Presentation
Hepatospleenomegaly and mild neck stiffness were present. Fundoscopy was normal. He had spastic gait and could walk with assistance and support. DTR were hypertonic, sensory deficit present below twelfth thoracic vertebra. [scielo.br]
We describe an extremely rare and previously unreported presentation of acute progressive paraparesis secondary to traumatic thoracic disc herniation in a child presenting to our institution. [ncbi.nlm.nih.gov]
Presentation with rapid onset of paraparesis or quadriparesis (onset within 2 weeks) is rarer still. The authors present their experience in the management and outcome of patients with such a presentation. [thejns.org]
Entire Body System
- Swelling
Spinal MRI revealed swelling of the lumbar and cervical spinal cord. CSF and blood chemistry showed normal results. [ncbi.nlm.nih.gov]
Medications like corticosteroids and anti-inflammatory drugs are given to reduce swelling of nerves in spinal cord. Often the treatment is to be continued for the entire life to avoid any complications. [diseasespictures.com]
Spinal cord swelling can be noted if one is suffering from paraparesis. Lumbar puncture This can identify for presence of the infective agent that may have caused the condition. [byebyedoctor.com]
However, in some people who are infected with the HTLV-1 virus, inflammation (swelling) occurs in the spinal cord; the immune system's attack on the virus involves sending cells called lymphocytes to the affected area. [nationalmssociety.org]
- Developmental Delay
Symptoms begin in infancy, and include hypotonia, developmental delay and intellectual disability, dysmorphic facial features, spasticity and ataxia. [sema4.com]
Learning difficulties and developmental delay O Children who do not meet their expected developmental milestones should be assessed for possible causes. [books.mcai.org.uk]
There was no developmental delay, but she was always in last place in her class in track and field. She had been working as a salesperson since graduating from high school. She began to feel stiffness in her legs in her mid-30s. [e-jmd.org]
- Unable to Stand
The patient was unable to stand on either leg alone and failed a trial of ambulation secondary to lower extremity weakness. Deep tendon reflexes were 2 + throughout. Sensation to touch, pinprick, and temperature was intact. [anesthesiology.pubs.asahq.org]
Eight patients were unable to stand or walk and were bed bound at presentation. In 1 infant (aged 8 months) with paraparesis, the parents noticed paucity in limb movements, and another child older than 1 year could not walk, even with support. [thejns.org]
- Developmental Disorder
J Mov Disord > Volume 10(3); 2017 > Article Park, Ryu, Kim, and Chung: Oculodentodigital Dysplasia Presenting as Spastic Paraparesis: The First Genetically Confirmed Korean Case and a Literature Review Case Report J Mov Disord 2017; 10(3): 149-153. [e-jmd.org]
- Pseudotumor
Empty Sella syndrome may be idiopathic or occur secondarily to a treated pituitary tumor, head trauma, or a condition known as idiopathic intracranial hypertension (pseudotumor cerebri). [ncbi.nlm.nih.gov]
Gastrointestinal
- Diarrhea
For example, more women reported bloating and alternating constipation and diarrhea compared to men, and functional gastrointestinal disorders are generally reported to occur more often among women. [mdmag.com]
Though most of the approximately 28 billion individuals who develop diarrhea survive, the health consequences of diarrhea are great in tropical areas. Infants and small children are most likely to die of diarrhea. [encyclopedia.com]
[…] worldwide disease with a predominance in tropical, rural areas and its presentation in combination with paraparesis and acute renal failure is uncommon. [1], [2] Case Report A 26 year-old female patient presented a week postpartum with a history of fever, diarrhea [indianjnephrol.org]
Symptoms are often non-specific and include a large abdominal mass, abdominal distension/pain, failure to thrive, diarrhea, vomiting and jaundice. [orpha.net]
6 %; diarrhea; and nausea 0 %. 11 % confirmed fecal incontinence weekly or daily. [ojrd.biomedcentral.com]
Musculoskeletal
- Joint Dislocation
Non-neurological manifestations may include ophthalmological abnormalities (cataracts, retinitis pigmentosa, macular degeneration), and orthopedic abnormalities (scoliosis, joint dislocation, and different foot deformities). [orpha.net]
Neurologic
- Tremor
Clinical description Some relatives presented with tremor, cataracts, sensory deficits, short stature, hypogonadism, elevated cerebrospinal fluid protein, and/or absent or prolonged somatosensory evoked potentials. [orpha.net]
(In a paragraph about the dx of PPMS) "Most commonly this is seen as increasing stiffness and weakness of the legs (progressive spastic paraparesis), but other symptoms can occur such as unsteadiness, tremor or visual loss. " My legs are getting progressively [community.mssociety.org.uk]
