2. WHAT IS PARAPLEGIA?
PARALYSIS OF LOWER PART OF BODY,COMMONLY AFFECTING BOTH LEGS AND OFTEN INTERNAL ORGANS BELOW WAIST.

3. ETIOLOGY DIVIDED INTO 2 TYPES DUE TO UPPER MOTOR NEURON LESION
DUE TO LOWER MOTOR NEURON LESION

4. UMN LESIONS SPINAL LESIONS (common)
Spinal cord compression( Pott’s disease,disc prolapse or fracture, tumors,epidural abscess,cervical spondylosis etc)
VASCULAR
Hemorrhage, Infarction
SYSTEMIC DEGENERATION OF TRACTS
Multiple sclerosis, MND, Sub acute combined degeneration of cord.
INFECTION
Transverse myelitis, Neurosyphilis

5. UMN LESIONS CEREBRAL LESIONS (uncommon)
Thrombosis of superior sagital sinus
Tumor of falx-cerebri
Hydrocephalus

6. LMN LESIONS Anterior horn cells Poliomyelitis, Motor neuron disease
Peripheral nerve
Peripheral neuropathy
Neuromuscular junction
Myasthenia gravis
Muscles
Muscular dystrophies

7. SPINAL CORD COMPRESSION
It may be acute with trauma,metastasis or
Arterial occlusion or it may be slow developing over weeks as in Pott’s disease,cervical spondylosis etc.

8. POTT’S DISEASE
TB of spine often involves two or more adjacent vertebral bodies. Lower thoracic and upper lumber vertebrae are commonly involved.Intervertebral disc is also destroyed. With advanced disease paravertebral cold abscess , gibbus formation and PARAPLEGIA occur.

9. TRANSVERSE MYELITIS
It is an acute or subacute inflammation of spinal cord occuring after infection or recent vaccination. Many agents like influenza,measles,CMV,EBV and mycoplasma have been implicated.

10. Guillain Barre Syndrome
Acute inflammatory or post-infective demyelinating polyneuropathy.
Develops 1-3 weeks after respiratoryinfection or diarrhea in >70% cases.
Ascending polyneuropathy.

11. MOTOR NEURON DISEASE
Progressive degenerative disorder of upper and lower motor neurons in spinal cord,cranial motor neurons and pyramidal neurons in motor cortex.
Cause- unknown.
Patterns
Progressive bulbar palsy
Progressive muscular atrophy
Amytrophic lateral sclerosis.

12. SUBACUTE COMBINED DEGENERATION OF SPINAL CORD
Syndrome of combined spinal cord and peripheral nerve damage
cause: Vit.B12 deficinency
Changes start in posterior columnn (affecting vibration and position sense) then involve lateral column(pyramidal tracts)

13. MYASTHENIA GRAVIS Acquired autoimmune disorder of NMJ.
Causes skeletal muscle fatigubility and weakness, esp of proximal limb muscles,ocular anb bulbar muscles.

14. DUCHENNE’S MUSCULAR DYSTROPHY
X-linked recessive disorder
Deficiency of protein dystrophin in muscles.
Symptoms start in childhood,become severe in adolescence and death occurs by age 20 years.

15. MANAGEMENT OF PARAPLEGIA
HISTORY
EXAMINATION
INVESTIGATIONS
TREATMENT

16. HISTORY
AGE AND SEX
Young age: Inherited disorders,muscle dis.,infections
Old age: malignancies r common.
DURATION
ACUTE:GBS,transverse myelitis, cord compression.
CHRONIC:MND,polyneuropathies,muscle dis.
SPHINCTER DISTURBANCES (INITIALLY URGENCY OR HESITENCY OF MICTURATION,THEN URINARY RETENTION)
Seen in UMN lesions.

