Paresis

Question 1

What is Paresis?

What is paraparesis?

Answer 1

Paresis is a weakness of voluntary movement, or partial loss of voluntary movement in a part of your body.

Is it a suffix which can be prefixed with the area of body affected i.e. stomach = gastroparesis.

Paraparesis is characterized by progressive weakness and BOTH legs.

Question 2

Year 3: Classify and differentiate the causes of Spastic paraparesis

Answer 2

Most comon causes;

Demyelination (multiple sclerosis)
Cord compression
Trauma
Anterior horn cell disease (motor neuron disease)
Cerebral palsy

Others;
HSP; Hereditary spastic paraparesis
TSP; Tropical spastic paraparesis
Caused by HTLV-1 virus;
Human T-cell lymphotropic virus

If you see RAPD (pupillary..) suggest demyelination
If you see fasciculations/small hand muscle wasting suggestss motor neuron disease
If you see upper motor neuron signs in the upper limbs suggests bilateral strokes

Question 3

Define these terms
Monoparesis
Paraparesis

Answer 3

Weakness in;
Monoparesis – One leg or one arm
Paraparesis – Both legs

Question 4

Define these terms
Hemiparesis
Triparesis

Answer 4

Weakness in;
Hemiparesis – One arm and one leg on either side of the body
Triparesis Three limbs. This can either mean both legs and one arm, both arms and a leg, or a combination of one arm, one leg, and face

Question 5

Define these terms
Double Hemiparesis
Tetraparesis
Quadriparesis

Answer 5

Weakness in;

Double Hemiparesis all four limbs are involved, but one side of the body is more affected than the other
Tetraparesis – All four limbs.
Quadriparesis All four limbs, equally affected

Question 6

What conditions does the term paresis usually refer to?

Answer 6

These terms frequently refer to the impairment of motion in multiple sclerosis.[1] and Cerebral palsy[2]

Question 7

What conditions does the term paresis usually refer to?

Answer 7

These terms frequently refer to the impairment of motion in multiple sclerosis.[1] and Cerebral palsy[2], Stroke [3], TBI [4]

TBI = trraumatic brain injury

rigidity is like parkinsons

Question 8

Is spasticity upper or lower MN?

Answer 8

It upper becuase;

think it is hypertonia - so increased tone so up for upper

Question 9

What is spasticity

Answer 9

Stiffness of muscle that gives; excessive velocity-dependent muscle contraction.
It ‘gives’ meaning that the stiffness is not constant, it stops and then moves at normal/quick velocity.

This ultimately leads to hyperreflexia;;; an exaggerated deep tendon reflex.

Question 10

Year 3: Recall the initial investigation and management of spastic paraparesis

Answer 10

MRI brain and spine (demyelination, trauma, cord compression)

Visual evoked potentials (if suspect demyelination)

Lumbar puncture (if suspect demyelination)

Bloods: FBC, U+E, LFT, bone profile, CRP, HIV, syphilis, HTLV-1, serum ACE, ESR, ANA, ANCA, antiphospholipid antibodies, immunoglobulins, paraneoplastic screen and serum electrophoresis, B12

Nerve conduction studies and EMG

Management;
Depends on cause but;
Baclofen (CNS depressant, muscle relaxant)
Benzos like diazepam
Botulinum toxin and like medications

Question 11

Year 3: Recall the initial investigation and management of hemiparesis

Answer 11

When you see hemiparesis think stroke! So what investigations would you do for stroke?

1. Bloods: FBC, U+E, LFT, CRP/PV/ESR, lipids, fasting glucose/Hba1c, clotting
2. 12 lead ECG (?atrial fibrillation), CXR, urine dipstick (for blood and protein)
3. Immediate CT head: infarct/ischaemia versus haemorrhage
   - exclude tumour/subdural, assess for complications e.g. hydrocephalus

NB: CT head is often normal in acute phase of ischaemic stroke.

MANAGEMENT of hemiparesis;

1. Rehab
2. Physio

Question 12

Define gastroparesis

Name some causes

Answer 12

Reduced stomach/gatric emptying due to PARTIAL paralysis of the stomach.

It can be caused by;
Abdominal surgery
Diabetes - autonomic neuropathy
Drugs i.e. opioids
Connective tissue diseases - ehlers-danlos