Paraplegia

Paraplegia: Excerpt from In a Page: Signs and Symptoms

Paralysis is the total loss of voluntary motor function of an affected area and most frequently indicates a serious neurologic problem in the site of distribution of the affected area. The key to correct diagnosis of paralytic syndromes is knowledge of the neurologic pathways and dermatomes, so the site of the problem can be defined anatomically, after which a focused imaging examination can define the specific etiology.

Differential Diagnosis

• Myelopathy
  –Compressive (e.g., spondylytic, spinal epidural abscess or hematoma)
  –Traumatic
  –Metabolic (e.g., vitamin B₁₂ deficiency)
  –Infectious (e.g., HIV or other viral myelitis, botulism)
  –Inflammatory (e.g., multiple sclerosis, SLE, vasculitis, transverse myelitis)
  –Vascular (spinal cord or cerebral infarct)
  –Neoplastic
• Congenital
  –Dysraphism: Spina bifida, tethered cord
  –Cerebral palsy
• Syringomyelia
• Cauda equina syndrome
  –Caused by compression of the cauda equina, often by a central disc herniation
  –Variable presentation with lower extremity weakness, sensory loss, pain, lower motor neuron findings on examination, and bowel/bladder disturbances
• Polyradiculopathy
• Peripheral neuropathy
  –Usually results in a chronic or insidious onset of lower extremity weakness (except Guillain-Barré syndrome, which may result in weakness over hours to days)
  –Guillain-Barré syndrome: Also results in upper extremity weakness
  –Myasthenia gravis
  –Eaton-Lambert syndrome
  –Amyotrophic lateral sclerosis
  • HTLV-I associated myelopathy
  • Hereditary spastic paraparesis
  • Spinocerebellar or Friedreich's ataxia
  • Myopathies (e.g., muscular dystrophy) may result in paraparesis, but usually also result in upper extremity weakness
  • Parafalcine meningioma
    –May result in bilateral lower extremity weakness by compressive effects on the medial frontal lobe bilaterally
  • Bilateral anterior cerebral artery infarction
  • Medications (e.g., pancuronium)
  • Periodic paralysis (secondary to hyper- or hypokalemia)
  • Tick paralysis
  • Lyme disease
  • Psychogenic (e.g., conversion disorder)

  Workup and Diagnosis

  • History and physical examination
    –Determine whether the weakness is more likely secondary to an upper or a lower motor neuron disorder (e.g., symmetric lower extremity weakness with hyperreflexia, positive Babinski's signs, and a dermatomal area of sensory loss suggests a myelopathy, whereas symmetric lower extremity weakness with areflexia and flexor plantar responses suggests a peripheral neuropathy; difficulty with bowel and/or bladder control suggests a myelopathy or cauda equina syndrome)
  • MRI is the usually the best imaging modality
    –Acute paraplegia/paraparesis is suggestive of an acute myelopathy or polyradiculopathy, and prompt imaging is required to identify surgically treatable lesions
  • EMG/nerve conduction studies to evaluate for possible neuropathy, polyradiculopathy, or myopathy
  • CSF examination may show signs of infection, elevated protein in Guillain-Barré syndrome, or findings consistent with multiple sclerosis (e.g., oligoclonal bands)
  • Laboratory testing may include CBC, electrolytes, calcium, glucose, ESR, vitamin B₁₂, folate, ANA
  • DNA testing is available for many of the inherited ataxias
  • Genetic testing

  Treatment

  • Paralysis or paraplegia is best managed by identifying and treating the underlying cause
    –In cases of compressive lesions of the spinal cord, cauda equina, or nerve roots, surgical therapy is usually required
    –Traumatic spinal cord injury often requires surgical stabilization; also, acute high-dose steroid treatment is effective in improving outcomes of traumatic myelopathy
  • Spinal dysraphism is often treated surgically
  • Infectious myelopathies: Antimicrobial agents
  • Multiple sclerosis: Acute exacerbations may be treated with steroids; prevent exacerbations with interferons, glatiramer acetate, and mitoxantrone
  • Guillain-Barré syndrome: Plasmapheresis or IVIG within 2 weeks of onset of symptoms
  • Physical therapy, assistive devices, orthotics, and wheelchairs may all be beneficial in improving the functional abilities of patients with paraplegia/paresis

Book Source Details

• Book Title: In a Page: Signs and Symptoms
• Author(s): Scott Kahan, Ellen G. Smith
• Year of Publication: 2004
• Copyright Details: In a Page: Signs and Symptoms, Copyright © 2004 Lippincott Williams & Wilkins.

More About Paraplegia

• Back to disease: Paraplegia: Introduction
• Next Book Extract About Paraplegia: Facial Paralysis & Bell's Palsy (In a Page: Signs and Symptoms)
• More Book Extracts: All Online Books for Paraplegia

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

More About This Book: Title: In a Page: Signs and Symptoms Authors: Scott Kahan, Ellen G. Smith Publisher: Lippincott Williams & Wilkins Copyright: 2004 ISBN: 1-4051-0368-X

 » Next page: Facial Paralysis & Bell's Palsy (In a Page: Signs and Symptoms)

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• Facial Paralysis & Bell's Palsy (In a Page: Signs and Symptoms)
• Facial Paralysis (In A Page: Pediatric Signs and Symptoms)
• FACIAL PARALYSIS (Differential Diagnosis in Primary Care)
• WEAKNESS OR PARALYSIS OF ONE OR MORE EXTREMITIES (Differential Diagnosis in Primary Care)
• EXTREMITY MASS (Differential Diagnosis in Primary Care)

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