Subject(s)
Aged , Female , Humans , Dermatomyositis , Diarrhea , Quadriplegia , Acute Kidney Injury/complications , Anti-Bacterial Agents/therapeutic use , Biopsy , Dermatomyositis/complications , Dermatomyositis/pathology , Diarrhea/drug therapy , Diarrhea/pathology , Fatal Outcome , Quadriplegia/complications , Quadriplegia/pathologyABSTRACT
The upper chest wall does not grow properly in children with spinal muscular atrophy (SMA) with paradoxical breathing. This suggests that long-term inability to take a deep breath in developing children may result in underdevelopment of the upper chest wall. In addition, a rapid and paradoxical breathing pattern is frequently observed in children with severe cerebral palsy (CP), which often corresponds to the underdevelopment of the upper chest wall. The present study is designed to evaluate the ratio of the upper to lower chest wall in children with severe spastic quadriplegic CP, compared with normal children. We compared normal children with children that had spastic quadriplegic CP who did not have kyphosis or scoliosis. Test subjects were matched in terms of age, height, and weight. The diameters of upper chest (D(apex)) and of lower chest (D(base)) were measured on the anteroposterior (AP) view of a chest X-ray and the D(apex) to D(base) ratio was calculated. In selected cases the forced vital capacity (FVC) was measured using a Wright Respirometer. The D(apex) to D(base) ratio was significantly lower in the CP group than in the control group (p < 0.001). The ratio increased linearly with age (p < 0.001) in both CP (R = 0.372) and control groups (R = 0.477). The FVC/preFVC showed significant correlation with the D(apex) to D(base) ratio (R = 0.542, p < 0.01). The results of this study suggest a deviation of optimal chest wall structure in children with spastic quadriplegic CP.
Subject(s)
Male , Humans , Female , Child, Preschool , Child , X-Rays , Vital Capacity , Time Factors , Thoracic Wall , Thoracic Cavity , Respiratory Tract Diseases/pathology , Respiration , Quadriplegia/pathology , Muscle Spasticity/pathology , Lung/pathology , Forced Expiratory Volume , Cerebral Palsy/pathology , Case-Control StudiesABSTRACT
Two patients developed the locked-in state characterised by quadriplegia and mutism with an alert sensorium. Initially they had mild dysarthria and uncrossed hemisensory or hemimotor deficits involving the face and ipsilateral extremities. Both patients died. Rostral brainstem infarctions were found at autopsy in them. Acute onset of uncrossed hemisensory and hemimotor deficits with dysarthria may be caused by infarction of the pons which may predispose to locked-in state.