| History: Individuals who have experienced spinal cord injury may present with various levels of impairment and may describe reduced or completely absent sensory or motor function in the extremities and torso. In cases of paralysis, individuals may report a history of traumatic injury, brain tumor or abscess, or infection. The individual may report weakness of muscles in the limbs, loss of sensation, increased muscle tone (spasticity), or loss of muscle tone (flaccidity).
Individuals with paraplegia may report a history of a traumatic injury; brain tumor; or diseases of the spinal cord, nerve roots, or peripheral nerves. The individual may report weakness of the muscles of both lower extremities, loss of pain and temperature sensation below a particular level, and loss of position and vibratory sense.
Quadriplegic individuals may report weakness of the muscles of all four extremities. Flaccidity of the arms and spasticity of the legs are typical patterns of paralysis. The individual may also experience pain in the neck and shoulders, numbness of the hands, and, if mobile, may report or exhibit staggering gait and postural imbalance (ataxia).
A complete health history is obtained, including current and prior disease conditions or injuries. Physical exam: A complete physical examination may reveal the presence of recent multiple injuries sustained in trauma. Paralysis and/or restricted movement of extremities may be seen. Motor strength and sensory testing is usually done using an impairment scale (ASIA or Frankel scales). The neurological exam may reveal spinal cord damage and localize the level of injury in individuals with paralysis. Spastic movement and increased tendon reflexes may be evident. Peripheral nerve damage is indicated by muscle wasting (atrophy) and weakness with reduced tendon reflexes. Affected muscles may reveal involuntary contraction or twitching of groups of muscle fibers (fasciculation).
In individuals who are paraplegic, the neurological exam may reveal spinal cord damage and localize the level of injury. A rectal examination may be done to check motor function or sensation of the anal musculature; if function is fully present and the sacral function is intact, as in a sacral-sparing spinal injury, normal or near normal bladder and rectal function may be present. In other individuals, the bladder and sphincter muscles may be affected and result in loss of bladder and rectal function.
Sensory loss is more prominent in the distal segments of the limbs. In hereditary spastic paraplegia, the individual may have normal upper extremity muscle tone with weakness in the legs; muscle wasting may be seen as well as signs of diminished sensation in the lower extremities, gait disturbances, high arched feet, and pathologic increases in lower extremity reflexes.
In quadriplegia, the neurological exam may reveal brain damage or lesions of the cervical spinal cord. In diplegia, the legs are more affected than the arms. There may be dislocation of spinal cord segments, especially in the presence of rheumatoid arthritis. In individuals with triplegia, the exam may reveal spastic weakness of one limb followed by involvement of the other limbs in a "round the clock" pattern. Loss of pain and temperature sensation may be observed. Tests: For paralysis, paraplegia, and quadriplegia, diagnostic tests include x-rays, CT scan, or MRI. The diagnostic tests may reveal a spinal cord injury or tumor in individuals with paralysis, lesions of the spinal cord or an extrinsic mass that narrows the spinal canal in individuals with paraplegia, atrophy of the spinal cord and cerebral cortex in hereditary spastic paraplegia, and lesions of the cervical spinal cord in individuals with quadriplegia. Electromyography tests the electrical activity of the muscles. A lumbar puncture (spinal tap) may be performed to rule out infection, and it often demonstrates a dynamic block and increase in cerebrospinal fluid protein. Complete blood count, serum chemistry panel, and urinalysis can be helpful in determining health status and possible underlying disease processes. Rheumatoid factor may be assayed to confirm rheumatoid arthritis. Genetic testing may be needed to help diagnose hereditary spastic paraplegia. |