Increases in severity over next tew days and then ascencte up to involve Trunk its , upper limbs and in some cases neck,

Cerebral angiography - If suspicion of expanding mass or vascular abnormality 3 BLOOD - (I) Megaloblastic anaemia In subacute combined degeneration. (II) VDRL positive In spinal syphilis. (Ill) Protein electrophoresis lor multiple myeloma. (iv) Prostaiic specific antigen for prostalic malignancy rt incfcaied. 4. GASTRIC ANALYSIS Peniagastrin fast achlorhydria In subacute combined degeneration 5. FUNDUS - Papilloedema in iniraoraniat tumour. Temporal pallor in multiple sclerosis. 6. URINE - for fluorine estimation In endemic fiuorosis. 7. THERAPEUTIC TEST - II suspected cervical disc degeneration, restriction of neck movements by rest or by wearing a collar for lew weeks will often produce marked improvemenl in walking DD of Flaccid paraplegias (paraparesis) 1 Poliomyelitis -(i) Acute onset with possibly signs ol meningeal irriialion (ii) Muscular weakness and flaccid parafysis til scattered muscle groups (ill) Not bilalerally symmetrical. 2. Peripheral neuritis - (I) Numbness and tingling at onset, (ii) Tenderness ol calf muscles. (iii) Glove and stocking type of anaesthesia (iv) Vasomotor and trophic changes - oedema, dyness. desquamation. (v) Bilaterally symmetrical paresis. 3, Acute lolopalhlcdernyelinating poly neuropathy - (i) Precetfng viral illness. (II) Weakness usually starting In lower limbs. Increases in severity over next tew days and then ascencte up to involve Trunk its , upper limbs and in some cases neck, face and bulbar ms. (lii) Areftexla Is the key to diagnosis.. .4. Cauda equina lesions (Any lesion In spinal canal below T10 can cause cauda equina syndrome) - (a) Lateral cauda equlna syndrome (e.g. neurofibroma) - Anterior thigh pain, weakness of quacfriceps and absent knee jerk. In casa of high lesion extensor plantar response. (b) Midine cauda lesion from within (Conus lesion) (e.g. ependymoma, dermoid or lipoma) Rectal and genifal painh micturition disturbances and Impotence Saddle anaesthesia Symmetrical findings (c) MidHne lesion from outside (e.g cfisc) - Signs of bilateral lumbar and sacral root involvement. 5. Lumbar disc syndrome -Paraplegia rare. (I) History of trauma may be obtained (ii) Initial phase of pain in lumbar region. (iii). Radiation ol pain to buttocks and back of thigh. (Iv). Pain often aggravated by coughing (v) Impairment of spinal movements. (vi). Impatment of sensation over dorsum of foot common. 6 Lumbar disc stenosis -Constriction of lumbo-sacral spinal canal can produce syrrploms due to direct compression or vascular insufficiency (syndrome of intermittent claudication of cauda equina) Presentation can be unremitting with backache and radicular radiation, or more commonly, with intermittent symptoms such as transient weakness or numbness as a result of exertion or hyperexiension of lumbar spine To ease symptoms, patient may adopt stooping posture wren walking. Absent reflexes, sensory loss, weakness and in-paired straight leg raising may be demonstrated only alter exertion CT scan myelography Characteristic angular or trefoil appearance ol neural canal. 7 .Tabes dorsalls - (I) Lightning pains. (II) Absent ankls and knee jerks. (iii) Pupillary changes. (iv) Positive Romberg'sign. 6. Friedreich's aiaxia-(i) Heredo-familial (II) Age - usually young. 10-15 years. (iii) Cerebellar signs - Nystagmus, ataxlc dysarthna or scanning speech, alaxia. and rhythmical oscillation ol the head (tltuballon). (Iv) Pyramidal