Spastic Paraparesis

Question 1

Signs

Answer 1

Scissoring gait
Contracture, wasting
Hypertonia and ankle clonus
Pyramidal weakness
Hyperreflexia

Question 2

Causes

Answer 2

With dorsal column signs:

• MS ( cerebellar and eye signs)
• Cervical myelopathy ( inversion of bicep and supination reflexes, Lhermitte’s sign)
• Friedreich’s ataxia ( cerebellar, pes cavus, kyphoscoliosis)
• Subacute combined degen of cord ( anaemia, glossitis, splenomegaly, peripheral neuropathy-> absent AJ, extensor plantar)
• Taboparesis ( Argyl Robertson pupil)

No sensory involvement:

• MND ( LMN signs, bulbar involvement)
• Hereditary spastic hemiparesis ( no peripheral nerve involvement)

Sensory level:

• Cord compression ( absence of signs above lesion)
• Trauma ( scars, deformities)

Dissociated sensory loss

• syringomyelia ( LMN weakness in UL, horner’s)
• ant spinal artery occlusion ( AF)