This results in symptoms of unsteady walking, hand tremor and slurred speech. Hereditary spastic paraparesis is a genetic condition in which the legs become stiff and weak. [hra.nhs.uk]
UMN, immature behavior, tremor, MRI WMC Iran 22 Shakiba et al. (2012) REFERENCES 1. Paznekas WA, Boyadjiev SA, Shapiro RE, Daniels O, Wollnik B, Keegan CE, et al. [e-jmd.org]
- Meningism
Two patients (Patients 2 and 4) had recurrent episodes of meningitis before presenting to us, and 1 of these patients had meningitis at presentation to us. [thejns.org]
Examination of the higher functions, cranial nerves, and cerebellar systems did not reveal any remarkable findings; there were no meningeal signs. Urine analysis showed 2+ proteinuria, a few RBCs, and occasional pus cells. [indianjnephrol.org]
Radiation treatment for a tumor, which can destroy pituitary gland tissue Chemotherapy Brain surgery Traumatic brain injury, such as with a head injury from an accident Severe bleeding in the brain or severe blood loss during childbirth Tuberculosis or meningitis [hormone.org]
Within opoon meningitis and spinal cord neurons are visible infiltrates the destruction of myelin. HTLV-I is a virus that normally does not occur in cells of the central nervous system. [lekarzkatowice.blogspot.com]
One of the control patients died of postoperative bacterial meningitis and sepsis, and the other 2 died of spread of metastatic malignant disease. [academic.oup.com]
- Abnormal Gait
The symptoms of HSP can include the following: Abnormal gait Delayed walking Repeated tripping or falling Weakness of the leg muscles Rigidity and increased tone of the person's leg muscles People with uncomplicated HSP can also experience additional [disabled-world.com]
Some studies have quantitatively evaluated gait impairment in hereditary spastic paraparesis patients, revealing several gait abnormalities of reduced step length, increased step width, reduced range of motion (RoM) at the knee joint [ 18 – 20 ], impaired [journals.plos.org]
At the extremes are asymptomatic patients with pyramidal signs in the lower limbs with a normal or only slightly abnormal gait and a few patients who are chairbound or bedridden. 71 94 There is marked variability in the age at onset of symptoms in chromosome [jnnp.bmj.com]
- Vertigo
She was in her usual state of health until 2 weeks back when she started to complain of recurrent attacks of vertigo, vomiting, and generalized weakness. The patient was not able to move her lower limbs, stand, or walk. [dovepress.com]
- Lethargy
The clinical manifestations range from nonspecific weakness and lethargy to sudden collapse and death, depending on the rapidity of onset of the disease, type and number of pituitary cells affected, and severity of hormonal deficiencies. [medicaljoyworks.com]
Urogenital
- Incontinence
Within the HSP sample, women more frequently reported both urge FI and stress urinary incontinence, which is known to be an independent risk factor for FI. [mdmag.com]
and sensory deficits in the lower limbs. 8 Our patient had paraparesis, urinary incontinence, abulia, and transcortical motor aphasia. [clinical.diabetesjournals.org]
Clinical manifestations include a slowly progressive spastic weakness of the legs, increased reflexes, Babinski signs, incontinence, and loss of vibratory and position sensation. [ncbi.nlm.nih.gov]
After the spread of infection it would begin as weakness in legs or in the form of urinary incontinence. In men it may cause erectile dysfunction and some people may lose sense in the extremities due to intense nerve damage. [diseasespictures.com]
Incontinence is usually associated with paraparesis, and can be both socially and medically disastrous. [books.mcai.org.uk]
- Urinary Retention
Complications such as eschars due to a prolonged decubitus, urinary retention to sphincter dysfunction, fractures, etc. make these patients potential surgery candidates. [scielo.org.co]
Workup
Therefore, upper endoscopy should be part of the diagnostic workup of vitamin B 12 deficiency. Multiple factors can lead to misdiagnosis of vitamin B 12 deficiency. [dovepress.com]
Treatment
Our patient was a 41-year-old female, affected by PsA in treatment since 2 years with low-dose methylprednisolone and low-dose subcutaneous MTX. The treatment was effective. [ncbi.nlm.nih.gov]
Therefore, we now need the therapeutic regimens to protect the development, or be able to commence the treatments as soon as possible after the development safely and inexpensively even in long-term course or lifelong course of treatment. [eurekaselect.com]
During the treatments I felt very relaxed and calm. Even though I hate needles acupuncture treatments are really OK. The clinic is quiet and the staff is friendly. [acupuncturerestoreshealth.com]
