Acute onset paraplegia

Causes:-
1)Spinal causes-
a) compression of the cord-
Any injury or disease can put pressure on the
cord causing backache, tingling, muscle
weakness. Some of the causes of compression to
the cord causing sudden paraplegia are-
 Complete Tran section of the cord due to trauma at
any level below T1.
 Injury to the vertebra causing fracture and dislocation
or collapse of the vertebra.
 Severe injury to the cord leading to haematoma
formation which presses on the cord.
 Prolapsed intervertebral disc.
 Spinal epidural abscess.

b) Non compressive causes-

 Acute transverse myelitis- inflammation with
destruction of myelin sheath that affects the cord
across its entire width and thus blocks transmission of
nerve impulses travelling up or down the cord.
Can occur at any age.
Initiates with severe pain in the back or neck.
Symmetrical type of paralysis ascending from the feet upwards. It
may be viral or post vaccinal .bladder inv is early and fever may
be present before paralysis develops.
Treatment is with high dose IV methylprednisolone (good
response)
 Spinal cord infarction-either due to anterior spinal artery or
total cord infarction. Occlusive lesions with atherosclerosis is
the most common cause.
Other causes are trauma, APL syndrome, thrombophilias, acute
myelitis, multiple sclerosis, compressive lesions, tumors,
syphilitic arteritis, spontaneous thrombosis of the ant. Spinal
artery.
The patient usually presents with acute radicular or diffuse pain,
flaccid paralysis, loss of distal pain and temp sensation, loss of
sphincter control sparing the posterior column.
 AV malformations, angiomas.
c) Other causes-
 Guillain Barre syndrome-acute post infective
polyradiculoneuropathy.
Occurs 1-4 weeks after infection (usu campylobacter)
CMI against myelin sheath and peripheral nerves and
spinal nerve roots.
Nerve conduction impaired by inflammatory cytokines.
Ascending symmetrical type of paralysis affecting the
proximal muscles first starting as paraplegia then
ascending to the upper limbs later.
The reflexes are diminished, CN inv. Resp failure can
occur. No sensory abnormalities.
 2)Cerebral causes- (rare)
 a) Thrombosis of unpaired anterior
cerebral artery.
 b) Superior sagittal sinus
thrombosis.
 c) traumatic injury at the
paracentral lobules.