Parasympathetic insufficiency

Parasympathetic outlined by the insufficiency due to various reasons, Deputy sympathetic activity and reduce the performance of the integrated clinical symptoms main expression of paralytic Mydriasis, voiding dysfunction and impotence. Cause pathogenesis one. Paralytic Mydriasis reasons : (1) orbital lesions : thrombotic phlebitis, Periostitis, Traumatic fractures. (2) skull base : meningitis, especially syphilitic meningitis, fractures, aneurysms, metastatic carcinoma. (3) the brain lesions associated with brain damage were : tumor, brain hemorrhage, cerebral thrombosis accompanied the foot of the brain lesion. (4) nuclear oculomotor nerve disease : Most sclerosis, epidemic encephalitis, and so on. These lesions enable E-M's nuclear oculomotor nerve fibers or ciliary ganglion damage Under the oculomotor nerve fibers sympathetic excitatory weakened or disappeared, the release of acetylcholine Quan reduce or not to release, so that the pupil to expand about muscle weakness, Pupil expand. 2. Dysuria reasons : (a) spinal cord lesions micturition reflex arc : Spinal cord prolapse trauma, Cauda equina tumor, arachnoid - yim, Spinal tuberculosis. These lesions reflex arc so damaged, reflecting the disruption caused tension-type bladder. (2) spinal cord lesions : acute myelitis, trauma, spinal arachnoid Yan, multiple sclerosis and so on. These lesions upper neurons inhibit lifted, as S2-4 is not damaged, reflex voiding surviving. (3) brain lesions : multiple sclerosis, encephalitis, Parkinson's disease, the frontal lobe lesions, brain trauma, brain hardening of the arteries. These lesions damage to the central urinating on motor neurons or their downlink fiber, not completely damaged, right bladder reflex was decreased, the absence of inhibition neurogenic bladder. 3. Sexual dysfunction or disappeared causes : (a) spinal cord diseases : cancer, spinal tuberculosis. (2) Vice erectile sympathetic nerve damage : spinal tuberculosis, diabetes and other neuritis. These lesions damage the under-reflex pathway caused impotence. A clinical performance. Paralytic Mydriasis, light reflex reflector and the role of regulation, 2.5% with methacholine eye can Miosis. Accompanied oculomotor nerve palsy symptoms : on the face sag, exotropia, were diplopia, not inward and upward movement. 2. Voiding Dysfunction : dysuria as delayed or intermittent urinary voiding dysfunction; Urinary frequency; urgency of urination as urgent urination or involuntary urination; Urine wandering stay; urinary incontinence; automatically voiding such. Lesions were different and dysuria performance not the same. 3. Sexual function weakening or disappearance of the main manifestations of impotence. A differential diagnosis, paralyzing Mydriasis (1) cavernous sinus thrombosis phlebitis (see chapter II). (2) superior orbital fissure syndrome (superior orbital fissure syndrome ) and the orbital apex syndrome (orbital apex syndrome) as vice sinusitis caused the spread of supraorbital crack or hole optic nerve caused the periosteum. Superior orbital fissure syndrome mainly for eye movement, pulleys and outreach nerve and the trigeminal nerve Supporting the dysfunction, But not the performance of local inflammation, if both the visually impaired to the orbital apex syndrome. (3) meningitis (meningitis) can be seen eye movement, pulleys, the abducens nerve palsy symptoms, also have a fever, headache, vomiting, neck stiffness, meningeal irritation and cerebrospinal fluid changes. A syphilitic who can be seen pupil Rose (narrow dark hole, light reaction disappear, regulating reflection existence). (4) a clear fracture of the skull base traumatic history, nasal or ear canal is BCSF outflow, eyelids purple exophthalmos. And the superior orbital fissure optic Kong fractures can lead to the optic nerve, Oculomotor, Trochlear nerve and the outer nerve, Supporting the trigeminal nerve paralysis performance. X-ray and CT brain diagnosis. (5) the skull base aneurysm was particularly prevalent in Central cerebral artery aneurysm, carotid artery aneurysm, posterior cerebral aneurysm, cerebellar artery aneurysm, posterior communicating artery aneurysm could lead to oculomotor nerve palsy. Performance of