Spastic paraparesis

Question 1

Very acute onset

Answer 1

Vascular cause - ?spinal stroke

Question 2

Acute onset

Answer 2

Disc herniation, trauma

Question 3

Days

Answer 3

Inflammatory - MS - transverse myelitis
Infection - VZV

Question 4

Weeks-months

Answer 4

Metabolic - Vitamin B12 deficiency
Infective - HIV

Question 5

Long term

Answer 5

MND, hereditary spastic paraparesis

Question 6

Investigations

Answer 6

MRI whole spine

Question 7

Chronic progressive myelopathy investigations

Answer 7

Blood - vit B12 and copper
FHx - genetic screen
MRI spine

Question 8

+ cerebellar signs?

Answer 8

MS, Friedrich’s ataxia

Question 9

Transverse myelitis causes

Answer 9

Autoimmune - MS, NMO,
Infective - EBV, HSV, CMV, VZV, HIV
Bacterial infection - syphilis, Lymes, TB
Cancer - paraneoplastic

Question 10

Presentation

Answer 10

Hypertonia, clonus, hyperreflexia, weakness, spastic gait
?sensory changes

Question 11

Definition of spasticity

Answer 11

Increase in muscle tone due to hyperexcitability of the stretch reflexes

Question 12

Spasticity versus rigidity

Answer 12

Rigidity - increased tone throughout movement
Spasticity - velocity dependent

Question 13

Management

Answer 13

Physiotherapy
Baclofeb
Contracture release
Botox