Causes of lower limb weakness

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Information about Causes of lower limb weakness

Published on December 6, 2008

Author: drbashir123


PARAPLEGIA : PARAPLEGIA By Dr Bashir Ahmed Dar Associate professor Medicine Chinkipora sopore kashmir Causes of flaccid paralysis : Causes of flaccid paralysis Anterior horn cells-poliomylitis Nerve root- radiculitis,polyradiculopathy,tabes dorsalis,cauda equina Peripheral nerves-GB syndrome,peripheral neuropathy Myoneural junction- myasthenia gravis,lambert eaton syndrome,periodic paralysis Muscles - myopathy Slide 3: Flaccid paralysis means lower motor neuron paralysis resulting from the disease of anterior horn cells,radicles,peripheral nerves and muscles Acute onset of UMN type of paralysis may present flaccid instead of spastic paralysis due to shock. Causes of spastic paraplegia Compressive : Causes of spastic paraplegia Compressive Extramedullary Intradural - -- meningioma,neurofibroma,arachnoiditis Extradural--- potts disease(caries spine) Vertebral neoplasms eg, metastasis,myloma Pachymeningitis Prolapsed IVD Epidural abcess or haemorrage Fracture dislocation of vertebra ,pagets disease,osteoporosis Intramedullary : Intramedullary syringomyelia, haematomyelia, intramedullary tumor eg, ependymoma, glioma What is Cerebral Paraplegia : What is Cerebral Paraplegia The lower limbs and bladder (micturition centre)are represented in paracentral lobule, leisions in this area produce paraplegia with bladder disturbance-eg retension urine and cortical type of sensory loss.may b associated with headache,vomiting and fits. Causes are cerebral diplegia superior sagital sinus thrombosis Parasagital meningioma Thrombosis of unpaired anterior cerebral artery Gunshot injury of this area Internal hydrocephalus What is spastic paraplegia : What is spastic paraplegia Involvement of spinal cord and cerebrum produce spastic UMN paraplegia. Has two types Paraplegia in flexion and paraplegia in extension. Differences : Differences Etramedullary Root pain---common UMN signs –early Sensory deficit—contralateral loss of pain and temp with ipsilateral loss of proprioception Intramedullary Rare Late Dissociated sensory loss Slide 9: Sacral sparing-absent Bowel bladder disturbances– early Vertebral tenderness may be present CSF changes –froins syndrome common Present Late Absent Rare Non compressive causes : Non compressive causes MND –amyotropic lateral sclerosis MS Acute transverse myelitis Subacute combined degeneration of cord vit 12 def. Lathyrism Syringomyelia Hereditory spastic paraplegia Tropical spastic paraplegia Radiation myelopathy Differences between compressive and non compressive paraplegia : Differences between compressive and non compressive paraplegia (compressive) Boney changes Root pains Upper level of sensory loss present Zone of hyperaesthesia may be present (non compressive) No boney changes No root pains No definite level Absent Slide 12: Usually gradual onset Asymetrical involvement of limbs Commonest cause is caries Bladder bowel disturbance occurs Usually acute onset Symmetrical involvement of limbs Commonest cause MND Occours but late Cord compression at multiple sites : Cord compression at multiple sites Arachnoiditis( tubercular there is patchy involvement) Neurofibromatosis Multiple sclerosis Secondary deposits Cervical spondylitis Paraplegia without sensory loss : Paraplegia without sensory loss Hereditory spastic paraplegia Lathyrism GB syndrome Amyotropic lateral sclerosis fluorosis Paraplegia with loss of deep tendon jerks : Paraplegia with loss of deep tendon jerks In paraplegia the tendon jerks are brisk.they can only become absent when pt is either in spinal shock or there is involvement of affrent or efferent side of reflex eg , in Neural shock(spinal) Radiculitis- the jerk whose root is involved will be absent Peripheral neuropathy-bilat ankle jerks will be absent Reflex activity may be absent in presence of severe infection due to supression. Difference between conus medularis and cauda equina syndrome : Difference between conus medularis and cauda equina syndrome The conus medularis is terminal portion at which cord ends and cauda equina is bunch of roots.therefore the main distinction between the two is the plantars extensor and symmetrical LMN Signs in conus medullaris while planter are flexor or not elicitable with asymmetrical LMN paralysis in cauda equina syndrome. Slide 17: Conus leison Bilateral symmetrical of both lower limbs No root pains Bilateral saddle anaesthesia Cauda equina leion Asymmetrical involvement of both lower limbs Severe root pains Asymetrical sensory loss Slide 18: Bulbocavernous s1-s2, and anal reflex are absent Bladder bowel disturbances common Planters extensors Depending upon root invlvement Relatively spared Normal or not elecitable Episodic weakness causes : Episodic weakness causes Mysthenia gravis Hyperthyroidism Periodic paralysis( hyperkalaemia or hypokalaemia) Investigations : Investigations Routine blood tests Urine test,also for culture and sensitivity Bllod chemistry eg blood urea,creatinine,electrolytes X ray chest Lymph node biopsy CSF examination CT scan,MRI CT –Myelography meniscus sign intradural,brush sign extradural,expansion sign in syringomyelia Tropical spastic paraplegia : Tropical spastic paraplegia Females 3rd ,4th decade Associated with HTLV-1 infection This is UMN spastic paraplegia without sensory disturbance. Bladder disturbances And is non compressive progressive myelopathy Features of paraplegia : Features of paraplegia Pain over spine or along roots Sensory loss below ,and hyperasthesia at the level Motor weakness Urgency or hesitency leading to retension of urine Involvement of spinothalamic and dorsal column tract. Loss of deep tendon reflexex at level due to root if All reflexes below level lost Tone increased, Lathyrism : Lathyrism It is due to khesari dal(lathyrus sativus) May involve families in locality The causative factor is BOAA, a neurotoxin.due to spasticity they pass through one stick stage,scissor gait,then Two stick stage then crawling.

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