Triparesis : Causes, Symptoms, Diagnosis & Treatment

• General Characteristics
• Why Does Triparesis Occur?
• Traumatic Injuries
• Spinal Circulation Disorders
• Amyotrophic Lateral Sclerosis
• Polio
• Cidp
• Volumetric Processes
• Diagnostics
• Treatment
• Help At The Prehospital Stage
• Conservative Therapy
• Surgery

Triparesis is detected in craniocerebral and spinal cord injuries, neoplasia, spinal cord abscesses, poliomyelitis, amyotrophic lateral sclerosis, and some polyneuropathies. The cause of the violation is established on the basis of complaints, neurological examination data, imaging techniques, and laboratory tests. The tactics of treatment is determined taking into account the nature of the pathology. Neuroprotectors, antibiotics, antiplatelet agents, hormonal agents, and other drugs are prescribed. Operations are performed according to indications.

general characteristics

Triparesis is a decrease in muscle strength in three limbs (two legs and an arm or two arms and a leg). It is a rarer variant compared to para- and tetraparesis. It is formed as a result of an asymmetric lesion of the spinal cord and brain, less often - peripheral nerves. It can be observed in the outcome of the disease or occur at a certain stage in the development of pathology, and then be replaced by tetraparesis.

Flaccid paresis is manifested by muscle atrophy, a decrease in muscle tone. With spastic paresis, muscle tone, on the contrary, is increased, atrophy is not detected. With a mixed nature of the disorder, the signs of flaccid and spastic paresis are combined with each other. The severity of triparesis varies from a slight decrease to a complete loss of muscle strength and ability to move.

Why does triparesis occur?

Traumatic injuries

Triparesis can be observed in patients with traumatic brain injury. The cause of the development of the symptom is severe bruising of the brain, crushing of the medulla with fractures of the vault and base of the skull, penetration of foreign bodies into the cavity of the cranium. In the early period, there is a prolonged loss of consciousness, a violation of vital functions. A combination of focal and stem symptoms is typical. In the long term, the phenomena of triparesis and mental disorders persist.

Another possible cause of triparesis is a spinal cord injury with damage to the cervical spine. Initially, as a rule, there is a picture of complete damage to the spinal cord, due to spinal shock. Then the functions are partially restored. Muscle weakness can be caused by compression of the nervous tissue due to edema, hematoma formation, hemorrhage, displacement of fragments. Sometimes triparesis is formed against the background of an incomplete anatomical interruption of the spinal cord.

Spinal circulation disorders

Spinal stroke at the level of the upper cervical segments is accompanied by spastic tetraplegia. When the cervical thickening is affected, flaccid upper and spastic lower paraparesis occur. In the acute stage, movements are absent in all limbs. Then, with an asymmetric location of the affected area, it is possible to restore the function of one limb against the background of a partial weakening or complete absence of muscle strength in the rest.

triparesis

amyotrophic lateral sclerosis

ALS is characterized by asymmetry of movement disorders. Various types of symptom can occur with the cervical debut of the disease. Flaccid triparesis, upper flaccid and spastic lower plegia are possible. With a segmented variant of the onset of the disease, the lower flaccid paresis is formed some time after the development of the upper one. Further progression of the pathology is accompanied by an increase in muscle weakness, its spread to previously intact parts of the limbs, and the occurrence of tetraparesis.

Polio

Triparesis is a rather rare variant of movement disorders in poliomyelitis. It is possible with the involvement of not only the lower, but also the upper limbs. Paralysis is preceded by two waves of fever. During the first, general infectious manifestations are observed, the second is accompanied by meningeal symptoms. Subsequently, there is a partial activation of movements. The asymmetry of the lesion and the asymmetry of recovery cause a significant variety of residual effects, including triparesis.

CIDP

Chronic inflammatory degenerative polyneuropathy is characterized by a symmetrical lesion of the extremities. Less common are atypical forms with an asymmetric lesion and predominant involvement of the distal sections. Triparesis is detected in some patients with multifocal motor neuropathy, Lewis-Sumner syndrome. CIDP is autoimmune in nature, weakness first appears in the legs, then spreads to the arms. Subsequently, regression of symptoms, a progressive or relapsing-remitting course is possible.

Volumetric processes

Triparesis can provoke neoplasms located at the level of the cervical segments. In the initial stages, the symptoms resemble cervical sciatica. The pathological condition sometimes occurs with extramedullary tumors, is an intermediate stage between the Brown-Séquard syndrome and a complete lesion of the diameter of the spinal cord.

Sometimes asymmetric symptoms are found with a subdural abscess of the spinal cord. The disease debuts with diffuse pain in the neck, chills, fever, severe hyperthermia. When tapping in the projection of the spinous processes, pain is determined. The spinal muscles are tense. Paralysis is formed in a few days.

