10/27/2010

La Fatiga Es el más común de los síntomas en las personas con SPP pero...


También el dolor oseaoarticular, hay personas que mantienen mayormente "dolor continuo" y no tienen fatiga, lo que considero que es más frecuente es la "fatiga Mental" Brain fatigue, cada individuo manifiesta uno o más síntomas que otros. No podemos generalizar cual síntoma es el que todos padecen más.

Personalmente considero que solamente con un diagnostico bien realizado, nos podría brindar datos  más exactos de los síntomas que los  pacientes en México, padecen más.
Estos son datos de USA. Liliana Marasco Garrido
Post-polio syndrome
Post-polio syndrome (PPS) can cause a wide range of symptoms, some of which are more common than others. These are explained below.

Common symptoms of PPS

Fatigue

Fatigue is the most common symptom of PPS. Fatigue can take many forms in PPS, including:
  • muscle fatigue, where your muscles feel very tired and heavy, particularly after physical activity
  • general fatigue, where you feel an overwhelming sense of physical exhaustion as if you have not slept for days
  • mental fatigue, where you find it increasingly difficult to concentrate, have problems remembering things and make mistakes that you would not usually make
Symptoms of fatigue are usually worse in the early afternoon and can often be improved with rest or brief naps.

Muscle weakness

Increasing muscle weakness is another common symptom of PPS. It can be easy to confuse muscle weakness with muscle fatigue, but they are different.
Muscle weakness means that you are increasingly unable to use affected muscles, whether you feel fatigued or not. Weakness can occur in muscles that were previously affected by an active polio infection, as well as in muscles that were not previously affected.
There may also be associated shrinking (atrophy) of affected muscles.

Muscle and joint pain

Muscle and joint pain is also common in PPS. Muscle pain is usually experienced as a deep ache in the muscles and/or muscle cramps and spasms.
The pain is often worse after you have used the affected muscles. Therefore, it can be particularly troublesome during the evening after a day’s activities.
Joint pain is similar to arthritis, consisting of soreness, stiffness and a reduced range of movement.

Associated symptoms

As well as the common symptoms of PPS, there are a number of associated symptoms that arise from the combination of fatigue, muscle weakness and muscle and joint pain. These are explained below.

Weight gain

Due to the combination of fatigue, muscle weakness and muscle and joint pain, most people with PPS become less physically active than they used to be. This can often lead to weight gain and, in some cases, obesity. This in turn can make the symptoms of fatigue, muscle weakness and pain worse.

Walking difficulties

As well as weight gain, the combination of fatigue, weakness and pain can lead to walking difficulties and increasing difficulties with mobility. Many people with PPS will require a walking aid, such as crutches or a cane, at some stage and some people may eventually require the use of a wheelchair.

Sleep apnoea

Sleep apnea affects many people with PPS. It is a condition in which the muscles in your throat relax during sleep.
Once the muscles relax, the airway in your throat can narrow or become totally blocked. This interrupts the oxygen supply to your body, which triggers your brain to pull you out of deep sleep so that your airway can be reopened and you can breathe normally.
As you need a certain amount of deep sleep for your body and mind to be fully refreshed, having only limited episodes of deep sleep will cause you to feel very tired the next day.

Swallowing problems

Weakness in the muscles you use for chewing and swallowing may lead to problems swallowing (dysphagia), such as choking or gagging when trying to swallow.
You may experience changes in your voice and speech, such as hoarseness, low volume or a nasal-sounding voice, particularly after you have been speaking for a while or when you are tired. 
Usually, swallowing problems are mild and progress very slowly. A speech and language therapist may be able to help.

Sensitivity to cold

Some people with PPS find that one particular part of their body, usually a limb, becomes very sensitive to the effects of cold temperature or a sudden drop in temperature.
Due to this intolerance to cold, you may need to add extra layers of clothing to the affected body part.

