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Paraparesis


Presentation

  • We describe an extremely rare and previously unreported presentation of acute progressive paraparesis secondary to traumatic thoracic disc herniation in a child presenting to our institution.[ncbi.nlm.nih.gov]
  • While pain remains the most common presenting symptom of spinal ABC, extensive anterior column involvement can result in vertebral fractures, spinal instability, and neurological deficits from compression of neural elements.[ncbi.nlm.nih.gov]
  • Diagnosis is generally delayed by variable presentation with non-specific constitutional and neurological symptoms, lack of reliable ancillary tests and it is often obtained only at autopsy.[ncbi.nlm.nih.gov]
  • Infantile Alexander disease is a rare progressive leukodystrophy caused by autosomal dominant mutations in the (GFAP) gene typically presenting with psychomotor retardation, progressive macrocephaly and refractory epilepsy.[ncbi.nlm.nih.gov]
  • A 21-year-old male student, presented to us with a 6-week history of progressive weakness in both lower limbs and loss of bowel bladder control.[ncbi.nlm.nih.gov]
Euthyroid
  • Episodes can be prevented by achieving a euthyroid state. This report describes a young gentleman presenting with thyrotoxic hypokalemic paraparesis.[ncbi.nlm.nih.gov]
Macrocephaly
  • Infantile Alexander disease is a rare progressive leukodystrophy caused by autosomal dominant mutations in the (GFAP) gene typically presenting with psychomotor retardation, progressive macrocephaly and refractory epilepsy.[ncbi.nlm.nih.gov]
Psychomotor Retardation
  • Infantile Alexander disease is a rare progressive leukodystrophy caused by autosomal dominant mutations in the (GFAP) gene typically presenting with psychomotor retardation, progressive macrocephaly and refractory epilepsy.[ncbi.nlm.nih.gov]
Progressive Macrocephaly
  • Infantile Alexander disease is a rare progressive leukodystrophy caused by autosomal dominant mutations in the (GFAP) gene typically presenting with psychomotor retardation, progressive macrocephaly and refractory epilepsy.[ncbi.nlm.nih.gov]
Urinary Retention
  • Over the next few hours, she developed back pain followed by progressive paraparesis associated with urinary retention and sensory impairment.[ncbi.nlm.nih.gov]

Workup

  • Therefore, upper endoscopy should be part of the diagnostic workup of vitamin B 12 deficiency. Multiple factors can lead to misdiagnosis of vitamin B 12 deficiency.[dovepress.com]
Liver Biopsy
  • Although clinical history appeared too long, we considered the hypothesis of IVLBCL on the basis of the laboratory constellation and proposed a liver biopsy, but the patient refused the procedure. The diagnosis was confirmed only at autopsy.[ncbi.nlm.nih.gov]

Treatment

  • Our patient was a 41-year-old female, affected by PsA in treatment since 2 years with low-dose methylprednisolone and low-dose subcutaneous MTX. The treatment was effective.[ncbi.nlm.nih.gov]
  • Although the treatment of choice is conservative, surgery is required in patients who develop progressive neurologic deficit or severe radicular pain. Transthoracic microdiskectomy without fusion is considered a treatment in similar cases.[ncbi.nlm.nih.gov]
  • During the treatments I felt very relaxed and calm. Even though I hate needles acupuncture treatments are really OK. The clinic is quiet and the staff is friendly.[acupuncturerestoreshealth.com]
  • There seems to be a trend toward better outcomes with earlier treatment.[ncbi.nlm.nih.gov]
  • Links: aetiology paraplegia General Practice Notebook General Practice Notebook The information provided herein should not be used for diagnosis or treatment of any medical condition.[gpnotebook.co.uk]

