Bilateral spastic paralysis (spastic paraplegia)

Published on 05/05/2015 by admin

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Last modified 05/05/2015

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36 Bilateral spastic paralysis (spastic paraplegia)

Instruction

Carry out a neurological examination of this patient’s lower limbs.

Salient features

Examination

• Increased tone in both lower limbs

• Hyperreflexia

• Ankle clonus

• Weakness in both lower limbs

• Then proceed to:

• Check the sensory level

• Examine the spine (spinal tenderness or deformity).

• Tell the examiner that you would like to do the following:

• Check sacral sensation

• Examine the hands to rule out involvement of upper limbs

• Check for cerebellar signs (multiple sclerosis, Friedreich’s ataxia).

• Try to localize the level of lesion using the following:

• Spasticity of the lower limb alone: lesion of thoracic cord (T2–L1)

• Irregular spasticity of lower limbs with flaccid weakness of scattered muscles of lower limbs: lesion of lumbosacral enlargement (L2–S2)

• Radicular pain: useful early in the disease, with time becomes diffuse and ceases to have localizing value

• Superficial sensation: not good for localizing as the level of sensory loss may vary greatly in different individuals and in different types of lesions.

Diagnosis

This patient has bilateral spastic paraparesis (lesion) at L1 spinal level caused by trauma (aetiology); it is complicated by bladder involvement (functional status).

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