The Polio Crusade

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Erradicación de La poliomielitis

Polio Tricisilla Adaptada

March Of Dimes Polio History

Dr. Bruno

video

movie

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A 41-year-old man developed an acute illness at the age of 9 months during which, following a viral illness with headache, he developed severe weakness and wasting of the limbs of the left side. After several months he began to recover, such that he was able to walk at the age of 2 years and later was able to run, although he was never very good at sports. He had stable function until the age of 18 when he began to notice greater than usual difficulty lifting heavy objects. By the age of 25 he was noticing progressive difficulty walking due to weakness of both legs, and he noticed that the right calf had become larger. The symptoms became more noticeable over the course of the next 10 years and ultimately both upper as well as both lower limbs had become noticeably weaker.

On examination there was wasting of the muscles of upper and lower limbs on the left, and massively hypertrophied gastrocnemius, soleus and tensor fascia late on the right. The calf circumference on the right exceeded that on the left by 10 cm (figure1). The right shoulder girdle, triceps, thenar eminence and small muscles of the hand were wasted and there was winging of both scapulae. The right quadriceps was also wasted. The wasted muscles were also weak but the hypertrophied right ankle plantar flexors had normal power. The tendon reflexes were absent in the lower limbs and present in the upper limbs, although the right triceps was reduced. The remainder of the examination was normal.

Figure 1

The patient's legs, showing massive enlargement of the right calf and wasting on the left

Questions

1
What is that nature of the acute illness in infancy?
2
What is the nature of the subsequent deterioration?
3
What investigations should be performed?
4
What is the differential diagnosis of the cause of the progressive calf hypertrophy?

Answers

QUESTION 1

An acute paralytic illness which follows symptoms of a viral infection with or without signs of meningitis is typical of poliomyelitis. Usually caused by one of the three polio viruses, it may also occur following vaccination and following infections with other enteroviruses.1 Other disorders which would cause a similar syndrome but with upper motor neurone signs would include acute vascular lesions, meningoencephalitis and acute disseminated encephalomyelitis.

QUESTION 2

A progressive functional deterioration many years after paralytic poliomyelitis is well known, although its pathogenesis is not fully understood.2 It is a diagnosis of exclusion; a careful search for alternative causes, for example, orthopaedic deformities such as osteoarthritis or worsening scoliosis, superimposed neurological disorders such as entrapment neuropathies or coincidental muscle disease or neuropathy, and general medical causes such as respiratory complications and endocrinopathies.3

QUESTION 3

Investigations revealed normal blood count and erythrocyte sedimentation rate and normal biochemistry apart from a raised creatine kinase at 330 IU/l (normal range 60–120 IU/l), which is commonly seen in cases of ongoing denervation. Electromyography showed evidence of denervation in the right APB and FDI with polyphasic motor units and complex repetitive discharges, no spontaneous activity in the left calf and large polyphasic units in the right calf consistent with chronic partial denervation. Motor and sensory conduction velocities were normal. A lumbar myelogram was normal. Magnetic resonance imaging (MRI) scan of the calves is shown in figure2.

Figure 2

Axial T1 weighted MRI scan (TR 588 ms, TE 15 ms) of the calves, showing gross muscle atrophy and replacement by adipose tissue on the left, and hypertrophy of the muscles on the right, with only minor adipose tissue deposition

QUESTION 4

The differential diagnosis of the progressive calf hypertrophy is given in the box.

Causes of calf muscle hypertrophy

Chronic partial denervation

  • radiculopathy

  • peripheral neuropathy

  • hereditary motor and sensory neuropathy

  • spinal muscular atrophy

  • following paralytic poliomyelitis

    Neuromyotonia and myokymia

  • Isaac's syndrome

  • generalised myokymia

  • neurotonia

  • continuous muscle fibre activity due to: chronic inflammatory demyelinating polyradiculopathy, Guillain Barre syndrome, myasthenia gravis, thymoma, thyrotoxicosis, thyroiditis

    Muscular dystrophies

    Myositis

    Infiltration

  • tumours

  • amyloidosis

  • cysticercosis

    Link here