EpistemisTetraparesis
Specialty: Neurology.
Why it occurs
- Cervical spinal cord injury with acute spinal cord injury
- Severe cervical spondylotic myelopathy or extruded cervical disc herniation with spinal cord involvement
- Severe Guillain-Barré syndrome (with rapid progression to upper extremities and intercostals)
- Myasthenic crisis (severe decompensation of Myasthenia Gravis with bulbar and respiratory weakness)
- Polyneuropathy of the critically ill patient or myopathy due to corticosteroids in the intensive care unit
- Upper cervical transverse myelitis
Initial workup
Urgent magnetic resonance imaging of the cervical spine; arterial blood gas and spirometry to measure forced vital capacity (FVC) in bed; lumbar puncture; four-limb electromyogram; determination of antibodies against acetylcholine receptors (anti-AChR) and anti-MuSK if myasthenia gravis is suspected.
red flags
Progressive or sudden tetraparesis accompanied by objective respiratory difficulty (dyspnea at rest, use of accessory muscles, ineffective cough), dysphagia, dysphonia or hemodynamic instability, which represents a life-saving emergency that requires endotracheal intubation and mechanical ventilation.
Standard management
- Intravenous immunoglobulins or plasmapheresis — first-line therapy for both Guillain-Barré and myasthenic crisis
- Neostigmine or Pyridostigmine — cholinesterase inhibitors, used under strict monitoring
- Methylprednisolone (in immunosuppressive doses or spinal trauma regimen according to current protocols).
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
- 6
- Treatment options
- 3