Presentation
Classically, the clinical presentation is a severe peripheral ischemia with bilateral leg pain as the predominant feature. [ncbi.nlm.nih.gov]
Entire Body System
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Fever
A 10-year-old boy was admitted with a 1-month history of progressive back pain and low fever for 7 days as well as sudden onset of paraplegia for 1 day. [ncbi.nlm.nih.gov]
(2) of the BStMG 2002, on the same basis as disabled persons resident or ordinarily resident in Austria. et Hoida laste eest varjatud ja kättesaamatus kohas en Patient has at least 1 of the following signs or symptoms with no other recognized cause: fever [et.glosbe.com]
He had no recent illness, fever, or trauma. On examination there was subjective sensory disturbance below T10 with sacral sparing, lower limb pyramidal weakness (4 /5), hypertonia, hyperreflexia, and an upgoing left planter response. [thelancet.com]
You have a fever. You have trouble urinating or urinate less than usual. Your abdomen is swollen and firm. You have blood in your urine or bowel movement. You have questions or concerns about your condition or care. [drugs.com]
We add a new family to the literature with 3 affected members and a remarkable phenotype of purely fever-induced ataxia with myokymia. [ng.neurology.org]
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Wheelchair Bound
Patients with progressive HSP are often wheelchair-bound by the age of 70 years. Patients with HSP have a normal life-expectancy. Epidemiology References:[1][2][3] Epidemiological data refers to the US, unless otherwise specified. [amboss.com]
‘For example, a person with paraplegia who is wheelchair-bound may be working successfully on a full-time basis as an accountant and therefore not meet the Social Security Administration's definition of disabled.’ [lexico.com]
Jellema et al9 reported in 2004 a series of 44 treated patients and mentioned 13 patients who were wheelchair-bound at the time of treatment. [ahajournals.org]
Browsing Articles by Date Published: December 25, 2018 Category: News Spinal Cord Injury: Paraplegia Don’t ever call me ‘wheelchair bound’. My wheelchair doesn’t bind me – it liberates me! [spinalcordinjuryzone.com]
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Unable to Stand
All individuals were unable to stand or walk independently or voluntarily move their lower extremities after their injuries. After implantation, the investigators tested the individuals’ ability to move voluntarily with epidural stimulation. [mdedge.com]
Using the qualitative Aminoff scale alone to classify these patients is a debatable decision, because Grade V of this classification system includes patients who are unable to stand and are confined to a wheelchair or bed, although it is unclear whether [ahajournals.org]
The definition of success pertaining to mortality and SCI will be assessed 30 days after TAAA repair, and ‘substantial SCI’ means that the patient is unable to stand without assistance and is defined using the modified Tarlov scale 22 (see below) and [bmjopen.bmj.com]
Gastrointestinal
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Fecal Incontinence
Impotence and various degrees of urinary and fecal incontinence are very common in those affected. [wikidoc.org]
This test was interpreted as normal, but during the next 2 months, the patient's symptoms progressed to bilateral lower extremity weakness, parasthesias, and urinary and fecal incontinence. [medscape.com]
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Constipation
It is well appreciated that an extreme sedentary lifestyle from paralysis, contributes to many secondary medical problems such as diabetes and insulin resistance, obesity, constipation, poor blood pressure regulation, cardiovascular disease, reduced quality [rewalk.com]
If they have inability to pass urine or stool then catheter may have to be put into the urinary bladder to decompress the bladder and enemas may required if there is constipation. [pediatriconcall.com]
Instead, treatment is aimed at problems associated with paraplegia, such as blood clots and constipation. To prevent blood clots, the patient is given special stockings to wear on the legs. A blood clot is a thick mass of blood. [medfriendly.com]
