Paralysis/paresis

Key Information

Appropriate Tests

 

Diagnostic approach dictated by clinical features. Consider likely cause(s) in terms of site of abnormality. Cerebrospinal fluid examination may be indicated.

Muscle

 

Myopathy

 

Neuromuscular junction

 

Myasthenia

 

Botulism

 

Lower motor neurone

 

Guillain Barré syndrome

 

Neuropathy

 

Poliomyelitis

 

Nerve root compression

 

Spinal cord compression

See trauma, tumour, abscess, below.

Upper motor neurone (cerebral, spinal cord lesions)

 

Disc prolapse

 

Infarction

 

Trauma

 

Tumour 

  • Primary tumour
  • Metastatic carcinoma
  • Lymphoma
  • Plasma cell myeloma

Lesion biopsy, including Fine needle aspiration biopsy, if appropriate.

Abscess

Lesion biopsy, Fine needle aspiration biopsy if appropriate: MCS pus (microscopy and culture).

Blood culture.

Motor neurone disease

Molecular genetics - genetic disorders studies on family members, if the disease is suspected to be familial - consult pathologist.

Multiple sclerosis

 

Neuromyelitis optica

 

HIV infection

 

Transverse myelitis

 

Syringomyelia

 

Inherited degenerative disorders

  • Spinocerebellar degeneration
  • Leucodystrophies

Enzyme studies or Molecular genetics - genetic disorders may be available - consult pathologist.

Subacute combined degeneration of the cord

See Vitamin B12 deficiency.