Spastic paraparesis Flashcards
1
Q
What are the clinical features of spastic paraparesis?
A
- Bilateral
- Hypertonia
- Pyramidal weakness
- Brisk reflexes
- Clonus
- Upgoing plantars
- Spastic scissoring gait
2
Q
What are the most common causes of spastic paraparesis?
A
- Demyelination (MS)
- Cord compression
- Trauma
- Anterior horn cell disease (MND)
- Cerebral palsy
3
Q
What are the causes of spastic paraparesis with a sensory level?
A
- Cord compression (disc disease, tumour, trauma, infection)
- Cord infarction
- Transverse myelitis
4
Q
What are the causes of spastic paraparesis with dorsal column loss?
A
- Demyelination (MS)
- Friedreich’s ataxia
- Subacute combined degeneration of the cord
- Syphilis
- Parasagittal meningioma
- Cervical myelopathy
5
Q
What are the causes of spastic paraparesis with spinothalamic loss?
A
- Syringomyelia
- Anterior spinal artery infarction
6
Q
What are the causes of spastic paraparesis with cerebellar signs?
A
- Demyelination (MS)
- Friedreich’s ataxia
- Spinocerebellar ataxia
- Arnold-Chiari malformation
- Syringomyelia
7
Q
What are the causes of spastic paraparesis with a small hand muscle wasting?
A
- Cervical myelopathy (C5-T1)
- Anterior horn cell disease (MND)
- Syringomyelia
8
Q
What are the causes of spastic paraparesis with UMN signs in upper limbs?
A
- Cervical myelopathy (above C5)
- Bilateral stroke
9
Q
What are the causes of spastic paraparesis with absent ankle jerk?
A
- MND
- Friedreich’s ataxia
- Subacute combined degeneration of the cord
- Syphilis
- Cervical myelopathy and peripheral neuropathy
- Conus medullaris
10
Q
What investigations should be carried out for spastic paraparesis?
A
- MRI head and spine (demyelination, trauma, compression)
- VEPs
- LP
- Standard bloods (FBC, U&Es, LFTs, CRP, ESR)
- HIV, syphilis, HTLV-1
- ANA, ANCA, antiphospholipid antibodies, immunoglobulins, AQP4 and MOG antibodies
- Paraneoplastic screen
- B12 (subacute degeneration of cord)
- Nerve conduction and EMG