Diagnostics

The etiology of triparesis is established by a neurologist. During the interview, the specialist finds out when and under what circumstances movement disorders occurred, how they developed over time, what symptoms were accompanied. During a neurological examination, the doctor assesses muscle strength, the volume of passive and active movements, examines reflexes, various types of sensitivity. The examination plan may include the following diagnostic techniques:

• Radiography . In case of TBI, an x-ray examination of the skull is prescribed; in case of spinal cord injuries, an x-ray of the spine is performed. Pictures in two main projections, according to indications, are supplemented with sighting radiographs. The method is informative for damage to solid structures.
• Myelography. A contrast study used to detect obstructions in the flow of cerebrospinal fluid. Recommended for patients with spinal cord injury, extramedullary tumors.
• Magnetic resonance imaging . MRI of the spine is performed for poliomyelitis, spinal cord injuries, abscesses, neoplasms. MRI of the brain is performed for TBI, if ALS is suspected, it is performed for differentiation with other pathologies.
• Other Imaging Techniques . CT of the skull and spine is indicative in clarifying the nature and extent of damage to solid structures in patients with injuries. Ultrasound of the nerve is performed with signs of CIDP, reveals thickening of the nerve trunk.
• Neurophysiological Methods . Electromyography and electroneuromyography are prescribed for ALS, polyneuropathies, poliomyelitis. They provide an opportunity to clarify the level of damage, to identify signs of demyelination, and other changes.
• Lumbar puncture. Confirms the increase in CSF pressure during volumetric processes. The resulting cerebrospinal fluid is sent for analysis to exclude hemorrhages and infectious lesions.
• Laboratory tests . In some patients with ALS, PCR can detect mutations in the corresponding genes. The poliomyelitis virus is detected by ELISA and RSK. In CIDP, an extended laboratory examination is indicated to exclude a provoking pathology.

Physical rehabilitation for triparesis

Treatment

Help at the prehospital stage

With a sudden decrease in muscle strength, regardless of the presence or absence of an injury, you should immediately call an ambulance. Conditions for adequate breathing should be provided, and an analgesic should be given for pain. Trauma victims should not be moved unnecessarily, as this may cause displacement of fragments and exacerbate neurological symptoms. All manipulations are carried out carefully, carefully. The patient is placed on a hard surface. The patient's neck is recommended to be fixed with a head holder.

Conservative therapy

Treatment of triparesis can be etiopathogenetic and symptomatic, including drug and non-drug therapy.

• Injuries . Upon admission, resuscitation is carried out. In the early stages, an important role is played by the fight against cerebral edema, hypovolemia, hypoproteinemia, the prevention of infectious complications, and the regulation of pelvic functions. Infusion therapy, angioprotectors, cytoprotectors, antihypoxants, antibiotics, vitamins are used. Then physical therapy, mechanotherapy, massage, electrical stimulation, reflexology come to the fore.
• Vascular pathologies . In ischemic stroke, vasodilators, anticoagulants, drugs to improve collateral circulation, stimulate the cardiovascular system are prescribed. In hemorrhagic stroke, medications are used that promote the formation of a blood clot and strengthen the vascular wall. The rehabilitation treatment scheme includes nootropics, neuroprotectors, antioxidants, antihypoxants, B vitamins. Subsequently, rehabilitation is indicated.
• BAS . As part of non-drug treatment, exercise therapy is performed to maintain muscle tone and prevent contractures. Select orthopedic appliances. With dysphagia, they switch to a semi-liquid diet. To ensure adequate breathing, according to indications, oxygen inhalations, mechanical ventilation are used. Anticonvulsants and muscle relaxants are prescribed. With salivation, anticholinergics are indicated, with weakening of the respiratory muscles - expectorants, mucolytics.
• Poliomyelitis . In the acute period, prevention of bedsores and contractures is necessary. With respiratory disorders, mechanical ventilation is performed, with dysphagia - tube feeding. Neostigmine, painkillers, ascorbic acid, vitamins, respiratory analeptics are recommended. During the rehabilitation period, exercise therapy, electromyostimulation, UHF, orthopedic massage, paraffin therapy are effective.
• CVDP . Three-component therapy is used, including plasmapheresis, intravenous immunoglobulin, and long-term use of corticosteroid drugs (from 1-1.5 years or more). If ineffective or contraindicated, corticosteroids are replaced with immunosuppressants. Massage, physiotherapy exercises, physiotherapy are carried out.

Abscesses require parenteral antibiotic therapy using broad-spectrum drugs. Patients with malignant tumors may be shown chemotherapy and radiation therapy.

Surgery

Depending on the reasons for the development of triparesis, the following operations are possible:

• Injuries : vertebroplasty, resection of the Urban wedge, various options for fixing the vertebrae, removal of intracerebral, epidural and subdural hematomas, removal of depressed skull fractures, decompressive craniotomy.
• Vascular disorders : spinal cord revascularization interventions, removal of aneurysms.
• Tumors : excision of extramedullary neoplasms.
• Abscesses : decompression of the spinal cord, drainage of the subdural space, removal of the affected areas of the bone, followed by fixation of the spine.

ALS patients with severe dysphagia may require a gastrostomy to provide nutrition. Long-term patients with poliomyelitis undergo arthrodesis, osteotomy, muscle and tendon repositioning, scoliosis correction surgery to eliminate deformities and restore the functions of the musculoskeletal system as much as possible.