Diagnosis and Evaluation of Acute Paraplegia
John M. Freeman MD1
1 Professor, Departments of Neurology and Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, MD 21205
CASE REPORT
A 14-year-old high school student is admitted to the pediatric neurology service because of the sudden onset of inability to use her legs. When she had gotten up in the morning she was unable to stand.
INTRODUCTION
Acute neurologic deficit in an adolescent girl (or in anyone else) always represents an emergency requiring immediate evaluation by a physician competent to analyze the deficit, localize its source, develop a differential diagnosis of possible etiologies, organize appropriate tests, and, when indicated, initiate emergency treatment.
Acute paraplegia (weakness or paralysis in the legs) is a particular emergency because acute compressive lesions of the cord are reversible. Hours of compression may result in irreversible damage. For this reason neurologic and neurosurgical consultation should be obtained promptly.
EVALUATION
The evaluation of an individual with an acute paraplegia is best performed with a differential diagnosis in mind. The major cause of paraplegia is spinal cord disease, and its differential diagnosis is shown in Table 1. Spinal cord disease with paraparesis (weakness) may be simulated by lesions in the parasagittal area of the brain, by muscle weakness in the legs (muscular dystrophy or polymyositis), and by conversion reaction.
History
In evaluating the patient with an "acute" paraplegia one must establish how acute is acute. An immediate total loss of function is almost always vascular.
