PARAPLEGIAPARAPLEGIA

AN IMPAIRMENT IN AN IMPAIRMENT IN MOTOR OR SENSORY MOTOR OR SENSORY FUNCTION OF THE LOWER FUNCTION OF THE LOWER EXTREMITIES.EXTREMITIES.

•Both upper limbs + Both Both upper limbs + Both lower limbslower limbs

QUADRIPLEGIAQUADRIPLEGIA•Only one upper limb Only one upper limb

MONOPLEGIA MONOPLEGIA

PARAPLEGIAPARAPLEGIA

•SpasticSpastic• Paraplegia in Paraplegia in

extensionextension• Paraplegia in Paraplegia in

flexionflexion

•FlaccidFlaccid

Paraplegia in Paraplegia in extensionextension

Paraplegia in Paraplegia in flexionflexion

Lower limbs take an Lower limbs take an extensor attitudeextensor attitude

Lower limbs take an Lower limbs take an attitude of flexionattitude of flexion

Only pyramidal tracts Only pyramidal tracts are involvedare involved

Both pyramidal & Both pyramidal & extrapyramidal tracts extrapyramidal tracts are involvedare involved

Evolution earlyEvolution early Evolution lateEvolution late

CAUSES OF SPASTIC CAUSES OF SPASTIC PARAPLEGIA (UMN type)PARAPLEGIA (UMN type)

• GRADUAL ONSETGRADUAL ONSET1.1. CEREBRAL CAUSESCEREBRAL CAUSES

• Cerebral diplegiaCerebral diplegia• Parasagittal meningiomaParasagittal meningioma

• SPINAL CAUSESSPINAL CAUSES1.1. CompressiveCompressive

2.2. Non compressiveNon compressive• Motor neuron diseaseMotor neuron disease• Multiple sclerosisMultiple sclerosis• Frederich`s ataxiaFrederich`s ataxia• Subacute combined degenerationSubacute combined degeneration

Compressive etiologyCompressive etiology

• Intramedullary (5%)Intramedullary (5%)1.1. GliomaGlioma

2.2. EpendymomaEpendymoma

3.3. ChordomaChordoma

• ExtramedullaryExtramedullary

• Intradural (15%)Intradural (15%)1.1. MeningiomaMeningioma

2.2. NeurofibromaNeurofibroma

3.3. Patchy arachnoiditis (TB,Syphilis)Patchy arachnoiditis (TB,Syphilis)

• Extradural (80%)Extradural (80%)1.1. Caries spineCaries spine

2.2. Myeloma,Lymphoma,Metastatic Myeloma,Lymphoma,Metastatic deposits in vertebradeposits in vertebra

3.3. Patchy meningitisPatchy meningitis

4.4. Prolapsed intervertebral discProlapsed intervertebral disc

• SUDDEN ONSETSUDDEN ONSET

• CEREBRAL CAUSESCEREBRAL CAUSES

1.1. Thrombosis of unpaired anterior Thrombosis of unpaired anterior cerebral arterycerebral artery

2.2. Superior sagittal sinus thrombosisSuperior sagittal sinus thrombosis

• SPINAL CAUSESSPINAL CAUSES

1.1. Acute tranverse myelitisAcute tranverse myelitis

2.2. Injury to spinal cordInjury to spinal cord

3.3. Thrombosis of anterior spinal Thrombosis of anterior spinal arteryartery

4.4. HaematomyeliaHaematomyelia

5.5. Post vaccinalPost vaccinal

6.6. Prolapsed intervertebral discProlapsed intervertebral disc

CAUSES OF FLACCID CAUSES OF FLACCID PARAPLEGIA (LMN type)PARAPLEGIA (LMN type)

• UMN lesion in shock stageUMN lesion in shock stage• Sudden onset in neuronal Sudden onset in neuronal

shock,acute transverse shock,acute transverse myelitis,spinal injurymyelitis,spinal injury

•LMN lesion involving anterior LMN lesion involving anterior horn cells or peripheral nerveshorn cells or peripheral nerves

1.1. Acute anterior poliomyelitisAcute anterior poliomyelitis

2.2. Acute infective polyneuropathyAcute infective polyneuropathy

3.3. Progressive muscular atrophyProgressive muscular atrophy

• Diseases affecting posterior Diseases affecting posterior nerve rootsnerve roots

• Tabes dorsalisTabes dorsalis

• Diseases affecting Diseases affecting myoneural junctionmyoneural junction

1.1. Myasthenia gravisMyasthenia gravis

2.2. Periodic paralysis due to hypo or Periodic paralysis due to hypo or hyperkalemiahyperkalemia

• Diseases affecting musclesDiseases affecting muscles

• MyopathyMyopathy

• Hysterical paralysisHysterical paralysis

5Ts5Ts

•TraumaTrauma•TumourTumour•TuberculosisTuberculosis•ThrombosisThrombosis•Transverse myelitisTransverse myelitis