WordNet

of critical importance and consequence; "an acute (or critical) lack of research funds"
having or demonstrating ability to recognize or draw fine distinctions; "an acute observer of politics and politicians"; "incisive comments"; "icy knifelike reasoning"; "as sharp and incisive as the stroke of a fang"; "penetrating insight"; "frequent penetrative observations" (同)discriminating, incisive, keen, knifelike, penetrating, penetrative, piercing, sharp
extremely sharp or intense; "acute pain"; "felt acute annoyance"; "intense itching and burning" (同)intense
having or experiencing a rapid onset and short but severe course; "acute appendicitis"; "the acute phase of the illness"; "acute patients"
of an angle; less than 90 degrees
drooping without elasticity; wanting in stiffness; "a flaccid penis"
loss of the ability to move a body part (同)palsy

PrepTutorEJDIC

(先の)『鋭い』,とがった / (痛み・感情などが)『激しい』,強い / (知力・感覚などが)『鋭い』,鋭敏な / (事態が)重大な / (病気が)急性の / (音が)高い,鋭い / 鋭角の
(筋肉などが)たるんだ / (人・性格などが)気力(覇気)のない,柔弱な
(体の)麻痺(まひ),中風 / (…の)停滞《+『of』+『名』》

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/08/20 11:18:38」(JST)

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Flaccid paralysis /ˈflæksɪd pəˈræləsɪs/ is a clinical manifestation characterized by weakness or paralysis and reduced muscle tone without other obvious cause (e.g., trauma).^[1] This abnormal condition may be caused by disease or by trauma affecting the nerves associated with the involved muscles. For example, if the somatic nerves to a skeletal muscle are severed, then the muscle will exhibit flaccid paralysis. When muscles enter this state, they become limp and cannot contract. This condition can become fatal if it affects the respiratory muscles, posing the threat of suffocation.^[2]

Causes

Polio

The term acute flaccid paralysis (AFP) is often used to describe a sudden onset, as might be found with polio.

AFP is the most common sign of acute polio, and used for surveillance during polio outbreaks. AFP is also associated with a number of other pathogenic agents including enteroviruses, echoviruses, and adenoviruses, among others.^[3]

Botulism

The Clostridium botulinum bacteria are the cause of botulism. Vegetative cells of C. botulinum may be ingested. Introduction of the bacteria may also occur via endospores in a wound. When the bacteria are in vivo, they induce flaccid paralysis. This happens because C. botulinum produces a toxin which blocks the release of acetylcholine. Botulism toxin blocks the exocytosis of presynaptic vesicles containing Acetylcholine (ACh).^[2] When this occurs, the muscles are unable to contract.^[4] Other symptoms associated with infection from this neurotoxin include double vision, blurred vision, drooping eyelids, slurred speech, difficulty swallowing, dry mouth, and muscle weakness. Botulism prevents muscle contraction by blocking the release of ACh, thereby halting postsynaptic activity of the neuromuscular junction. If its effects reach the respiratory muscles, then it can cause respiratory failure, leading to death.^[5]

Curare

Curare is a poison that comes from a plant grown in the rainforests of South America. The people of South America crush and cook the roots and stems of curare and then mix it with venom from other plants and animals to create a poisonous syrup mixture that they put on the tips of their arrows. This poison has also been used by South Americans to treat madness, dropsy, edema, fever, kidney stones, and bruises.^[6] Curare acts as a neuromuscular blocking agent which induces flaccid paralysis. This poison binds to the Acetylcholine (ACh) receptors on the muscle, blocking them from binding to ACh. As a result, ACh accumulates within the neuromuscular junction, but since ACh cannot bind to the receptors on the muscle, the muscle cannot be stimulated. This poison must enter the bloodstream for it to work. If curare affects the respiratory muscles, then its effects can become fatal, placing the victim at risk for suffocation.^[2]

Other

Flaccid paralysis can be associated with a lower motor neuron lesion. This is in contrast to an upper motor neuron lesion, which often presents with spastic paralysis, although early on this may present with flaccid paralysis. Included in AFP's list are Poliomyelitis (Polio), Transverse myelitis, Guillain-Barré syndrome, enteroviral encephalopathy,^[7] traumatic neuritis, Reye's syndrome, etc. An AFP Surveillance programme is conducted to increase case yield of poliomyelitis. This includes collection of 2 stool samples within 14 days of onset of paralysis and identification of virus. and control of the outbreak and strengthening immunisation in that area.

