Spastic Paraparesis

CLINICAL DIAGNOSTIC MANUAL

Spastic paraparesis is a condition characterised by progressive weakness and stiffness in the muscles of the lower limbs due to an impairment of the motor nerve pathways in the spinal cord. This condition may result from various pathologies that compress, injure, or otherwise affect the spinal cord and its surrounding structures.

Spasticity is a clinical sign manifested by increased muscle tone and exaggerated tendon reflexes. Identifying the underlying cause of spastic paraparesis is crucial for appropriate treatment and improving the patient’s mobility and quality of life.

Condition	Clinical Symptoms and Signs	Suspected Diagnosis	Confirmatory Diagnosis
Intervertebral disc prolapse	Radicular pain, weakness, and spasticity in the lower limbs, sensory loss	Clinical history, neurological exam, radiating lumbar pain	Spinal MRI, spinal CT
Displaced vertebral fracture	Acute pain, spinal deformity, weakness and spasticity in the lower limbs, loss of reflexes	History of trauma, physical exam, signs of spinal injury	Spinal X-rays, spinal MRI
Vertebral collapse	Severe back pain, progressive weakness, and spasticity in the lower limbs	Clinical history, physical exam, history of osteoporosis or cancer	Spinal MRI, spinal CT
Spondylotic bone formation	Chronic back pain, stiffness, progressive weakness, and spasticity in the lower limbs	Clinical history, physical exam, signs of spinal cord compression	Spinal MRI, spinal CT
Multiple sclerosis affecting the spinal cord	Weakness and spasticity in the lower limbs, bladder and/or bowel dysfunction, sensory disturbances	Clinical history, neurological exam, episodes of neurological dysfunction	Brain and spinal MRI, CSF analysis
Space-occupying lesion in the spinal cord	Back pain, progressive weakness, spasticity, sensory loss, autonomic dysfunction	Clinical history, physical exam, signs of spinal cord compression	Spinal MRI, spinal CT
Spinal cord glioma	Progressive weakness, spasticity, neuropathic pain, sensory disturbances	Clinical history, physical exam, signs of spinal cord injury	Spinal MRI, biopsy if necessary
Spinal cord ependymoma	Back pain, progressive weakness, spasticity, sensory disturbances	Clinical history, physical exam, signs of spinal cord compression	Spinal MRI, biopsy if necessary
Parasagittal cerebral meningioma	Progressive weakness in the lower limbs, spasticity, headache, signs of intracranial hypertension	Clinical history, neurological exam, signs of focal lesion	Brain MRI, biopsy if necessary