EpistemisParaparesis
Specialty: Neurology.
Why it occurs
- Compressive myelopathy (massive central disc herniation, lumbar canal stenosis, epidural metastases)
- Guillain-Barré syndrome (acute inflammatory demyelinating polyradiculoneuropathy with ascending weakness)
- Transverse myelitis (inflammatory, infectious or autoimmune)
- Spinal cord infarction (ischemia in the territory of the anterior spinal artery)
- Familial spastic paraparesis (long pathway genetic neurodegenerative disorder)
Initial workup
Full spine magnetic resonance imaging (cervical, dorsal and lumbosacral) with and without contrast urgently; lumbar puncture for cerebrospinal fluid (CSF) analysis looking for albumin-cytological dissociation (typical of Guillain-Barré) or oligoclonal bands (suggestive of multiple sclerosis/myelitis); electromyogram of lower limbs.
red flags
Progressive or sudden loss of strength in both legs associated with anesthesia or perineal hypoesthesia ("in the saddle"), acute urinary retention or fecal incontinence, which constitutes Cauda de Cauda Syndrome or acute spinal cord compression, requiring emergency neurosurgical decompression.
Standard management
- Methylprednisolone — intravenous boluses of 1000 mg/day for 3-5 days in case of confirmed transverse myelitis or strong suspicion of a demyelinating flare
- Intravenous human immunoglobulin (0.4 g/kg/day for 5 days for Guillain-Barré syndrome) or plasma exchange (plasmapheresis).
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
- 2