Prognosis

  • Prognosis HAM/TSP is a progressive disease, but it is rarely fatal. Most individuals live for several decades after the diagnosis.[brainfacts.org]
  • Prognosis Prognosis depends on the phenotype (pure/complex form), genotype, and is highly variable due to incomplete penetrance and variable gene expression.[orpha.net]
  • Burkitt’s lymphoma with paraparesis is a sign of advanced disease and is often associated with a poor prognosis. Both thorough clinical assessment to estab- lish the level of the lesion, and reassessment to look for changes, are essential.[books.mcai.org.uk]
  • Michaelis LS (1969) International inquiry on neurological terminology and prognosis in paraplegia and tetraplegia. Paraplegia 7:1–5 PubMed Google Scholar 24.[link.springer.com]
  • Differentiation between HSP and PLS is important for genetic counseling of family members and for the patients' prognosis because HSP generally has a more favorable prognosis than PLS. 1 Furthermore, progression to ALS, as may occur in PLS, 24 is not[jamanetwork.com]

Etiology

  • An intrahepatic portosystemic venous shunt (IPSVS) was observed on enhanced computed tomography, and hyperammonemia suggested leakage of neurotoxins from the shunt as the etiology of the patient's symptoms.[ncbi.nlm.nih.gov]
  • Etiology The disease is due to the dysfunction of the upper motor neurons of the corticospinal tract. To date, more than 80 genes have been linked.[orpha.net]
  • Hypokalemic paralysis: a review of the etiologies, pathophysiology, presentation, and therapy. Am J Emerg Med. 1992; 10:143-8. 9.Magsino CH Jr, Ryan AJ Jr. Thyrotoxic periodic paralysis.[bjmp.org]
  • HTLV-1 could not be definitely linked etiologically to cases of TSP in our series. HTLV-1 has not been linked to cases of TSP reported from the rest of India. Our cases had many similarities to seronegative SSP.[neurologyindia.com]

Epidemiology

  • How to use this case study General instructions : Case studies in applied epidemiology allow students to practice applying epidemiologic skills in the classroom to address real-world public health problems.[panafrican-med-journal.com]
  • Summary Epidemiology It has been described in affecting at least six male members spanning three generations of a large family.[orpha.net]
  • HSP data were compared to data from HUNT-3, a Norwegian epidemiological population study that enrolled more than 46,000 individuals. The survey was based on 19 items, each of which was also covered in HUNT3.[mdmag.com]
  • Summary Epidemiology The prevalence of hereditary spastic paraplegia (HSP) is highly variable, ranging from 1/11,000-77,000 in Europe. Clinical description Clinically, HSPs can be divided into the pure and complex form.[orpha.net]
  • Epidemiology of tropical spastic paraparesis in Colombia and associated HTLV-1 infection. Ann Neurol 1988;23:161-5. 11. Roman GC, Roman LN.[neurologyindia.com]
Sex distribution
Age distribution

Pathophysiology

  • We review previously reported cases and current understanding of the pathophysiology of this complication. All cases had symptom onset several hours after the procedure. There seems to be a trend toward better outcomes with earlier treatment.[ncbi.nlm.nih.gov]
  • It could be argued that the observed findings are an epiphenomenon, resulting from longstanding retrograde degeneration, rather than a direct reflection of the underlying TSP pathophysiology.[hippokratia.gr]
  • Hypokalemic paralysis: a review of the etiologies, pathophysiology, presentation, and therapy. Am J Emerg Med. 1992; 10:143-8. 9.Magsino CH Jr, Ryan AJ Jr. Thyrotoxic periodic paralysis.[bjmp.org]

Prevention

  • Episodes can be prevented by achieving a euthyroid state. This report describes a young gentleman presenting with thyrotoxic hypokalemic paraparesis.[ncbi.nlm.nih.gov]
  • O Contractures: all joints need to be moved through their full range of movement to prevent contractures develop- ing.[books.mcai.org.uk]
  • Their prognosis improves if they take steps to prevent urinary tract infection and skin sores, and if they participate in physical and occupational therapy programs.[brainfacts.org]
  • The management is to deal with the acute attack as well as treatment of the underlying condition to prevent future attacks.[bjmp.org]
  • Physical therapy and exercise can help maintain mobility and muscle strength, improve range of motion and endurance, reduce fatigue, and prevent cramps and spasms. Baclofen (a muscle relaxant) is the drug of choice to reduce spasticity.[msdmanuals.com]

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