Condition gradually improved as he could walk without help after three months of treatment, when further treatment was stopped. [scielo.br]
Prognosis
Prognosis HAM/TSP is a progressive disease, but it is rarely fatal. Most individuals live for several decades after the diagnosis. [brainfacts.org]
Prognosis The prognosis for pediatric cases is usually good if the tumor is resectable, but recurrences still occur. If unresectable and in the presence of metastasis, pancreatoblastoma has an aggressive course and prognosis is poor. [orpha.net]
A further combination of valproic acid and zidovudine has demonstrated a decrease in proviral loads (in animals). [10] Prognosis [ edit ] The prognosis for Tropical spastic paraparesis indicates some improvement in a percentage of cases due to immunosuppressive [en.wikipedia.org]
Michaelis LS (1969) International inquiry on neurological terminology and prognosis in paraplegia and tetraplegia. Paraplegia 7:1–5 PubMed Google Scholar 24. [link.springer.com]
Etiology
An intrahepatic portosystemic venous shunt (IPSVS) was observed on enhanced computed tomography, and hyperammonemia suggested leakage of neurotoxins from the shunt as the etiology of the patient's symptoms. [ncbi.nlm.nih.gov]
In addition to the above, signs and symptoms specific to the underlying etiology may also be present, e.g. headaches, diplopia, and bilateral visual defects in the case of a pituitary tumor. [medicaljoyworks.com]
Etiology The etiology is unknown but pancreatoblastoma can occur in any part of the pancreas. [orpha.net]
That this was not the true pathogenesis was shown by Sheehan in a series of papers.2-4 In these papers he proved that the etiology in cases developing post partum was that the blood supply of the gland after delivery is normally reduced rapidly. [annals.org]
The association between human T-lymphotropic virus type I (HTLV-1) and TSP opened new vistas in its etiology and epidemology. [neurologyindia.com]
Epidemiology
How to use this case study General instructions : Case studies in applied epidemiology allow students to practice applying epidemiologic skills in the classroom to address real-world public health problems. [panafrican-med-journal.com]
Summary Epidemiology It has been described in affecting at least six male members spanning three generations of a large family. [orpha.net]
Epidemiology Congenital forms affect both sexes equally and are diagnosed early in childhood. The epidemiology of acquired or secondary forms depends on the underlying cause. [unboundmedicine.com]
HSP data were compared to data from HUNT-3, a Norwegian epidemiological population study that enrolled more than 46,000 individuals. The survey was based on 19 items, each of which was also covered in HUNT3. [mdmag.com]
Epidemiology of tropical spastic paraparesis in Colombia and associated HTLV-1 infection. Ann Neurol 1988;23:161-5. 11. Roman GC, Roman LN. [neurologyindia.com]
Pathophysiology
We review previously reported cases and current understanding of the pathophysiology of this complication. All cases had symptom onset several hours after the procedure. There seems to be a trend toward better outcomes with earlier treatment. [ncbi.nlm.nih.gov]
Pathophysiology Pathology is based on specific deficiency or deficiencies. [unboundmedicine.com]
It could be argued that the observed findings are an epiphenomenon, resulting from longstanding retrograde degeneration, rather than a direct reflection of the underlying TSP pathophysiology. [hippokratia.gr]
"Clinical Pathophysiology of Human T-Lymphotropic Virus-Type 1-Associated Myelopathy/Tropical Spastic Paraparesis". Frontiers in Microbiology. 3 : 389. doi : 10.3389/fmicb.2012.00389. PMC 3494083. PMID 23162542. ^ Ali, A (2006). [en.wikipedia.org]
Pathophysiology The effects of hypopituitarism in children depend on the affected hormones. GH deficiency can result in hypoglycemia and short stature. [emedicine.medscape.com]
Prevention
O Contractures: all joints need to be moved through their full range of movement to prevent contractures develop- ing. [books.mcai.org.uk]
Episodes can be prevented by achieving a euthyroid state. This report describes a young gentleman presenting with thyrotoxic hypokalemic paraparesis. [ncbi.nlm.nih.gov]
Tropical Spastic Paraparesis - Get information and read articles on Tropical Spastic Paraparesis sign, symptoms, causes, treatment, prevention and diagnosis at onlymyhealth.com, your complete health guide. [onlymyhealth.com]
Their prognosis improves if they take steps to prevent urinary tract infection and skin sores, and if they participate in physical and occupational therapy programs. [brainfacts.org]
[…] encouraging the adoption of primary and secondary preventive measures. [clinical.diabetesjournals.org]