This document discusses paraplegia, which is an impairment of motor or sensory function in the lower extremities. It defines different types such as paraplegia, quadriplegia, and monoplegia. It then describes the causes of spastic and flaccid paraplegia, including compressive and non-compressive spinal causes as well as gradual and sudden onset cerebral and spinal causes. Common etiologies include glioma, meningioma, myeloma, transverse myelitis, and injury to the spinal cord.

2. PARAPLEGIA
AN IMPAIRMENT IN MOTOR OR
SENSORY FUNCTION OF THE LOWER
EXTREMITIES.

3. • Both upper limbs + Both lower limbs
QUADRIPLEGIA
• Only one upper limb
MONOPLEGIA

4. PARAPLEGIA
• Spastic
• Paraplegia in
extension
• Paraplegia in
flexion
• Flaccid

5. Paraplegia in
extension
Paraplegia in flexion
Lower limbs take an
extensor attitude
Lower limbs take an attitude
of flexion
Only pyramidal tracts are
involved
Both pyramidal &
extrapyramidal tracts are
involved
Evolution early Evolution late

6. CAUSES OF SPASTIC
PARAPLEGIA (UMN type)
• GRADUAL ONSET
1. CEREBRAL CAUSES
• Cerebral diplegia
• Parasagittal meningioma

7. • SPINAL CAUSES
1. Compressive
2. Non compressive
• Motor neuron disease
• Multiple sclerosis
• Frederich`s ataxia
• Subacute combined degeneration

8. Compressive etiology
• Intramedullary (5%)
1. Glioma
2. Ependymoma
3. Chordoma

9. • Extramedullary
• Intradural (15%)
1. Meningioma
2. Neurofibroma
3. Patchy arachnoiditis (TB,Syphilis)

10. • Extradural (80%)
1. Caries spine
2. Myeloma,Lymphoma,Metastatic deposits in
vertebra
3. Patchy meningitis
4. Prolapsed intervertebral disc

12. • SUDDEN ONSET
• CEREBRAL CAUSES
1. Thrombosis of unpaired anterior cerebral
artery
2. Superior sagittal sinus thrombosis

13. • SPINAL CAUSES
1. Acute tranverse myelitis
2. Injury to spinal cord
3. Thrombosis of anterior spinal artery
4. Haematomyelia
5. Post vaccinal
6. Prolapsed intervertebral disc

14. CAUSES OF FLACCID
PARAPLEGIA (LMN type)
• UMN lesion in shock stage
• Sudden onset in neuronal shock,acute transverse
myelitis,spinal injury

15. •LMN lesion involving anterior horn cells
or peripheral nerves
1. Acute anterior poliomyelitis
2. Acute infective polyneuropathy
3. Progressive muscular atrophy

16. • Diseases affecting posterior nerve roots
• Tabes dorsalis
• Diseases affecting myoneural junction
1. Myasthenia gravis
2. Periodic paralysis due to hypo or hyperkalemia

17. • Diseases affecting muscles
• Myopathy
• Hysterical paralysis

18. 5Ts
• Trauma
• Tumour
• Tuberculosis
• Thrombosis
• Transverse myelitis