MONOPLEGIA
MONOPLEGIA: Excerpt from Algorithmic Diagnosis of Symptoms and Signs
Ask the Following Questions:
- Are there hyperactive or pathologic reflexes of the involved extremity? These findings suggest spinal cord tumor, parasagittal tumor, amyotrophic lateral sclerosis, anterior cerebral artery occlusion, spinal cord injury, transverse myelitis, and multiple sclerosis.
- Are there decreased or absent reflexes of the involved extremity? These findings suggest a herniated disk, a cauda equina tumor or early cervical cord tumor, progressive muscular atrophy, brachial plexus neuropathy, sciatic neuritis, or peripheral neuropathy.
- Is the onset acute or gradual? An acute onset would suggest a vascular lesion such as anterior cerebral artery occlusion, a spinal cord injury, transverse myelitis, and multiple sclerosis. A gradual onset suggests a space-occupying lesion such as spinal cord tumor, parasagittal tumor, and degenerative diseases such as amyotrophic lateral sclerosis.
- Are there exacerbations or remissions? The presence of exacerbations or remissions should suggest multiple sclerosis, transient ischemic attack, and migraine.
DIAGNOSTIC WORKUP
Monoplegia of the upper extremities with hyperactive reflexes should suggest the need to order a CT scan or MRI of the brain and/or MRI of the cervical spine.
Monoplegia of the lower extremities with hyperactive reflexes or pathologic reflexes would suggest the need to order MRI of the thoracic spine. However, because an anterior cerebral artery occlusion or parasagittal tumor may cause similar findings, a CT scan of the brain may be necessary. Rather than make this difficult choice yourself, a neurologist should be consulted. He may want to do a spinal fluid analysis or evoked potential studies as well. If he believes a vascular lesion is possible, then he may want to do a four-vessel angiography or simply a carotid scan.
The findings of monoplegia with hypoactive reflexes, especially of gradual onset, would suggest a radiculopathy, peripheral neuropathy, or plexopathy. In the lower extremities, these findings would indicate the need for a CT scan or MRI of the lumbosacral spine. In the upper extremities, these findings would suggest the need for MRI of the cervical spine.
A neuropathy workup is also indicated in monoplegia of the upper or lower extremity. Nerve conduction velocity studies and EMG studies of the involved extremities are extremely valuable also. The most cost-effective approach is to refer the patient to a neurologist at the outset.
Book Source Details
- Book Title: Algorithmic Diagnosis of Symptoms and Signs
- Author(s): R. Douglas Collins
- Year of Publication: 2003
- Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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