Venomous snakes that contain neurotoxic venom such as kraits, mambas, and cobras can also cause complete flaccid paralysis.^{[citation needed]}

References

^ Alberta Government Health and Wellness (2005) Acute Flaccid Paralysis Public Health Notifiable Disease Management Guidelines.
^ ^a ^b ^c Saladin, Kenneth S. Anatomy & Physiology: The Unity of Form and Function. McGraw-Hill. 6th Edition. 2012.
^ Kelly H, Brussen KA, Lawrence A, Elliot E, Pearn J, Thorley B (2006). "Polioviruses and other enteroviruses isolated from faecal samples of patients with acute flaccid paralysis in Australia, 1996-2004". Journal of paediatrics and child health 42 (6): 370–6. doi:10.1111/j.1440-1754.2006.00875.x. PMID 16737480.
^ Disease Listing, Botulism, General Information | CDC Bacterial, Mycotic Diseases
^ "flaccid paralysis - definition of flaccid paralysis in the Medical dictionary - by the Free Online Medical Dictionary, Thesaurus and Encyclopedia". Medical-dictionary.thefreedictionary.com. Retrieved 2014-02-26.
^ "Curare - Chondrodendron tomentosum". Blueplanetbiomes.org. Retrieved 2014-02-26.
^ Anis-ur-Rehman, Idris M, Elahi M, Jamshed, Arif A (Jan–Mar 2007). "Guillain Barre syndrome: the leading cause of acute flaccid paralysis in Hazara division". J Ayub Med Coll Abbottabad 19 (1): 26–8. PMID 17867475.

External links

Approach to Acute Flaccid Paralysis (Diagnosis, Management etc.)
WHO Programme for Immunization Preventable Diseases (IPD) A Collaboration between World Health Organization and Government of Nepal
ACUTE FLACCID PARALYSIS information from the IPD
National Polio Surveillance Project of India
"Progress towards poliomyelitis eradication, Nepal, 1996-1999". Wkly. Epidemiol. Rec. 74 (42): 349–53. October 1999. PMID 10895300.
Centers for Disease Control and Prevention (CDC) (September 2002). "Acute flaccid paralysis syndrome associated with West Nile virus infection—Mississippi and Louisiana, July–August 2002". MMWR Morb. Mortal. Wkly. Rep. 51 (37): 825–8. PMID 12353741.
Sejvar JJ, Leis AA, Stokic DS et al. (July 2003). "Acute Flaccid Paralysis and West Nile Virus Infection". Emerging Infect. Dis. 9 (7): 788–93. doi:10.3201/eid0907.030129. PMC 3023428. PMID 12890318.
Saeed M, Zaidi SZ, Naeem A et al. (2007). "Epidemiology and clinical findings associated with enteroviral acute flaccid paralysis in Pakistan". BMC Infect. Dis. 7: 6. doi:10.1186/1471-2334-7-6. PMC 1804272. PMID 17300736.

Look up flaccid in Wiktionary, the free dictionary.

UpToDate Contents

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1. ポリオおよび前角細胞への感染性疾患 polio and infectious diseases of the anterior horn
2. 小児におけるギラン・バレー症候群の疫学、臨床症状、および診断 epidemiology clinical features and diagnosis of guillain barre syndrome in children
3. 筋力低下を呈する小児の病因および評価 etiology and evaluation of the child with muscle weakness
4. 成人におけるギラン・バレー症候群の臨床的特徴および診断 clinical features and diagnosis of guillain barre syndrome in adults
5. 横断性脊髄炎 transverse myelitis

English Journal

Prolonged ventilatory failure and flaccid quadriparesis after ingestion of poison hemlock.

