D. Radha Krishnan1, G. Soumini2, S. Hari3, P. Satish Srinivas4
AIMS & OBJECTIVES: Patients presenting with acute quadriparesis may pose therapeutic challenge to the treating physician especially the development of bulbar palsy and respiratory paralysis and require intensive monitoring and treatment in acute clinical and respiratory care units. So this study was conducted to know the etiology of cases of non-traumatic Quadriparesis and its outcome.
MATERIALS AND METHODS: 50 adult patients admitted in medical and neurology wards with non-traumatic quadriparesis were prospectively studied between October ’2012 to September ’2014at Government General Hospital, Kakinada, a teaching hospital with rural referrals.
OBSERVATIONS AND RESULTS: In the study cohort of 50 cases the age of patients ranged from 13 to 80 years with more number of male patients. 29 patients (58%) presented with flaccid and 21 cases (42%) with spastic quadriparesis. Guillian barre syndrome with 18 (36%) cases was the most common cause of quadriparesis followed by Spondylotic myelopathy 11 cases (22%) and Hypokalemic periodic paralysis in 8 cases (16%). Transverse Myelitis. Caries spine. Secondaries cervical spine, spinal epidural abscess were in other cases.7 (14%) patients had cranial nerve dysfunction. 4(8%) patients had facial nerve palsy.
CONCLUSION: Guillian barre syndrome constituted the most common cause of nontraumatic quadriparesis, followed by Spondylotic myelopathy, Transverse Myelitis. Caries spine. Secondaries cervical spine, spinal epidural abscess. AIDP and Hypokalemic periodic paralysis were the most frequent causes of flaccid quadriparesis while Spondylotic myelopathy was the most common cause of spastic quadriparesis. M.R.I was the most useful and appropriate investigation. Severity of paralysis and need for ventilator support were associated with poor prognosis in patients with acute flaccid quadriparesis. Decompressive surgery in spondylotic myelopathy had good recovery after surgery. Patient recovery was complete in majority of cases in AIDP, transverse myelitis, hypokalemic periodic paralysis. Patients with axonal and mixed pattern of neuropathy had only partial recovery.