Bilateral Spastic Paraparesis Frequently Asked Questions

What are the causes of spastic paraparesis?
Youth:
· Trauma.
· Multiple sclerosis.
· Friedreich's ataxia.
· HIV.

Adults':
· Multiple sclerosis.
· HIV (Neurology 1989; 39: 892).
· Trauma (motor vehicle or diving accident).
· Spinal cord tumour (meningioma, neuroma).
· Motor neuron disease.
· Syringomyelia.
· Subacute combined degeneration of the cord (associated peripheral neuropathy).
· Tabes dorsalis.
· Transverse myelitis.
· Familial spastic paraplegia.

Elderly:
· Osteoarthritis of the cervical spine.
· Vitamin deficiency.
· Metastatic carcinoma.
· Anterior spinal artery thrombosis.
· Atherosclerosis of spinal cord vasculature

What do you know about transverse myelitic syndrome?
· Causes include: trauma, compression by bony changes or tumour, vascular disease.
· All the tracts of the spinal cord are involved.
· The chief clinical manifestation is spastic or flaccid paralysis.
· The lesion can be incomplete cord compression or total cord transection:

What do you know about hereditary spastic paraplegia?
This is an autosomal dominant condition, first described by Seeligmuller and Strumpell, in which spasticity is more striking than muscular weakness. The age of onset is variable and the condition has a relatively benign course. When the onset is in childhood, there may be shortening of the Achilles tendon, often requiring surgical lengthening. There is usually no sensory disturbance.

What are the clinical features of spinal cord compression from epidural metastasis?
The initial symptom is progressive axial pain, referred or radicular, which may last for days to months. Recumbency frequently aggravates the pain, unlike the pain of degenerative joint disease where it is relieved. Weakness, sensory loss and incon-tinence typically develop after the pain. Once a neurological deficit appears, it can evolve rapidly to paraplegia over a period of hours to days. In suspected cases MR! of the spine must be done by the next day. About 50% of cases in adults arise from breast, lung or prostate cancer. Compression usually occurs in the setting of dis-seminated disease. It is at the thoracic level in 70% of cases, lumbar in 20% and cervical in 10%, and occurs at multiple, non-contiguous levels in less than half of the cases. The tumour usually occupies the anterior or anterolateral spinal canal. CSF findings are non-specific in metastatic epidural compression. The cell count is usually normal, bu! protein levels may be raised because the flow of CSF is impeded. Lumbar puncture has been known to worsen the neurological deficit, presumably due to impaction of the cord.