Data for: Sudden paraparesia in an old man
The first consideration with this presentation pattern is a spinal cord lesion, most likely anterior cord syndrome characterized by loss of motor function, pain, pinprick, and light touch below the level of the lesion . In general, pathologic processes involving the spinal cord may be divided into processes affecting the cord or its blood supply primarily and processes that compress the cord, most often originating outside the dura.The main causes of anterior cord syndrome are external compression (such as mass, discopathy, trauma) , ischemia (such as aortic surgery or involvement, aortic angiography, laceration or thrombosis of the anterior spinal artery or a major feeding vessel, severe hypotension, myocardial infarction , vasospasm),Inflammation, infection and demyelination. Note that lesions from ischemia usually are incomplete. If the physical examination does not support a cord syndrome or cauda equina syndrome (absence of UMN signs or a clear thoracic pinprick level, loss of perianal sensation and rectal tone, and urinary retention), the patient may have a peripheral neuropathy affecting the longest nerve tracts first (such as Guillain-Barré syndrome).