SGD CASE: Sept.

23

VACCINATE!

An 11-year old girl complained of pain in the neck and the left shoulder and had a fever of
38.8OC TO 39.4OC. A few days later the left arm, forearm, and hand were paralyzed; the
muscles flaccid. Reflexes in the left upper limb were absent. Motor control of other parts of the
body was intact. After 4 weeks, the forearm and the hand could be slightly extended by
voluntary effort, but no other voluntary movement of these parts could be executed. The
paralyzed muscles remained flaccid and showed marked atrophy.

a. Locate the site of the lesion. Baldelovar

Spinal cord?

b. What nerve structure arises from C5-T1 segments of the spinal cord? Bartolay

● The brachial plexus serves the chest, shoulders, arms and hands and is formed by the
ventral rami of C5, C8, and T1 spinal nerves, and the lower and upper halves of the C4
and T2 spinal nerves

c. What condition is nowadays sometimes responsible for this clinical picture? Cabab

● Polio or poliomyelitis

d. What is the etiology of acute poliomyelitis? Cao

● Acute poliomyelitis is caused by small ribonucleic acid (RNA) viruses of the enterovirus
group of the picornavirus family. The single-stranded RNA core is surrounded by a
protein capsid without a lipid envelope, which makes poliovirus resistant to lipid solvents
and stable at low pH.
● Poliovirus, the virus causing both acute polio and PPS, is a member of the
Picornaviridae family and species Enterovirus C. There are three serotypes of wild
Poliovirus: Poliovirus 1, 2, and 3. Wild type 1 poliovirus was the primary cause of the
majority of the world’s paralytic polio cases until vaccines became widespread.
● A virus called poliovirus causes polio. The virus enters the body through the mouth or
nose, getting into the digestive and respiratory (breathing) systems. It multiplies in the
throat and intestines. From there, it can enter the bloodstream.

e. Discuss the acute stage of poliomyelitis. Catchillar

Acute Stage-3 to 6 weeks from the onset of Poliomyelitis.

❖ Signs and Symptoms

● Muscle tenderness is the most important sign seen in this stage.
● To test this, press the calf muscles when the child is quiet. If he cries,he has
tenderness.
● Acute poliomyelitis is a disease of the anterior horn motor neurons of the spinal
cord and brain stem caused by poliovirus. Flaccid asymmetric weakness and
 muscle atrophy are the hallmarks of its clinical manifestations, due to loss of
motor neurons and denervation of their associated skeletal muscles.

❖ Treatment
● Rest-The child should not be over handled.
● Isolation
● Booster dose
● Nutrition-Diet rich in" Protein".
● Sister Kenny's Bath: This is a form of moist heat.This helps to resolve
inflammation to some extent.
● Massage should not be given as it may cause more damage due to which the
patient may not be able to walk later on.

f. Discuss the recovery stage of poliomyelitis. Cortuna

● In the recovery stage, also known as the convalescent stage, the acute symptoms
and muscle tenderness disappear, and the paralyzed muscles begin to recover. This
stage lasts for up to 2 years after the onset of the disease
● Stage of Recovery-This stage extends for almost 2 years.Thus muscles in the polio
patient can be strengthened to their maximum capacity up to 2 years.
● Improvement usually begins at the end of the first week as the edema in the affected
area subsides and the function returns to the neurons that have not been destroyed.

Stage of Residual Paralysis- Post-Polio Syndrome

Treatment
● Patient is given a combination of stretching,strengthening and calliperization.
● Tailor-made calipers can prevent the deformity from aggravating.
● Tendon transfers may be done for compromising balance on that side.
● Arthrodesis

g. Discuss the residual-paralysis stage of poliomyelitis. Cruz

● The period beyond 2 years after the onset of the disease is called the residual-paralysis
stage. No recovery of muscle power occurs in this stage. Deformities are liable to occur
as a consequence of imbalance of muscle power and poor posture. There is also disuse
atrophy of muscles and shortening of the leg from interference with growth. In neglected
cases, gross fixed deformities of the hip, knee, and foot occur with severe wasting of
muscles. Children with extensive paralysis and gross deformities have to crawl on all
fours to move from place to place.

h. What parts of the body are innervated by the medial group of neurons in the anterior
gray horn? Dacut

● Innervates the skeletal muscles of neck and trunk, including intercostal and abdominal
musculature
i. What parts of the body are innervated by the central group of neurons in the anterior
gray horn? Dean

● In the cervical part of the spinal cord. Nerve cells in segments C3-C5 specifically
innervate the diaphragm and are collectively referred to as the phrenic nucleus.
● In the upper five or six cervical segments, some nerve cells innervate the
sternocleidomastoid and trapezius muscles and are referred to as accessory nucleus.

j. What parts of the body are innervated by the lateral group of neurons in the anterior
gray horn? may sobra: Grp 2

● Innervates the skeletal muscles of the limbs.