Higher the injury site greater will be the loss of sensation Pain, electrical sensations and other intermittent feelings also called phantom sensations may occur Loss of sexual function, libido or fertility Incontinence or Constipation due to decreased [healthproductsforyou.com]
Other treatment may include a high-bulk diet and the administration of suppositories to prevent constipation. paraplegia Neurology Complete paralysis, paresthesias, loss of sensation and control of voluntary movement in legs, post spinal cord injury or [medical-dictionary.thefreedictionary.com]
Cardiovascular
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Hypertension
We report a not yet described clinical situation of a young patient (51 years) admitted to the emergency care department for treatment of systemic arterial hypertension of difficult control with 4 antihypertensive medication classes. [ncbi.nlm.nih.gov]
Paroxysmal Hypertension in Spinal Cord Injuries. New England J. Med. 239 : 291 (1948). CrossRef Google Scholar 12. Gilberti, B. J. ; Goldfein, J. ; & Rovenstine, E. A. Hypertension during Anesthesia in Patients with Spinal Cord Injuries. [link.springer.com]
Musculoskeletal
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Muscle Spasticity
Treatment is mainly supportive, with skeletal muscle relaxants, botulinum toxin, and physiotherapy for muscle spasticity. HSP may be nonprogressive (childhood-onset) or progressive (adult-onset). [amboss.com]
Muscle spasticity and weakness can also be caused by other conditions including (but not limited to) Tropical Spastic Paraparesis and conditions called Lathyrism and Konzo caused by toxins in the plants lathyrus sativus and cassava that also cause muscle [sp-foundation.org]
One caveat however: although early childhood-onset forms of HSP may be “non-progressive”, the degree of spasticity may increase slowly if adequate range-of-motion is not maintained through stretching exercises and muscle spasticity reduction. [rarediseases.org]
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Muscle Cramp
Uncontrolled muscle cramps may cause spasms of the extensors and flexors in the legs. These can range from tembling legs to fully extended knees, hips and feet. [paravan.de]
There are three main features of FSP: the legs become stiff (spasticity) and there is a variable amount of weakness (paraplegia), and muscle cramps and spasms can also be present. [contact.org.uk]
Stretching exercises help to maintain or increase ROM and to reduce such problems as tendinitis, bursitis, and muscle cramps. Aerobic exercises improve cardiovascular fitness, reduce fatigue, and increase endurance and general fitness. [emedicine.medscape.com]
Pure HSP: Pure HSP has the following symptoms: gradual weakening and stiffening of the legs balance difficulties muscle cramps in the legs high foot arches change in sensation in the feet urinary problems, including urgency and frequency erectile dysfunction [healthline.com]
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Musculoskeletal Pain
OBJECTIVES: To determine the prevalence, patterns, and predictors of musculoskeletal pain in the upper extremity joints among wheelchair-dependent individuals with post-traumatic paraplegia. [ncbi.nlm.nih.gov]
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Elbow Pain
Of this sample, 61% had shoulder pain, 33% had elbow pain, and 43% had wrist pain, 19% had shoulder, elbow, and wrist pain, 27% had shoulder and elbow pain, 34% had shoulder and wrist pain, 21% had elbow and wrist pain. [ncbi.nlm.nih.gov]
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Wrist Pain
Of this sample, 61% had shoulder pain, 33% had elbow pain, and 43% had wrist pain, 19% had shoulder, elbow, and wrist pain, 27% had shoulder and elbow pain, 34% had shoulder and wrist pain, 21% had elbow and wrist pain. [ncbi.nlm.nih.gov]
Urogenital
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Urinary Retention
Immediately after LP, the patient remarked a sudden worsening in muscular balance of his inferior limbs and a worsening of urinary retention. This fact was the clue to the SDAVF diagnosis. [ncbi.nlm.nih.gov]
CASE REPORT Case 1 A 33-year-old man, complaining of dorsal thoracic pain for 2 months, was admitted to the emergency unit with paraplegia for 4 days and urinary retention with partially preserved tactile and painful sensitivity in lower limbs. [scielo.br]
