. Disease of the vertebral column - (a) Degenerative- Cervical spondylosis and myelopathy, thoracic disc, lumbarD. D. of Flaccid paraplegias (parapare

D. D. of Flaccid paraplegias (paraparesis) 1. Poliomyelitis - (i) Acute onset with possibly signs of meningeal irritation. (ii) Muscular weakness and flaccid paralysis of scattered muscle groups. (iii) Not bilaterally symmetrical.l 2 Peripheral neuritis - (i) Numbness and tingling at onset (ii) Tenderness of calf muscles (iii) Glove and stocking type of anaesthesia (iv) Vasomotor and trophic changes - oedema, dryness,desquamation. (v) Bilaterally symmetrical paresis. 3 Acute idiopathic emyelinating polyneuropathy - (i)Preceding viral illness. (ii) Weakness usually starting in lower limbs, increases in severity over next few daysand then ascends up to involve trunk ms., upper limbs and in some cases neck, face and bulbar ms. (iii)Areflexia is the key to diagnosis 4. Cauda equina lesions (Any lesion in spinal canal below T10 can causecauda equina syndrome) - (a) Lateral cauda equina syndrome (e.g. neurofibroma) - Anterior thigh pain,weakness of quadriceps and absent knee jerk. In case of high lesion extensor plantar response. (b) Midlinecauda lesion from within (Conus lesion) - (e.g. ependymoma, dermoid or lipoma) -Rectal and genital pain,micturition disturbances and impotence. Saddleanaesthesia. Symmetrical findings. (c) Midline lesion fromoutside (e.g .disc) - 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 of pain to buttocks and back of thigh. (iv) Pain often aggravated by coughing (v) Impairment of spinal movements. (vi) Impairment of sensation over dorsum of foot common. 6. Lumbar disc stenosis - Constriction of lumbo-sacral spinal canal can produce symptoms 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 hyperextension of lumbar spine. To ease symptoms, patient may adopt stooping posture when walking. Absent reflexes, sensory loss, weakness and impaired straight leg raising may be demonstrated only after exertion. CT scan myelography - Characteristic angular or trefoil appearance of neural canal. 7. Tabes dorsalis - (i) Lightning pains. (ii) Absent ankle and knee jerks. (iii) Pupillary changes (iv) Positive Romberg's sign. 8. Friedreich's ataxia - (i) Heredo-familial. (ii) Age - usually young, 10-15 years (iii) Cerebellar signs - Nystagmus, ataxic dysarthria or scanning speech, ataxia, and rhythmical oscillation of the head (titubation). (iv) Pyramidal signs - Absent abdominal reflexes, extensor plantars. (v) Posterior column involvement - Loss of tendon reflexes. (vi) Deformities - Pes cavus and scoliosis. 9. Peroneal muscular atrophy- (i) Usually young adults. (ii) Muscular wasting in lower limbs, muscles involved transversely (fat bottle or inverted champagne bottle appearance). (iii) High steppage gait and clubbed feet. 10. Hysterical - (i) Paralysis generally preceded IV pain or discomfort in the Limbs. (ii) Muscular wasting may occur after some time due to disuse. (iii) Stocking type time anaesthesia common. (iv) Patient can often move legs normally when lying or sitting, but collapses at once when he tries to stand or walk (astasia abasia). 11. Distal myopathy of Welander - Very rare Slowlyprogressive, predominantly distal wasting and weakness. Compression of the spinal cord Causes: 1. Disease of the vertebral column - (a) Degenerative- Cervical spondylosis and myelopathy, thoracic disc, lumbar