SPASTICITY

SPASTICITY: Excerpt from Differential Diagnosis in Primary Care

This is hypertonicity of the muscle and is almost invariably due to a lesion along the pyramidal tract from the spinal cord to the brain. Knowledge of neuroanatomy is extremely useful in developing a differential diagnosis. Spinal cord. This prompts the recall of space-occupying lesions of the spinal cord, amyotrophic lateral sclerosis, Friedreich ataxia, transverse myelitis, neurosyphilis, multiple sclerosis, and anterior spinal artery occlusion. Advanced syringomyelia may also be a cause. Brainstem. Common causes of spasticity originating here include brainstem tumors, hemorrhage, basilar artery thrombosis, multiple sclerosis, bulbar amyotrophic lateral sclerosis, encephalomyelitis, and neurosyphilis. Cerebral hemispheres. Once again, space-occupying lesions are important to recall but hemorrhage, embolism, and thrombosis are also prominent causes. In children it is wise to consider cerebral palsy, encephalitis, and Schilder disease. There are many degenerative disorders of the cerebrum that eventually develop spasticity, but the diagnosis will be well established by that time. Multiple sclerosis that predominantly involves the cerebral cortex also is unlikely to cause spasticity until late in the course of the disease. Miscellaneous. The Stiffman syndrome is associated with stiffness of the muscles of the neck, trunk, and extremities. The location of the lesion is unknown.

Approach to the Diagnosis

After the level of the lesion is established, an MRI or CT scan of that area can be ordered. A neurologist should be consulted first. A spinal tap will be useful in establishing the diagnosis of multiple sclerosis, encephalitis, and neurosyphilis if a space-occupying lesion has been ruled out.

Other Useful Tests

1. MRA (cerebrovascular disease)
2. Evoked potential (VEP), brainstem evoked potential (BSEP) (multiple sclerosis)
3. Carotid duplex scans (carotid stenosis or occlusion)
4. Four-vessel cerebral angiography (cerebrovascular disease)
5. CBC, serum B12 (pernicious anemia)

Book Source Details

• Book Title: Differential Diagnosis in Primary Care
• Author(s): R. Douglas Collins MD, FACP
• Year of Publication: 2007
• Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2007 Lippincott Williams & Wilkins.

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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: Differential Diagnosis in Primary Care Authors: R. Douglas Collins MD, FACP Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 0-7817-6812-8

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