Highlights
- •Acute tetraparesis is a debilitating and sometimes life-threatening condition.
- •History and examination are essential in establishing the correct diagnosis.
- •A practical approach is to use the neuroaxis as an anatomical guide.
- •Updated information on new neurological entities and treatments are also mentioned.
Abstract
Introduction
Potentially life-threatening disorders may present in the emergency department with
acute tetraparesis, and their recognition is crucial for an appropriate management
and timely treatment. Our review aims to systematize the differential diagnosis of
acute non-traumatic tetraparesis.
Results
Causes of tetraparesis can be classified based on the site of defect: upper motor
neuron (UMN), peripheral nerve, neuromuscular junction or muscle. History of present
illness should include the distribution of weakness (symmetric/asymmetric or distal/proximal/diffuse)
and associated clinical features (pain, sensory findings, dysautonomia, and cranial
nerve abnormalities such as diplopia and dysphagia). Neurological examination, particularly
tendon reflexes, helps further in the localization of nerve lesions and distinction
between UMN and lower motor neuron. Ancillary studies include blood and cerebral spinal
fluid analysis, neuroaxis imaging, electromyography, muscle magnetic resonance and
muscle biopsy.
Conclusions
Acute tetraparesis is still a debilitating and potentially serious neurological condition.
Despite all the supplementary ancillary tests, the neurological examination is the
key to achieve a correct diagnosis. The identification of life-threatening neurologic
disorders is pivotal, since failing to identify patients at risk of complications,
such as acute respiratory failure, may have catastrophic results.
Keywords
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Article info
Publication history
Accepted:
February 22,
2021
Received:
December 8,
2020
Identification
Copyright
© 2021 Elsevier Ltd. All rights reserved.
