PARAPLEGIA AND

QUADRIPLEGIAnur amalina aminuddin baki

Introduction Definition Etiology Approach

Definition

Paralysis of both lower limbs

Paralysis of all four limbs

Paraplegia Quadriplegia

Etiology of paraplegia1) Due to UMN

lesionsa) Intracranialb) Spinal

i. Non-compressiveii. Compressive

3) Functional/ Hysterical

2) Due to LMN lesions

a) Anterior horn cells

b) Rootsc) Peripheral

nervesd) NM junctione) Muscles

1. Due to UMN lesionsa) Intracranial Acute Gradual

• Thrombosis of azygos Ant. Cer. Artery

• Thrombosis of Sup. Sagittal Sinus

• Tumour of falx cerebri (meningioma)

• Space Occupying Lesions over motor area (Glioma)

b) Spinal

Acute Gradual Non –compressive

• Trauma ( electric shock)• Infection ( TB, EBV)• Vascular ( Leriche’s

syndrome, Caisson’s disease)• Demylinating disease ( MS)

• Heriditary ( friedrich’s ataxia, HSCA)

• Paraneoplastic syndrome• Toxic ( lathyrism, uremia)• Nutritional ( pellagra, SACD)

Compressive

• Trauma ( fracture dislocation of vertebral column)

• Infection ( epidural abscess)• Arachnoiditis ( TB,

toxoplasmosis)

• Tumour ( lipoma, neurofibroma)

• Aortic aneurysms compressing vertebral column

• Syringomyelia

2. Due to LMN lesionsAcute Gradual

Anterior horn cells

• Infection• Motor neuron disease

Roots • Gullian Barre Syndrome

• Viral radiculitis

• Tabes Dorsalis• Cauda Equina Syndrome• Diabetic Amyotrophy

Peripheral nerve

• Peripheral neuritis

NMJ • Periodic paralysis • Mysthenia Gravis• Eaton Lambert Syndrome

Muscles • Polymositis• Myopathy• Muscular dystrophy

3. Functional

Functional

Organic

• Hysterical rigidity

Tone • Hypotonia or clasp knife rigidity

• Astasia abasia Power • Grade 0 to 4• None Involuntary

movements• Fasciculations

• Absent Wasting • Present • Normal or

briskDeep reflexes • Absent or brisk

• Never extensor Plantar response • Extensor • Absent Sphincter

disturbances• Pesent

Quadriplegia

Etiology of quadriplegia Spastic Examples Cortical lesion

• Cerebral palsy• Decerebrate state

Brain Stem lesion

• Vertebrobasilar insufficiency• Brainstem space occupying lesions• Infection• Degeneration conditions• Demyelinating diseases

High cervical cord lesion

• Fracture dislocation of cervical spine

• Craniovetebral anomaly• Cervical spondylosis• Hematomyelia• Cervical cord tumors

Flaccid Examples

Polyneuropathy • Acute infective polyneuritis

• Porphyria• Diptheria• Botulinism• Organophosphorus

poisoning• Infective mononucleosis

Muscles diseases • Acute mysthenia gravis• Periodic paralysis• Polymyositis

Anterior horn cell disease

• Poliomyelitis

Brain stem lesions with neuronal shock

Complaints Weakness, incoordination or paralysis Numbness, tingling Difficulty with balance and walking Loss of movement,sensation,bowel or

bladder control Changes in sexual function Difficulty in breathing, coughing Extreme pain in neck, head or back

History Age: young vs. old Onset and duration :

acute vs. chronic History of

Trauma Infection Vaccination

Any pain in back, head or neck

Any loss of sensations Any sphincter

disturbances

Past history: malignancy?

Drug and surgery history?

Family history: hereditary?

Personal history: diet?

Is it really CNS problem?

ExaminationFor localisation of lesion Sensory deficits Motor deficits Tone and power of muscles Reflexes LMN vs. UMN

Referance Harrison’s Principles of Internal Medicine Davidson’s Principles and Practice of

Medicine PJ Mehta’s Practical Medicine Macleod’s Clinical Examination http://draswinikumars/clinical-approach-

to-paraplegia