ian, Dutton Helen, Acute Nursing Care, 2020
SCI is classified by the clinical effects of the injury: Quadriplegia (also called tetraplegia).Paraplegia.
Depressed skull fracture compressing eloquent cortex causing focal neurologic deficits
Published in Brain Injury, 2023
Alexander In, Brittany M. Stopa, Joshua A. Cuoco, Adeolu L. Olasunkanmi, John J. Entwistle
Diffusion tensor imaging of patients with traumatic brain injuries suggests that motor weakness is most often caused by diffuse axonal injury in addition to intracerebral hemorrhage, transtentorial herniation, and focal cortical contusions (8). However, a depressed fracture fragment can rarely cause focal neurologic deficit(s) due to direct compression of the eloquent cortex (4–7). There are a few reports in the literature that have documented such phenomena (4–7). Mathew et al. (4) reported a case of a 26-year-old male who presented with acute onset isolated quadriplegia after an assault. Imaging demonstrated a midline biparietal depressed fracture with bilateral frontoparietal mixed-density lesions and surrounding edema suggesting venous infarction (4). CT venogram confirmed the injury of the superior sagittal sinus with a lack of filling within the middle one-third of the sinus (4). The patient underwent a biparietal parasagittal craniotomy, elevation of the depressed fracture, and repair of the superior sagittal sinus (4). At 6-month follow-up, the patient demonstrated marked improvement in neurologic function with MRC grade 4/5 power in all four extremities (4). Similarly, Syed et al. (5) described a case of a 55-year-old male who presented initially without neurologic deficits after an assault with imaging demonstrating a biparietal depressed skull fracture overlying the precentral gyri. One day later, progressive paraparesis was observed on examination; however, surgical intervention was not pursued (reason undisclosed) (5).
Quality of life of persons with traumatic spinal cord injury in rural Kilimanjaro, Tanzania: a community survey
Published in Disability and Rehabilitation, 2021
Haleluya Moshi, Gunnevi Sundelin, Klas-Göran Sahlen, Ann Sörlin
The level of physical activities and engagement in leisure activities has also been shown to have a significant impact on quality of life [18]. Thus, it is not surprising that this study found a significant difference in the mean scores for the physical domain between persons with paraplegia and those with quadriplegia. The physicality of persons with quadriplegia is normally much reduced due to paralysis of both the upper and lower limbs as compared with those persons with paraplegia who have normal function in their upper limbs. A systematic review by Kawanishi and Greguol found that most studies indicate that increased levels of physical activity for persons with SCI improves their quality of life. They further explained that physical activity achieves this by influencing domains such as social relationships, functional independence and psychological well-being [16]. However, with inaccessible environments both within and outside the home and a lack of appropriate mobility equipment, even a person with paraplegia might be unable to lead an active and productive life. Not only does this affect their quality of life, it also exposes them to health conditions associated with a sedentary lifestyle such as high cholesterol, hypertension, overweight, and obesity [53]. With programs to motivate mobility and an active lifestyle within an accessible environment, the level of activity can be increased, thereby reducing the risk of such health conditions and also improving quality of life [18,52].
Emergency preparedness – The perceptions and experiences of people with disabilities
Published in Disability and Rehabilitation, 2020
Adi Finkelstein, Ilan Finkelstein
Participants with quadriplegia described themselves as completely dependent on machines and on other people to take care of their vital needs, such as breathing and eating. Such dependence is a major factor in an emergency, according to Ronit: “The most frightening thing is this electric wheelchair. If I don't have the electric wheelchair, that's traumatic for me… Because then I am not mobile.” Jonathan explained that there is a respirator that is always attached to his wheelchair and its battery needs to be recharged regularly, but the most important thing is to have someone on hand who knows how to extract the secretions from his trachea, otherwise he will suffocate. Susan, who has a feeding tube attached directly to her stomach and whose breathing depends on a machine and an oxygen tank, said the following: