paralysis

/peuh ral"euh sis/, n., pl. paralyses /-seez'/.

1. Pathol.

a. a loss or impairment of voluntary movement in a body part, caused by injury or disease of the nerves, brain, or spinal cord.

b. a disease characterized by this, esp. palsy.

2. a state of helpless stoppage, inactivity, or inability to act: The strike caused a paralysis of all shipping.

[bef. 1150; < L < Gk parálysis, equiv. to paraly-, var s. of paralýein to loosen (i.e., disable) on one side (para- PARA-¹ + lýein to loosen) + -sis -SIS; r. ME paralisi(e) < OF < L, as above; r. late OE paralisin (acc.) < L, as above; cf. PALSY]

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or palsy

Loss or impairment of voluntary use of one or more muscles.

It may be flaccid (with loss of muscle tone) or spastic (stiff). Hemiplegia (one-sided paralysis) is usually caused by stroke or brain tumour on the opposite side. Diplegia (two-sided paralysis, as in cerebral palsy) results from generalized brain disease. Spinal-cord damage (from bone or joint disease, fracture, or tumour affecting the vertebrae; inflammatory and degenerative diseases; or pernicious anemia) paralyzes the body at and below the level of the damage (paraplegia if the legs and lower body only; quadriplegia if arms and legs). Poliomyelitis and polyneuritis (neuritis of multiple nerves) result in paralysis with muscle wasting. Bell palsy (a type of neuritis) paralyzes the muscles of one side of the face. Muscular dystrophy causes paralysis by attacking muscle. Metabolic causes include myasthenia gravis. Paralysis may also have psychiatric causes (see hysteria).

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▪ pathology

Introduction

also called  palsy 

      loss or impairment of voluntary muscular movement caused by structural abnormalities of nervous or muscular tissue or by metabolic disturbances in neuromuscular function. Paralysis can affect the legs and lower part of the body ( paraplegia) or both arms and both legs (quadriplegia). Sometimes the muscles of the lower face, arm, and leg on only one side of the body are involved ( hemiplegia).

      Most diseases that cause paralysis can be divided into two main groups depending on whether they entail structural alterations in nervous or muscular tissue, or lead to metabolic disturbances in neuromuscular function. Some act systemically and affect one of the three elements in the motor system (upper neuron, lower neuron, or muscle) more or less extensively and exclusively. More often, however, one element or neighbouring portions of two of the three elements are involved over a limited extent by a single focal lesion.

Paralysis from nervous tissue damage

      The most common cause of hemiplegia is damage to the corticospinal tracts and associated motor tracts in one hemisphere of the brain from obstruction (blood clot or thrombosis) or rupture (cerebral hemorrhage (stroke)) of a major cerebral artery. Brain tumour is another but less common cause of hemiplegia and increases in severity gradually over a period of weeks or months. When the lesion is in the left hemisphere of a right-handed person, the resulting right hemiplegia is often associated with one of the various forms of aphasia, the inability to sound words, to write, or to read.

      Bilateral hemiplegia with pseudobulbar palsy results from diffuse, bilateral brain diseases such as occurs in severe cerebral arteriosclerosis or cerebral vascular syphilis. The terms cerebral palsy and spastic diplegia refer to bilateral hemiplegia resulting from prenatal developmental brain defects or from injury to the brain at birth.

      The spinal cord is rarely the site of vascular obstruction or hemorrhage. Common causes of damage to the corticospinal tracts in the cord include deformities of the spinal column from bone and joint disease and from fracture or dislocation of the spine, spinal cord tumours (tumour), multiple sclerosis, strokes, and a number of inflammatory and degenerative diseases associated with pernicious anemia. One of the most common causes of progressive spastic paraplegia in persons past middle age is spinal degenerative arthritis, in which an intervertebral disk protrudes into the lower cervical portion of the spinal canal.

Paralysis from muscle tissue damage

      Of the diseases that attack lower motor neurons and result in paralysis with muscular (muscle disease) wasting, the most common are poliomyelitis (polio) and polyneuritis, the former affecting the cell bodies or the bulbar and spinal motor neurons and the latter affecting their peripheral processes. Bell palsy is a peripheral neuritis of unknown cause affecting the facial nerve and resulting in paralysis of all the muscles of one side of the face.

      Diseases that result in paralysis through primary changes in muscle tissue are fewer than the above. Of the conditions belonging in this category, muscular dystrophy is one of the few that are apparently confined to the muscles. Muscular dystrophy is a hereditary disease that results in paralysis through primary changes in muscle tissue. It is characterized by progressive, symmetrical muscular weakness and atrophy. Pseudohypertrophic muscular dystrophy is a rare variety of the disease that begins before puberty, is more common in males, and usually progresses to severe disability within a few years. The other types of dystrophy, in general, begin in adolescence or young adulthood, equally affect males and females, and progress more slowly.

Paralysis from metabolic disease

      Muscular weakness without structural alteration in nerve or muscle tissue may be a symptom of disturbances in metabolism arising from a wide variety of causes. Among such conditions are diseases of the endocrine glands, certain intoxications, and several metabolic defects. The most common example of a metabolic disorder (metabolic disease) in neuromuscular function of unknown cause is myasthenia gravis. Myasthenia gravis is characterized by muscular weakness, without atrophy, which may be mild or severe and either generalized or restricted to a few muscle groups. Muscles innervated by cranial nerves (cranial nerve) usually are affected. Weakness results from a localized defect in the chemical processes involved in the transmission of impulses from motor nerve endings to muscle fibres. Several medications, including neostigmine, may benefit individuals with the disease.

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