Lower paraparesis develops as a result of traumatic injuries, circulatory disorders, hereditary, infectious and degenerative pathologies, compression of the spinal cord in tumors, abscesses and diseases of the spine. The cause of the symptom is determined according to the history, neurological examination, electrophysiological methods, neuroimaging, lumbar puncture, laboratory tests. As part of the treatment, antibiotics, vascular drugs, vitamins, and neuroprotectors are prescribed. Provide comprehensive rehabilitation. Sometimes a correction is made.
Lower paraparesis is a neurological syndrome characterized by a weakening of the strength of the leg muscles. It can be symmetrical or asymmetric, appear suddenly or form gradually. Perhaps a non-progressive course or aggravation of symptoms over time. There are the following types of syndrome:
- Sluggish. There is a decrease in reflexes and muscle tone, atrophy. There are no pathological signs.
- Spastic. Muscle tone is increased. Hyperreflexia, pathological reflexes and synkinesis are revealed. There is no muscle atrophy.
- Mixed. At the same time, signs of flaccid and spastic paraparesis are determined.
The severity of symptoms of paraparesis varies significantly: both slight muscle weakness and complete loss of the ability to actively move are possible. Lower paraparesis is often combined with dysfunction of the pelvic organs and sensory disorders in the affected area.
Why does lower paraparesis occur?
Traumatic injuries
The etiological factor is spinal cord injury: severe compression fractures, dislocations, subluxations and fracture-dislocations of the vertebrae. Less commonly, pathology occurs due to bruises of the spine. With bruising and compression, the severity of symptoms gradually decreases, and residual effects of varying severity are observed in the outcome. With complete damage to the spinal cord with its anatomical interruption, the violation persists until the end of life. At the time of injury, paresis is flaccid, later spastic in nature.
Non-traumatic compression myelopathy
According to statistics, compression myelopathy is one of the most common provoking factors of lower paraparesis. Occurs with diseases such as:
- Tumors. The cause of weakness in the legs are intramedullary and extramedullary neoplasms of the spinal cord: meningiomas, astrocytomas, neurofibromas, ependymomas. Sometimes a symptom is provoked by metastases in neoplasia of other localizations (lung cancer, breast cancer, etc.).
- Abscesses. They arise as a result of the spread of the infectious process in spinal tuberculosis, osteomyelitis, and infected wounds.
- Diseases of the spinal column. The spinal cord can be compressed due to displacement of the vertebra in spondylolisthesis or progression of the intervertebral hernia.
Spinal stroke is characterized by the sudden development of paresis in combination with loss of sensation and pelvic disorders. In chronic disorders of the spinal circulation, a gradual progression of symptoms is noted. In patients with arteriovenous malformations, two options are possible. In the apoplexy form, the vessel ruptures, paresis is formed at once. With paralytic, a progressive or intermittent course is noted.
The lower paraparesis accompanies the following congenital anomalies:
- Meningomyelocele. A hernia-like protrusion is revealed in the lumbar region. Muscle weakness and other neurological manifestations worsen with age.
- Dermal sinus. It is located in the lumbar region or on its border with the sacrum. In some patients, the pathology is asymptomatic, in others, signs of flaccid lower paresis are found.
- Fixed spinal cord syndrome. It is formed against the background of defects, tumors, traumatic injuries. In the congenital form, the changes are aggravated during periods of rapid growth (1-4 and 11-15 years).
lower paraparesis
Degenerative diseases
The picture of degenerative pathologies is very diverse. Along with lower paraparesis, upper paraparesis or paraplegia, cerebellar, extrapyramidal and other disorders can be observed. The symptom is found in the following diseases:
- Multiple sclerosis. The most typical variant is the development of lower spastic paresis. Sometimes tetraparesis is formed. Hyperkinesis, cerebellar ataxia, damage to the optic nerve, mental disorders are revealed.
- Lateral amyotrophic sclerosis. With the lumbar debut, the weakening of the muscles of the lower extremities is detected already in the initial stages. In patients with other variants, the disorder joins with the progression of the disease.
- Strümpel's disease. With early manifestation, unsharply expressed difficulties are determined even at the stage of learning to walk. The interval between the appearance of the first signs and a significant decrease in muscle strength takes several years. In the later stages, a pronounced paraparesis of the lower extremities is formed in combination with urinary incontinence, sometimes with spastic paresis of the hands.
- Opticomyelitis. Has an autoimmune nature. In the debut, optic neuritis occurs more often, less often - myelitis, manifested by paraparesis or tetraparesis, decreased sensitivity, urinary and fecal incontinence. Subsequently, both disorders are combined in the clinical picture.
hereditary diseases
The phenomena of paraparesis are typical for such hereditary diseases as:
- Adrenoleukodystrophy. It is caused by metabolic disorders, includes hypocorticism and neurological disorders, and is characterized by significant polymorphism. Weakness in the legs is characteristic of adrenomyeloneuropathy and symptomatic adrenoleukodystrophy.
