DIAGNOSIS CHECKLIST
for Paralysis symptoms

Why: to determine if acute or chronic.

Why: e.g. hemiplegia is complete loss of power of the limbs of one side and is usually, but not always due to a lesion within the brain such as a stroke or tumor; paraplegia is complete loss of power of both lower limbs and is usually due to a spinal cord lesion; facial paralysis is usually due to a lesion of the seventh cranial nerve.

Why: The terms hemiplegia and paraplegia strictly indicate total paralysis. Hemiparesis means weakness of the limbs of one side. Paraparesis means weakness of both lower limbs.

Why: may suggest migraine, transient ischemic attacks from the basilar artery or carotid artery disease, epilepsy.

Why: Sudden onset of hemiplegia would most commonly suggest a stroke (due to cerebral thrombosis, hemorrhage or embolism); however a contusion (bruising) of the spinal cord may also produce a sudden onset of paralysis. A history of trauma and a sudden onset of hemiplegia (complete loss of power of the limbs of one side) would suggest a subdural or epidural haematoma (blood clot pressing on the outside of the brain). A gradual onset of hemiplegia may suggest a brain tumor or brain abscess. A sudden onset of facial paralysis would suggest Bell's palsy, diabetic neuropathy and stroke as cause. If gradual onset of facial paralysis must consider acoustic neuroma, advancing petrositis, brain tumor or brain abscess.

Why: e.g. if still able to furrow the brow and wrinkle the forehead, the cause of the facial paralysis is most likely due to a brain stroke or brain tumor.

Why: would suggest a subdural or epidural haematoma (blood clot pressing on the outside of the brain) or a hemorrhage in the brain itself. Trauma to the head may also cause a fracture of the petrous temporal bone causing a facial nerve palsy.

Why: e.g. measles, chicken pox, mumps, rubella - may suggest Acute disseminated encephalitis.

Why: e.g. recent immunization with rabies, influenza, pertussis or smallpox vaccine may suggest acute disseminated encephalomyelitis.

Why: e.g. high blood pressure, high cholesterol, diabetes, smoking, family history, atrial fibrillation, cardiovascular disease, increasing age. Less well documented risk factors for stroke include oral contraceptive pill, obesity, stress, sedentary lifestyle, migraine and excessive alcohol consumption.

Why: e.g. berry aneurysm in brain, arteriovenous malformations in the brain, bleeding disorders, bacterial endocarditis, bacterial endocarditis, brain tumor, Marfan's syndrome, Ehlers -Danlos syndrome.

Why: e.g. if history of high blood pressure must consider a stroke (due to a cerebral hemorrhage, cerebral thrombosis or cerebral aneurysm); angina; intermittent claudication.

Why: e.g. some medications may increase the risk of thrombotic cerebrovascular disease such as the oral contraceptive pill and hormone replacement therapy; some medications can increase the risk of hemorrhagic stroke such as warfarin.

Why: Cigarette smoking is a major risk factor for thrombotic stroke.

Why: e.g. stroke, cerebral aneurysm.

Why: a painful joint or muscle disease may interfere with assessment of leg power.

Why: If facial paralysis is associated with complete loss of power of the limbs of one side of the body, should suspect a cause within the brain. If paralysis of the facial muscles is absent, more likely to suggest a cause in the spinal cord.

Why: If associated with hemiplegia may suggest cerebral abscess, venous sinus thrombosis or encephalitis. If associated with paraplegia may suggest venous sinus thrombosis, abscess of the spinal cord or myelitis. If associated with facial paralysis must consider mastoiditis or middle ear infection.

Why: may suggest brain cancer or metastasis, encephalitis, stroke.

Why: may suggest brain cancer or brain metastasis, subdural or extradural haematoma, stroke.

Why: If associated with facial paralysis should consider acoustic neuroma, petrositis, mastoiditis, herpes zoster and cholesteatoma.

Why: e.g. sudden onset of neurological deficit that lasts for less than 24 hours (average length of time is 5 minutes) with complete clinical recovery. Consciousness is usually preserved. Symptoms may include sudden blindness in one eye; inability to speak; weakness, paralysis or numbness of one side of the face, arm and leg.

Why: e.g. sudden onset of neurological deficit lasting longer than 24 hours. Symptoms depend on the specific blood vessel to the brain that is affected by the stroke. Symptoms may include weakness or paralysis on one side of the body, difficulty with speaking, visual field deficits, numbness to one side of the body.

Why: e.g. blurry vision, double vision, dizziness, weakness, numbness or tingling in any limbs.

Why: e.g. sudden severe headache at the back of the head. This is usually followed by vomiting and often loss of consciousness. Focal symptoms depend on amount and site of bleeding and may include weakness or paralysis to one side of the body or visual loss.

Why: e.g. follows many common viral infections such as measles, chicken pox, mumps and rubella or rarely after immunization against rabies, influenza or pertussis. Symptoms may include abrupt onset of fever, neck stiffness, headache, lethargy, confusion, drowsiness, seizures, paralysis of one limb or one side of body or all four limbs may be seen, may also have numbness in the limbs.

Why: e.g. symptoms begin 7-10 days after an infective illness. It results in muscle paralysis which typically ascends from the lower to the upper limbs. Sensory loss (numbness) is usually minimal. The disease usually begins 7-10 days after an infective illness.

Why: e.g. sudden severe leg pain, pallor of skin, paresthesia or numbness of lower leg, paralysis or weakness of leg.

Why: e.g. marked weakness on one side of the face, mouth sags, drooling from the affected side of mouth, loss of taste on front of tongue, eye may water, pain behind the ear. Due to a seventh cranial nerve palsy.