Lung DD, Scott BJ, Wu AH, Gerona RR.SourceDepartment of Emergency Medicine, University of California, San Francisco, 1001 Potrero Avenue, Room 1E21, San Francisco, California, 94110, USA.
Muscle & nerve.Muscle Nerve.2013 Nov;48(5):823-7. doi: 10.1002/mus.23916. Epub 2013 Aug 30.
Introduction: A 28-year-old man presented with acute flaccid paralysis and respiratory failure that persisted for 2 weeks after suicidal ingestion of unknown substances. Methods: Extensive clinical, nerve, laboratory, and neuroimaging testing excluded alternative causes of this neuromuscular syndrom
PMID 23733387

Complete genome sequence of the last representative genotype of wild indigenous poliovirus type 1, which circulated in Brazil.

Tavares FN, da Costa EV, Kew OM, da Silva EE.SourceLaboratório de Enterovírus, Instituto Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, Rio de Janeiro, Brazil.
Genome announcements.Genome Announc.2013 Oct 31;1(6). pii: e00811-13. doi: 10.1128/genomeA.00811-13.
Polioviruses are the major etiological agents associated with acute flaccid paralysis (AFP). The complete genome sequence of a representative of the last wild poliovirus type 1 genotype isolated in Brazil from a paralytic poliomyelitis case is reported here.
PMID 24179117

Clinico-radiological spectrum in enterovirus 71 infection involving the central nervous system in children.

Lee KY, Lee YJ, Kim TH, Cheon DS, Nam SO.SourceDepartment of Pediatrics, Ulsan University Hospital, University of Ulsan College of Medicine, 290-3 Jeonha-dong, Dong-gu, Ulsan 682-714, Republic of Korea. Electronic address: pdsnoopy@naver.com.
Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia.J Clin Neurosci.2013 Oct 26. pii: S0967-5868(13)00387-1. doi: 10.1016/j.jocn.2013.04.032. [Epub ahead of print]
Enterovirus 71 infection causes hand, foot and mouth disease in children, and can produce diverse neurologic complications. Epidemics occurring in Korea between 2009 and 2012 resulted in the death of some patients. The present study aimed to clarify the correlation between clinical features and MRI
PMID 24169271

Japanese Journal

Methotrexate髄注後に急性脳脊髄炎を発症して重篤な神経障害を残した急性リンパ性白血病

西川拓朗,岡本康裕,丸山慎介,田邊貴幸,倉内宏一郎,児玉祐一,中川俊輔,新小田雄一,河野嘉文
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症例は維持療法中の急性リンパ性白血病の4歳女児。21回目のmethotrexate髄注(it-MTX)の投与を受けた日から頭痛と腰痛，翌日からは両足の痺れと痛みが出現した。次第に手の痺れも出現し，発熱して髄注後8日目に入院となった。抗菌薬投与で翌日には解熱したが，下肢は麻痺し尿閉となった。髄注後12日目には上肢も麻痺し，終には痙攣し，意識障害となった。MRI検査では大脳皮質，脊髄前角に異常信号を認 …
NAID 130004705980

チロシンキナーゼ阻害薬で分子学的寛解を7ヶ月間維持したフィラデルフィア染色体陽性急性リンパ性白血病

高橋徹,重岡徹,鈴川宗弘,石堂亜希,富永貴元
臨床血液 54(2), 210-213, 2013
患者は28歳，男性。フィラデルフィア染色体陽性急性リンパ性白血病(Ph+ALL)の寛解導入療法早期に重症感染症を合併しICU管理となり，イマチニブも含めた化学療法を中断した。感染症は改善したが弛緩性四肢麻痺による著しい脱力と運動機能低下が判明し，重症感染後に続発したミオパチーである経過からcritical illness myopathy (CIM)の診断に至った。Ph+ALLは第42病日には分子 …
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急性腹膜炎術後に発症したcritical illness polyneuropathyの1例

松井大輔,木下淳,二宮致,伏田幸夫,藤村隆,太田哲生
日本臨床外科学会雑誌 74(6), 1704-1708, 2013
症例は77歳，女性．嘔吐を主訴に救急外来を受診し，イレウスの診断で保存的加療が行われるも経過中に敗血症性ショックとなり，閉塞性大腸炎に伴う大腸壊死の診断で緊急手術を施行した．開腹所見ではS状結腸に憩室炎による狭窄を認め，口側の結腸は著明に拡張し，広範な虚血・壊死に陥っていたため，結腸亜全摘・回腸人工肛門造設術を施行した．術後，全身状態は改善するも，意識障害の遷延と四肢の弛緩性麻痺を認めた．CT/M …
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