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Paraplegia


Presentation

  • Classically, the clinical presentation is a severe peripheral ischemia with bilateral leg pain as the predominant feature.[ncbi.nlm.nih.gov]
  • We report a 22-year-old Omani male who presented to the Sohar Hospital, Sohar, Oman, in 2016 with acute-onset rapidly progressive flaccid areflexic paraplegia as the presenting manifestation of thyrotoxicosis.[ncbi.nlm.nih.gov]
  • Abstract Ten years after placement of a spinal cord stimulator (SCS) and resolution of pain, this patient presented with progressive paraplegia, worsening thoracic radicular pain at the same dermatome level of the electrodes, and bowel and bladder incontinence[ncbi.nlm.nih.gov]
  • The authors present a case of delayed-onset spinal cord infarction after repeated tumor excision surgeries of the thoracic spine.[ncbi.nlm.nih.gov]
  • We describe a new case with this unusual presentation of aortic dissection and here we emphasize that this condition must be considered in all patients with painless paraplegia.[ncbi.nlm.nih.gov]
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]
  • 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]
  • 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]
  • .  Associated symptoms (fever: infective causes. seizures, delayed milestones: cerebral cause.[slideshare.net]
Wheelchair Bound
  • ‘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.’[en.oxforddictionaries.com]
  • Many become wheelchair-bound before their teens. Others can walk with a waddling gait.[childrenshospital.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]
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.[neurologyreviews.com]
  • 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]
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]
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]
  • 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]
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]
  • CONCLUSIONS: Venous hypertension with subsequent rapid resolution after surgical treatment is the pathophysiological mechanism underlying a dural arteriovenous fistula, in contrast to historical views suggesting that these lesions result from irreversible[ncbi.nlm.nih.gov]
  • These devices have been associated with acute hypertension and cardiac remodeling. Less stiffer stent grafts should be studied for young patients. High attention must be posed in the follow-up for the immediate resolution of eventual problems.[ncbi.nlm.nih.gov]
  • A history of hypertension at young age and aortic regurgitated murmurs may serve as clues for further diagnostic studies.[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]
Muscle Spasticity
  • 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]
  • EudraCT Number: 2009-012073-34 Sponsor Protocol Number: R0000063 Start Date * : 2009-07-08 Sponsor Name: Radboud University Nijmegen Medical Centre Full Title: Botulinum toxin for treating calf muscle spasticity in Hereditary Spastic Paraparesis (HSP)[clinicaltrialsregister.eu]
  • Treatment is exclusively symptomatic and aimed mainly at reducing muscle spasticity and urinary urgency, and improving strength and gait.[frontiersin.org]
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]
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]
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]
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]
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]
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]
  • 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]
  • 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]
  • 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]
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]
Dysautonomia
  • .  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]
Radiculomyelopathy
  • Enterogenous cyst should be considered in the differential diagnosis of spinal intradural cysts in children with radiculomyelopathy.[ncbi.nlm.nih.gov]
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]
  • A 70-year-old Arab man with no previous known medical or surgical conditions was hospitalized for brutal heaviness of his lower limbs associated to urinary retention. A neurological examination revealed flaccid paraplegia without sensory disorder.[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]
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]
  • 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]

Workup

  • While this adds considerable challenges in the diagnostic workup, certain specific complicating features may guide the differential diagnosis between the different HSPs.[scielo.br]
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]
Right Bundle Branch Block
  • Severe chest pain occurred with newly onset right bundle branch block that developed the other day. Coronary artery angiography revealed myocardial bridge of left anterior descending coronary artery at middle third and coarctation of aorta.[ncbi.nlm.nih.gov]

Treatment

  • Early endovascular treatment can reverse this type of situation.[ncbi.nlm.nih.gov]
  • RESULTS: SDAVF was totally resolved after surgical treatment. During next months, paraplegia slightly improved and he is currently receiving rehabilitation treatment.[ncbi.nlm.nih.gov]
  • CASE DESCRIPTION: This case report on a young patient with an unusual clinical onset of Foix-Alajouanine syndrome coincidentally occurring after his outpatient clinic appointment illustrates how prompt surgical treatment can result in rapid recovery of[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]
  • Patients will be randomized to one of the two treatment strategies: a) aneurysm repair without MISACE pre-treatment, or b) aneurysm repair with MISACE pre-treatment.[clinicaltrials.gov]

Prognosis

  • 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]
  • Know, however, that even the best doctors cannot be certain about the prognosis, and you should not allow even a grim prognosis to undermine your motivation to keep working toward recovery.[spinalcord.com]
  • In some of these patients a spinal stabilising operation was later performed, but it is not possible to compare the remote prognosis in these patients with those treated conservatively— e.g. by spinal braces.[nature.com]
  • Understanding these terms can help you communicate more effectively with your doctors, enabling you to better understand your prognosis. Many spinal cord injury survivors are confused by the distinction between quadriplegia, tetraplegia, paraplegia.[spinalcord.com]

Etiology

  • Transient paraplegia of the lower limbs is a rare condition and, when has a vascular etiology, is usually associated with thromboembolic events, aortic dissection, aortic aneurysms, or as a complication of the surgical correction of those diseases.[ncbi.nlm.nih.gov]
  • 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]
  • […] 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]
  • Autonomic Hyperreflexia Anatomy: Spinal cord injury T7 or above Stimulus: Cutaneous, visceral (bladder), proprioceptive, below the level of the lesion Etiology: Spinal reflex which is normally inhibited by descending feedback Result: hypertension followed[openanesthesia.org]
  • Etiology To date, 31 different loci responsible for pure and complex HSP have been mapped.[orpha.net]

Epidemiology

  • 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]
  • 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]
  • Epidemiology/Etiology The cause of paraplegia due to a spinal cord injury is most often by a car accident. It can also result from a firearm injury, which is not the case in many countries in the world.[physio-pedia.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]
Sex distribution
Age distribution

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]
  • Mobility and changes in size are rare pathophysiological findings. The authors speculate that the cyst wall did not adhere to the surrounding structures and had ruptured and quickly reformed.[ncbi.nlm.nih.gov]
  • CONCLUSIONS: Venous hypertension with subsequent rapid resolution after surgical treatment is the pathophysiological mechanism underlying a dural arteriovenous fistula, in contrast to historical views suggesting that these lesions result from irreversible[ncbi.nlm.nih.gov]
  • Traumatic, as in subdural hematomas Inflammatory, as following meningoencephalitis Vascular, as superior sagittal sinus thrombosis Tumors of the parasagittal region Degenerative, as in cerebral palsy Affecting the brainstem Midline tumors syringomyelia Pathophysiology[news-medical.net]
  • The pathophysiology of SPG4 is one of the more well studied.[clinicaltdd.com]

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]
  • Imaging is important for early diagnosis to prevent patients persistent neurological deficits.[ncbi.nlm.nih.gov]
  • Aortic occlusion presenting as an isolated acute onset of paraplegia due to spinal cord ischemia is very rare and requires improved awareness to prevent adverse outcomes associated with delayed diagnosis.[ncbi.nlm.nih.gov]
  • Its function is to prevent the delicate nerve tissue from the inside of the vertebrae.[physio-pedia.com]

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