EpistemisHyporreflexia or areflexia
Specialty: Neurology.
Why it occurs
- Acute inflammatory demyelinating polyradiculoneuropathy (Guillain-Barré Syndrome)
- Advanced chronic sensory-motor peripheral polyneuropathy (diabetic, alcoholic, uremic)
- Severe unilateral compressive radiculopathy (with selective involvement of the motor/sensory root of the reflex arc, e.g. S1 for the Achilles reflex)
- Myopathies or muscular dystrophies in advanced stages
- Eaton-Lambert syndrome (presynaptic disorder of the neuromuscular junction with hyporeflexia that improves after repeated voluntary muscle contraction)
Initial workup
Systematic examination of deep tendon reflexes (bicipital, tricipital, stylorradial, patellar, Achilles) using Jendrassik maneuver if necessary; electroneuromyogram (ENMG) to evaluate latencies, conduction velocities, action potential amplitudes, and presence of conduction blocks; lumbar puncture; specific anti-ganglioside antibodies (GQ1b, GD1a, etc.).
red flags
Generalized areflexia of rapid onset (days or hours) associated with ascending muscle weakness and respiratory difficulty (Guillain-Barré), or asymmetric hyporeflexia accompanied by loss of sphincter control (cauda equina syndrome).
Standard management
- Intravenous human immunoglobulin or Plasmapheresis — in Guillain-Barré
- Pyridostigmine — for myasthenia or neuromuscular junction disorders
- Support treatment, intense motor physiotherapy to maintain ranges of joint mobility and prevent contractures.
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Neurology
- Listed causes
- 5
- Treatment options
- 3