Approximately 12 hrs post-Caesarian section, the patient started to complain of mild paresthesia in both feet and calves, and over the next 12 hrs she presented with complete paraplegia and anesthesia from L1, including urinary retention and absent anal [j-neurooncology.imedpub.com]
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Urinary Incontinence
A 57-year-old male 8 days after uneventful OPCAP presented with severe lower extremity pain and sudden fecal and urinary incontinence, followed by the absence of pulsations in the lower limbs and paraplegia, during 20-minute period. [ncbi.nlm.nih.gov]
incontinence or retention 2 Total incontinence or persistent retention 3 The optimal treatment for each patient was selected after discussion between neurosurgical and neuroradiological staff. [ahajournals.org]
In case of urinary incontinence, frequent change of bed-sheets. Care of the bladder: If there is retention, use parasympathomimetic drugs. If this fails, use a catheter to evacuate the bladder. II. Physiotherapy 59. III. [slideshare.net]
Neurologic
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Unable to Walk
The disorders are progressive and may lead to patients being unable to walk, and more. [sp-foundation-org.presencehost.net]
Many of these people were paralyzed and were unable to walk. To enable someone to move in their environment, the doctors would typically prescribe wheelchairs. [blogs.biomedcentral.com]
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Spastic Paralysis
To any one interested in the physiologic implications of lesions of the spinal cord and the general problem of spastic paralysis few subjects can be more fascinating. [jamanetwork.com]
paralysis of of the preserved or absent remaining LL Lower abdominal reflexes are Spastic paralysis of lower limbs Diminution or loss of knee jerk absent Sensory along the inguinal Ankle reflex exaggerated, Spastic paralysis of lower limbs region Plantar [slideshare.net]
paralysis and spastic paraplegia caused by HTLVI infection). [orpha.net]
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Paresthesia
Paresthesia Paresthesia in lower extremity can recognized in pure HSP.. Paresthesia Paresthesia in lower extremity can recognized in pure HSP.. Sensory neuropathy and Ulcers Found in complicated HSP. [medicaljoyworks.com]
& n. paraplegia Neurology Complete paralysis, paresthesias, loss of sensation and control of voluntary movement in legs, post spinal cord injury or disease par·a·ple·gi·a (par'ă-plē'jē-ă) Paralysis of both lower extremities and, generally, the lower [medical-dictionary.thefreedictionary.com]
In patients complaining of a history of increasing low back pain, bladder dysfunction, weakness, or paresthesias of the lower limbs, Jaeger et al. [ 20 ] strongly recommended postponing the procedure. [j-neurooncology.imedpub.com]
Paresis of flexors & extensors Weakness of small muscles of Root pain or paresthesias of little fingers the hand mimick intercostal neuralgia Sensory loss at & below 3rd & Associated spastic Para Sensory loss below a thoracic 4th digits paresis level [slideshare.net]
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Dysautonomia
One patient (6.3%) presented dysautonomia during pregnancy. The cesarean rate was 47% (the indication was in any case an obstetrical reason). Among vaginal deliveries, four (44%) required an instrumental extraction. [ncbi.nlm.nih.gov]
Dysautonomia is common and is suggested by tachycardia, arrhythmia, labile BP ,bladder dysfunction and impaired thermoregulation Diagnosis depends on clinical features, electrophysiology(NCV) - absent f wave ,reduced compound muscle action potential [slideshare.net]
Workup
The patient’s hospital course including a workup for a hypercoagulable state revealed no clear etiology for embolus formation. [hindawi.com]
(See Prognosis, Presentation, Workup, Treatment, and Medication.) The most useful classifications now are based on the mode of inheritance and genetic linkage. [medscape.com]
While this adds considerable challenges in the diagnostic workup, certain specific complicating features may guide the differential diagnosis between the different HSPs. [scielo.br]
X-Ray
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Nephrolithiasis
[…] of traditional risk factors for CKD such as advanced age, diabetes, hypertension, and cardiovascular disease, individuals with paraplegia have elevated incidence of recurrent and chronic urinary tract infections, neurogenic bladder dysfunction, and nephrolithiasis [intechopen.com]
