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Acute non-traumatic tetraparesis – Differential diagnosis

  • Author Footnotes
    1 ORCID: 0000-0003-1181-1418.
    Renato Oliveira
    Correspondence
    Corresponding author at: Hospital da Luz - Lisboa, Avenida Lusíada 100, 1500-650 Lisbon, Portugal.
    Footnotes
    1 ORCID: 0000-0003-1181-1418.
    Affiliations
    Department of Neurology, Hospital da Luz Lisboa, Lisbon, Portugal

    Department of Neurology, Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal

    CHRC Comprehensive Health Research Centre, Universidade Nova de Lisboa, Lisbon, Portugal
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  • Filipa Ramalho Rocha
    Affiliations
    Department of Internal Medicine, Hospital da Luz Lisboa, Lisbon, Portugal
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  • Tomás Teodoro
    Affiliations
    CHRC Comprehensive Health Research Centre, Universidade Nova de Lisboa, Lisbon, Portugal

    Department of Psychiatry, Centro Hospitalar Psiquiátrico de Lisboa, Lisbon, Portugal
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  • Miguel Oliveira Santos
    Affiliations
    Department of Neurology, Hospital da Luz Lisboa, Lisbon, Portugal

    Department of Neurology, Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal

    Institute of Physiology, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
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  • Author Footnotes
    1 ORCID: 0000-0003-1181-1418.

      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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