mellss yr3 med para and quadriplegia
TRANSCRIPT
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