Spastic paraparesis

Question 1

Signs in Spastic Paraparesis

Answer 1

Scissor gait
Disuse atrophy and contractures
Hypertonia, hypereflexia and upgoing plantars
Ankle clonus
Generalised weakness

Question 2

Causes of Spastic Paraparesis

Answer 2

Multiple sclerosis -> Cerebellar signs
Cord compression -> Absence of signs above the lesion
Trauma
MND -> No sensory signs
Anterior spinal artery occlusion -> loss of spinothalamic
Syringomyelia -> LMN in upper limbs + loss of spinothalamic
Subacute combined degeneration (B12 deficiency) -> areflexia + upgoing plantars
Cervical myelopathy

Question 3

Management of Spastic Paraparesis

Answer 3

Conservative:
PT -> Stretches + strengthening exercises, orthoses + casts

Medical:
Pharmacotherapy
-> Benzodiazepines
-> Baclofen
-> Clonidine
-> Gabapentin

Neurosurgery