Landry Ascending Paralysis (a1546)

LANDRY ASCENDING PARALYSIS (DISEASE) [paralysie ascendante aigue, paralysis ascendens acuta (Landry)], an acute disease of the nervous system, first described by Landry in 1859. By Landry's paralysis is meant a characteristic symptom complex representing a unique clinical picture of the disease, or a special form of the disease course, in the basis of which various etiological factors may lie. The Landry symptom complex is characterized by: 1) paralysis that begins in the lower extremities and then progresses in sequential order to the upper extremities and cranial nerves, 2) acute course of the disease, 3) most often fatal outcome. Landry assumed that paralysis develops on the basis of poisoning; subsequent researchers, however, observed the development of paralysis with both infections and intoxications. In most cases, the etiological factor is acute infection (influenza, pneumonia, smallpox, diphtheria, sepsis, erysipelas, whooping cough, rabies, rarely syphilis, tuberculosis); acute anterior poliomyelitis sometimes occurs in the form of Landry ascending paralysis; during the epidemic of encephalitis, similar forms of encephalitis were also observed. Paralysis resulting from rabies vaccination treatment, in severe cases, may occur in the form of Landry paralysis. On microscopic examination, postmortem pathological changes are not always found, especially in acute cases with lightning-fast course where apparently changes do not have time to develop. In all other cases, changes are found either in the central or peripheral nervous system, on the basis of which three groups of Landry ascending paralysis are distinguished: polyneuritic, poliomyelitic, and myelitic. It should be noted that pure forms are never observed; usually the entire nervous system is affected by the pathological process with emphasis either on the peripheral nerves or on the spinal cord. In the spinal cord, degenerative changes are observed in the cells of the anterior horns, in the cells of Clarke and the ependyma, in the fibers - breakdown of myelin, various changes in the axis cylinders up to their death; the glial reaction is weakly expressed; everywhere a significant vascular reaction is noticeable. In the peripheral nerves of the spinal and cranial nerves, degenerative changes are noted in the form of breakdown of myelin, axis cylinder; the vascular reaction is clearly expressed; changes sometimes do not affect the entire nerve, but only individual sections. Regarding the spread of the virus, opinions differ (lymphatic vessels, blood vessels, cerebrospinal fluid); its virulence is so great that the protective reaction in the nervous system is immediately paralyzed. After a brief prodromal period in the form of general malaise and paresthesia in the extremities, paralysis develops first in one leg, then in the other, sometimes in both simultaneously; further paralysis spreads to the musculature of the trunk - back and abdomen, to the upper extremities and finally to the muscles innervated by cranial nerves (above the nucleus of the facial nerve the process rarely ascends). The paralysis is flaccid, tendon and skin reflexes are absent; in acute forms, changes in electrical excitability are absent, in more prolonged cases, muscle atrophy and regeneration reaction are observed. Disorders of swallowing, breathing, phonation form the most severe symptoms of the disease. Sensitivity is slightly reduced. The pelvic organs are in order; bedsores and other trophic disorders are very rare; temperature is not elevated in most cases. Consciousness remains clear. In rarer cases, the development of the disease goes in a descending direction. The development of the disease is very rapid (within 1-3 days); much less frequently - a prolonged course. Mortality is very high; cases of recovery are very rare. The clinical picture and course of the disease are so characteristic that they do not present difficulties in diagnosis. Treatment in cases with a clear etiological factor should be directed against the underlying disease (diphtheria, malaria, etc.); in addition, diaphoresis (general light baths) and means that tone the nervous system (injection of strychnine, quinine) and disinfectants (Urotropin) are used. Taking into account that the occurrence of Landry paralysis may be based on various infectious and toxicological processes, it is necessary to direct general preventive measures to protection from the underlying disease; careful anamnestic data and peculiarities of the development of the disease in each given case may also be important for the correct direction of treatment.