(LANDRY’S PARALYSIS)
=Definition.=—An acute disease, characterized by an advancing
paralysis, beginning in the legs, passing upward to the trunk and the
arms and finally it may involve the centers in the medulla. =Toxic= and
=infectious= influences that congest the nerve courses and ultimately
destroy the cells seem to be the important factor. The anterior gray
matter of the cord is involved, and it is probable that many cases are
a form of acute poliomyelitis. The spleen is congested and in some
instances the lymphatics.
=Etiology.=—A definite cause has not been found, although osteopathic
lesions are important predisposing factors. A toxic cause seems
probable. The disease is most common in males between twenty and
forty years of age. It may follow traumatism, exposure, cold or the
infectious fevers.
=Symptoms.=—Weakness of the lower extremities is generally the first
symptom, though the arms may be involved first. This is shortly
followed by paralysis. The paralysis then extends to the trunk and
within a few days the arms are also affected. The muscles of the neck
are next involved and finally those of respiration, deglutition and
articulation. The reflexes are abolished. The muscles are relaxed,
but generally do not waste or show electrical modification. Sensation
is usually not affected, but there may be tingling, numbness,
hyperesthesia and muscular tenderness. The sphincters are not
involved as a rule. The spleen is usually enlarged. The =course= is
variable. Death often occurs in from two days to a few weeks. When the
improvement takes place, the part last affected recovers first.
=Diagnosis.=—This is not always easy. It is sometimes impossible
to differentiate between this disease and =multiple neuritis=. The
history, the motor paralysis, the absence of wasting and of electrical
modification, as well as the absence of involvement of the sphincters,
will definitely aid in the diagnosis.
=Prognosis.=—The prognosis is unfavorable. A large majority of cases
prove fatal. In a few cases treated osteopathically, results were
favorable if the patient was seen early. The muscles of the spinal
column were markedly contracted.
=Treatment.=—The treatment of Landry’s disease consists principally
of thorough treatment of the spine, especially of the lower dorsal
and lumbar regions, and attention to the underlying toxic condition.
The treatment should be most thorough; the vertebræ and ribs found
disordered should be corrected and each vertebra should be carefully
separated (if conditions permit) from its neighbor. When the paralysis
has extended to the trunk and neck, a thorough treatment all along the
spinal column should be given with a view to relaxing the contracted
muscles and to render flexible the entire spinal column, so that the
cord may be properly nourished and the progress of the disease checked.
Careful relaxation of the contracted spinal muscles unquestionably has
a potent effect upon the cord circulation, which tends to check and
retard degenerative processes. Treatment of the limbs directly will be
found a help, as well as direct treatment of all tissues paralyzed. If
swallowing is impossible, the patient should be fed through the rectum,
or by the stomach or nasal tube. See that the patient is carefully
nursed. Massage is beneficial.