17. HISTORY SENSORY SYMPTOMS ROOT PAIN In cord compression. BACKACHE
Numbness,tingling and hyperesthesias in neuropathy.
ROOT PAIN
In cord compression.
BACKACHE
In cord compression,transverse myelitis.
HEADACHE,VOMITING
Intracranial lesions
PRECEDING FEVER,URTI
In GBS

18. EXAMINATION MOTOR SYSTEM FEATURES UMNL LMNL Muscle waisting absent
present
Muscle tone
Power
Deep reflexes
+++ _
Superficial reflex
Planters
Fasciculations

19. SENSORY SYSTEM
Sharp sensory level in transverse myelitis differentiates it from GBS. Neuropathy:glove and stocking distribution.
Romberg sign +ve if posterior column is involved.

20. SIGNS OF SPINAL CORD COMPRESSION
CERVICAL,ABOVE C5
UMN signs and sensory loss in all 4 limbs
CERVICAL,C5 TO T1
LMNsigns and segmental sensory loss in arms,and UMN signs in legs
THORACIC CORD
Spastic paraplegia with a sensory level on trunk.
CONUS MEDULLARIS
Sensory loss in sacral area and extensor plantar response
CAUDA EQUINA
LMN signs in lower limbs.

21. EXAMINATION EXAMINATION OF SPINE For deformity and tenderness.
SPHINCTERS:Look for incontinence or retention of urine or faeces.
OTHER FEATURES:
Anemia-B12 deficiency
Stiff neck in cervical spondylosis
Site of malignancy.

22. INVESTIGATIONS X-RAY SPINE:
May show collapse or erosion of vertebrae,herniated interverteberal disc,mets.,# or dislocation of vertebra etc.
MRI:
Investigation of choice
CT SCAN
BLOOD CP:
Megaloblastic anemia in subacute combined degeneration of spinal cord.
ESR is raised in inflammatory cases.
CSF

23. INVESTIGATIONS CSF examination:
Inflammatory lesions, both cells and proteins are increased.
In malignancy,malignant cells may be present.
In transverse myelitis ,proteins are increased and upto 50 lymphocytes/cmm are present.
In MS,monoclonal IgG is increased.
In GBS,protein cell dissociation is seen.

24. INVESTIGATIONS MYELOGRAPHY: Site of cord compression is demonstrated.
NERVE CONDUCTION STUDIES:
Helpful in diagnosis of neuropathies.
FUNDOSCOPY:
For papilloedema due to intracranial tumor or MS.
BONE SCAN:
Mets and inflammatory vertebral lesions r detected.

25. TREATMENT GENERAL MEASURES SKIN CARE:
Change posture every 2-4 hrly to avoid bed sores.
Keep skin dry and clean.
BLADDER CARE:
CATHETERIZATION for urinary retention.
BOWEL CARE:
Avoid constipation by suitable diet and laxatives.

26. TREATMENT PREVENTION OF CONTRACTURES By regular passive movements.
REHABILITATION
By using wheel chair,standing frames,vocational training etc.

27. SPECIFIC TREATMENT POTT’S DISEASE Immobilization ATT
Surgery:Anterior transthoracic decompression.
TRANSVERSE MYELITIS
Glucocorticiods are given.Initially I/V methylprednisolone,then oral prednisolone.

28. TREATMENT
MND
Symptomatic T/M like physiotherapy,walking aids,splints and speech therapy.
Glutamate antagonist,RILUZOLE ?
SUBACUTE COMBINED SPINALCORD DEGENERATION
Injection vit.B ug I/M daily for 7-10 days,then weekly for a month and then monthly for whole life.

29. TREATMENT GBS Plasma pharesis(effective only in first 2 weeks)
i/v immunoglobulins(2g/kg in 5 days)
No role of steriods.
SPINAL CORD TUMORS
Radiotherapy
Surgical decompression.

30. COMPLICATIONS BEDSORES BOWEL AND BLADDER INCONTINENCE DVT
PULMONARY EMBOLISM
PSYCHIATRIC LAYOUT
HYPOSTATIC PNEUMONIA
DISEASE RELATED COMLICATIONS

31. THANK YOU