Spastic paraparesis
| Incidental findings | Fasciculation |
| +ve signs | ↑Tone lower limbs, ↓power, hyper-reflexia, clonus |
| Differential diagnosis | As below |
| Function | Walking aids, bladder involvment - catheter |
| Tests |
FBC – anaemia; ESR – infection Vitamin B12 level, syphilis serology, PSA Urgent MR spine |
Causes
Cord damage: trauma, OA, spinal met
MS
MND
Cord tumour
Friedreich’s ataxia
B12 deficiency
(Parasagital meningioma)
Cord damage: trauma, OA, spinal met
MS
MND
Cord tumour
Friedreich’s ataxia
B12 deficiency
(Parasagital meningioma)
Extensions
- Observe gait – if patient can ambulate
- Find sensory level
- Check for cerebellar signs (Freidreich’s ataia)
- Check sacral sensation
- Examine spine
Notes
- Other causes: Hereditary spastic paraplegia, tropical spastic paraplegia, anterior spinal artery occlusion
- Knee jerk = L4, Ankle jerk = S1