major muscle paralysis, the pupil to expand, fixed, the affected eye pain and headache, ptosis. Brain CT scan, MRI, DSA or cerebral angiography can be diagnosed. (6) brain tumor (brain tumur) of primary brain tumors nuclear oculomotor nerve damage caused oculomotor Ma weakness; hemispheric tumors in the Atrium hiatal hernia oculomotor nerve palsy caused ipsilateral and contralateral hemiplegia; sphenoid ridge meningiomas involving the medial superior orbital fissure, parasellar tumor oppression cavernous, the slope of chordoma, pineal tumors, pituitary tumors, craniopharyngiomas are oppressed eye movement, pulleys, outreach and the trigeminal nerve paralysis occurred. while the increased intracranial pressure performance and focal symptoms. Brain CT and MRI can clearly diagnose. (7) cerebral hemorrhage and cerebral thrombosis (cerebral huemorrhage and cerbr ac ehrombosis) middle age disease, the rapid onset, brain edema serious Atrium hernia oppression to make it oculomotor nerve palsy, brain hemorrhage nuclear oculomotor nerve damage, coma for performance, vomiting, limb paralysis, sensory dysfunction, pathology and other levies. Brain CT or MRI can clearly diagnose. (8) epidemic encephalitis (epidemic encephalitis) rapid onset, more common in young people, have a fever, headache, vomiting, somnolence, syncope, seizures, meningeal irritation and pathological sign, oculomotor nerve damage brain nuclear arise oculomotor nerve palsy symptoms. (9) multiple sclerosis (multiple sclerosis) occurred in 20 ~ 40 years old female, multiple lesions, and mitigation course often relapse, subacute onset, the lesions were different, different clinical manifestations. ① mental disorders; ② cranial nerve dysfunction; ③ sensory dysfunction; ④ movement disorders; ⑤ language barrier; ⑥ minority patients have urinary frequency, urgency and urge the late urinary retention, urinary incontinence, some impotence and loss of libido. Brain or spinal CT, MRI, myelography to differentiate. 2. urination and sexual dysfunction (1) Spinal cord prolapse (meningomyelocele) lumbar bottom can see protruding from the basement broad, unilateral or bilateral lower extremity entirely or completely flaccid paralysis or sensory loss, anal reflex, sphincter relaxation, incontinent, some with hydrocephalus, or clubfoot. (2) spinal cord injury have a clear history of trauma, spinal shock earliest. Following damaged plane feeling, movement disorders and voiding dysfunction, autonomic dysfunction. Spinal X-ray diagnostic help. (3) spinal cord tumors (spinal tumor) Mawei slow tumor onset, development, a bilateral sciatica, saddle-perineal feeling disappeared and two leg weakness, sphincter obstacles, often urinary retention, bladder paralysis and impotence. Above spinal cord tumors and spinal cord compression levy reflex neurogenic bladder, does not affect more sexual function. CSF was light yellow, protein increased Quaker's test (1), spinal CT, MRI, angiography can be diagnosed. (4) spinal arachnoid Yan (spinal SA) long course and slow progress, Cystic a remission period. Symptoms as a casual or short-term in nature sensory dysfunction, a wider scope and level is not fixed, the more obvious barriers to movement, accompanied muscular atrophy. Mawei lesions to the sexual performance of sciatica, significantly lower limb atrophy, myasthenia gravis, or weakened tendon reflexes disappear and sensory loss, sphincter dysfunction. CSF protein increased, leukocytosis Quaker's test (1), myelography can be diagnosed. (5) acute myelitis (acutemyelitis) rapid onset, accompanied general malaise, fever, muscle soreness, spinal cord damage symptoms suddenly appeared, a few hours to several days peaked plane involved more clearly, limbs were flaccid paralysis, combined with sensory and sphincter barrier. CSF leukocytosis, monocytes and lymphocytes mainly protein slightly increased. (6) Spinal Tuberculosis (tabesdorsalis) syphilis infection, the lightning-like pain, physical constrictions sense of deep feeling of obstacles, A-Rose pupil sphincter dysfunction. S2-4 segment of root damage to the bladder sensory impact, filling urinary retention or incontinence. Impotence may be feeling and ataxia, cerebrospinal fluid FTA-Abs positive.