Treatment
Early endovascular treatment can reverse this type of situation. [ncbi.nlm.nih.gov]
ASIA E which is the restoration of all neurologic function.[1] Treatment[edit] Individuals with paraplegia can range in their level of disability, requiring treatments to vary from case to case. [en.wikipedia.org]
Working closely with the doctors and educating yourself can help in creating a treatment plan that is most effective for the patient. Treatment Unfortunately, there is no specific treatment to reverse or cure paraplegia. [robertnkatz.com]
Prognosis
References:[2][5][9] Treatment Prognosis Hereditary spastic paraplegia Summary Epidemiology Etiology Pathophysiology Clinical features Pure HSP (Uncomplicated HSP) Complicated HSP Diagnostics Treatment Prognosis [amboss.com]
Abstract Aortic coarctation complicated with spinal artery aneurysm rupture is exceptionally rare and can be source of intraspinal hemorrhage with markedly poor prognosis. [ncbi.nlm.nih.gov]
Prognosis Prognosis depends on the phenotype (pure/complex form), genotype, and is highly variable due to incomplete penetrance and variable gene expression. [orpha.net]
Instead, the goals of treatment include improving the long-term prognosis, reducing immediate threats to your life and health, and teaching your brain and spinal cord how to work around the injury. [spinalcord.com]
Etiology
The presentation is often not as clinically obvious as those of traumatic etiology; therefore a high index of clinical suspicion is needed to rapidly assess the various possible etiologies. [hindawi.com]
METHODS: We present a 68-year-old male with a progressive paraparesis of unknown etiology over the course of 12 months. [ncbi.nlm.nih.gov]
References:[2][5][9] Treatment Prognosis Hereditary spastic paraplegia Summary Epidemiology Etiology Pathophysiology Clinical features Pure HSP (Uncomplicated HSP) Complicated HSP Diagnostics Treatment Prognosis [amboss.com]
[…] tuberculosis, syphilis, poliomyelitis, malaria, septic meningomyelitis and abscess; (4) simple degeneration or myelomalacia, accompanying diseases of the hematopoietic system and thrombosis; (5) exogenous toxins, such as lead and alcohol; (6) unknown etiology [jamanetwork.com]
Epidemiology
Epidemiology References:[1][2][3] Epidemiological data refers to the US, unless otherwise specified. [amboss.com]
The first covers the epidemiology and psychological conditions associated with paraplegia, the second discusses surgical management and common rehabilitation interventions; the third medical complications and special musculoskeletal issues, while the [intechopen.com]
Spinal cord injuries: Practice essentials, background, anatomy, pathophysiology, etiology, epidemiology, prognosis, patient education. [Internet] 10 August 2017. Available from: . Accessed March 2018. Swiss Paraplegic Research. Community. [icf-casestudies.org]
Summary Epidemiology HSP is estimated to affect 1 in 20 000 individuals in the general population of Europe, with variable frequencies in distinct populations (from 1.3 to 9/100 000 individuals). [orpha.net]
Dr Marion is a professor in the Department of Health Care and Epidemiology, Faculty of Medicine, UBC. [bcmj.org]
Pathophysiology
This case raises questions about the pathophysiology of muscle ruptures in highly functional patients with hereditary spastic paraplegia (HSP) who have only minor spasticity and no significant muscle shortening. [ncbi.nlm.nih.gov]
References:[2][5][9] Treatment Prognosis Hereditary spastic paraplegia Summary Epidemiology Etiology Pathophysiology Clinical features Pure HSP (Uncomplicated HSP) Complicated HSP Diagnostics Treatment Prognosis [amboss.com]
Spinal cord injuries: Practice essentials, background, anatomy, pathophysiology, etiology, epidemiology, prognosis, patient education. [Internet] 10 August 2017. Available from: . Accessed March 2018. Swiss Paraplegic Research. Community. [icf-casestudies.org]
Prevention
Author information 1 Preventive Cardiovascular Research Centre Kermanshah, Kermanshah University of Medical Sciences, Kermanshah, Iran. 2 Preventive Cardiovascular Research Centre Kermanshah, Kermanshah University of Medical Sciences, Kermanshah, Iran [ncbi.nlm.nih.gov]
Its function is to prevent the delicate nerve tissue from the inside of the vertebrae. [physio-pedia.com]