- Machado-Joseph disease. Lower paresis is the first sign of pathology. Later, upper paraparesis, damage to the oculomotor nerves, dysphagia and dysarthria join.
- Refsum's disease. In the debut, the muscles of the distal legs weaken. Then the picture is supplemented by cerebellar symptoms, paresis of the hands, ophthalmological manifestations, and hearing loss.
Other reasons
In patients with syringomyelia, symptoms occur against the background of congenital disorders, may be the result of infections and traumatic injuries. The main role in the clinical picture is played by a decrease or loss of sensitivity, to which lower paraparesis can eventually join. Funicular myelosis occurs due to hypovitaminosis B12. There is a decrease in deep sensitivity, lower flaccid paraparesis, mental disorders.
Diagnostics
Establishing the etiology of the disorder is the responsibility of a neurologist. Patients with injuries are examined by a neurosurgeon. During the conversation, the specialist establishes the time and circumstances of the onset of weakness of the lower extremities, other symptoms, the dynamics of the disease. The examination program includes procedures such as:
- Neurological examination. It precedes other diagnostic manipulations, allows you to assess the nature of the violations, suggest the presence of a particular disease, and draw up a plan for further examination. The doctor examines muscle strength, sensitivity and reflexes, performs special tests.
- X-ray methods. X-ray of the spine is indicated for injuries, degenerative diseases, tuberculosis and osteomyelitis. Informative in assessing the state of solid structures. Contrast myelography is performed to detect processes that impede the circulation of cerebrospinal fluid (tumors, hernias, etc.)
- Tomography. For a detailed study of soft tissues, an MRI of the spinal cord is prescribed. To clarify the data obtained in the process of radiography, a CT scan of the spine is performed. The methods are recommended for circulatory disorders, tumors, syringomyelia, non-traumatic and traumatic compression myelopathy, and degenerative pathologies.
- Electrophysiological methods. The conduction of nerve impulses and the contractility of the muscles are determined taking into account the data of electromyography and electroneurography. In addition, studies can clarify the level of damage (peripheral nerve or CNS).
- spinal function. It is necessary to assess the pressure and nature of the cerebrospinal fluid, to conduct laboratory studies in patients with hemorrhages, tumors, and inflammatory processes.
- Laboratory tests. To study the state of the body, to establish the presence and severity of inflammation, general studies are performed (KLA, OAM, biochemistry of blood and urine). Extended tests may be required to determine hereditary diseases. A CSF sample is examined by microscopy and inoculation on nutrient media. If an autoimmune nature of paresis is suspected, tests for antibodies are prescribed. For the differentiation of neoplasia, a cytological or histological examination of the biopsy is carried out.
medical rehabilitation
Treatment
First aid
If a spinal cord injury is suspected, the patient is placed on a shield, covered, and given an anesthetic. In case of acute occurrence of lower paraparesis, it is necessary to immediately call the SMP team. If this is not possible, the patient should be taken to the neurology department, trying to change the position of the body less and not subject the spine to unnecessary stress.
Conservative therapy
Patients with paraparesis are shown drug therapy and complex rehabilitation to restore the muscle strength of the lower extremities. As part of drug treatment, drugs such as:
- Analgesics. Recommended for diseases accompanied by severe pain. Taking into account the severity of the pain syndrome, narcotic and non-narcotic analgesics are used parenterally, NSAIDs in tablets.
- Antibacterial agents. Abscesses, open traumatic injuries, and conditions after spinal surgery are indications for the use of antibiotics. First, a broad-spectrum drug is administered, then the therapeutic regimen is adjusted taking into account the results of sowing.
- vascular drugs. As part of the treatment of strokes and chronic circulatory disorders, anticoagulants, venotonics, and vasoactive drugs are used.
- immunosuppressive drugs. Corticosteroids and non-hormonal agents are indicated for radicular syndrome, optomyelitis, multiple sclerosis, spinal cord edema of various etiologies.
- other medicines. To improve metabolism, stimulate recovery processes, patients are prescribed vitamins and neuroprotectors.
An important part of treatment is the prevention of complications. Special anti-decubitus mattresses are used, patients are regularly turned over in bed to prevent the occurrence of pressure sores. Conduct breathing exercises and passive exercises for the limbs to prevent congestive pneumonia, thrombosis and contractures. In the recovery period, verticalization is carried out. Physiotherapy exercises according to individually designed programs are recommended.
Surgery
Patients with paraparesis perform the following surgical interventions:
- Traumatic injuries: intervertebral fixation with cages or transpedicular fixation, plate placement, interbody fusion, Urban wedge resection.
- Vascular problems: embolization of aneurysms and arteriovenous malformations.
- Abscesses: opening and drainage of abscesses using laminectomy.
- Neoplasms : removal of intramedullary tumors, meningiomas, hourglass neoplasias.
- Malformations: suturing of the defect and formation of the spinal column in meningomyelocele, microsurgical removal of the dermal sinus in combination with correction of vertebral anomalies.