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{{Infobox_Disease |
__NOTOC__
  Name          = {{PAGENAME}} |
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  DiseasesDB    = |
  ICD10          = |
  ICD9          = |
  ICDO          = |
  OMIM          = |
  MedlinePlus    = |
  eMedicineSubj  = |
  eMedicineTopic = |
  MeshID        = |
}}
{{SI}}
{{SI}}
{{CMG}}
{{CMG}} {{AE}} {{LRO}}
==Overview==
Paralysis is the complete loss of [[muscle]] function for one or more muscle groups. Paralysis often includes loss of feeling in the affected area.
==Pathophysiology==
Paralysis is most often caused by damage to the [[nervous system]] or [[brain]], especially the [[spinal cord]]. Partial paralysis can also occur in the [[REM stage of sleep]].


{{Editor Help}}
Paralysis may be localized, or generalized, or it may follow a certain pattern. For example, localized paralysis occurs in [[Bell's palsy]] where one side of the face may be paralyzed due to inflammation of the [[facial nerve]] on that side. Patients with [[stroke]] may be weak throughout their body (global paralysis) or have [[hemiplegia]] (weakness on one side of the body) or other patterns of paralysis depending on the area of damage in the brain.


'''Paralysis''' is the complete loss of [[muscle]] function for one or more muscle groups. Paralysis often includes loss of feeling in the affected area.
Other patterns of paralysis arise due to different [[lesion]]s and their [[sequela]]e. For example, lower [[spinal cord]] damage from a severe back injury may result in [[paraplegia]], while an injury higher up on the [[spinal cord]], such as a neck injury, can cause [[quadriplegia]]. Patients with [[paraplegia]] or [[quadriplegia]] often use equipment such as a [[wheelchair]] or [[standing frame]] for mobility and to regain some independence.


==Pathophysiology==
Most paralyses caused by nervous system damage are constant in nature; however, there are forms of [[periodic paralysis]], including [[sleep paralysis]], which are caused by other factors.
Paralysis is most often caused by damage to the [[nervous system]] or [[brain]], especially the [[spinal cord]]. Partial paralysis can also occur in the [[REM stage of sleep]]. Major causes are [[stroke]], [[Physical trauma|trauma]], [[poliomyelitis]], [[amyotrophic lateral sclerosis]] (ALS), [[botulism]], [[spina bifida]], [[multiple sclerosis]], and [[Guillain-Barré syndrome]].
 
Poisons that interfere with [[action potential|nerve function]], such as [[curare]], can also cause paralysis.
==Causes==
===Common Causes===
*[[Amyotrophic lateral sclerosis]] (ALS)
*[[Botulism]]
*Drugs
**[[Amikacin sulfate]]
**[[Iodixanol]]
**[[Pergolide]]
*[[Guillain-Barré syndrome]]
*[[Multiple sclerosis]]
*Poisons that interfere with [[action potential|nerve function]], such as [[curare]]
*[[Poliomyelitis]]
*[[Spina bifida]]
*[[Stroke]]
*[[Physical trauma|trauma]]
 
===Causes by Organ System===
{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" |'''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | [[Arachnoiditis]],  [[Arteriovenous malformation]],  [[Cerebrovascular accident]],  [[Hemorrhagic stroke]],  [[Ischemic stroke]],  [[Stroke]]
|-
|bgcolor="LightSteelBlue"| '''Chemical/Poisoning'''
|bgcolor="Beige"| [[Amnesic shellfish poisoning]],  [[Apricot seed poisoning]],  [[Bird cherry seed poisoning]],  [[Bitter almond seed poisoning]],  [[Blue-ringed octopus poisoning]],  [[Bog rosemary poisoning]],  [[Bottlebrush buckeye poisoning]],  [[Brown snake poisoning]],  [[Buckeye poisoning]],  [[Bush lily poisoning]],  [[California buckeye poisoning]],  [[Carbamate insecticide poisoning]],  [[Cherry seed poisoning]],  [[China tree poisoning]],  [[Chokecherry seed poisoning]],  [[Clupeotoxism]],  [[Coastal leucothoe poisoning]],  [[Cobra poisoning]],  [[Conium maculatum]],  [[Corn lily poisoning]],  [[Curare]],  [[Delphinium poisoning]],  [[Dimethyl phthalate]],  [[Donepezil toxicity]],  [[Elapid poisoning]],  [[Everlasting pea poisoning]],  [[Fetterbush poisoning]],  [[Flax poisoning]],  [[Florida leucothoe poisoning]],  [[Golden chain tree poisoning]],  [[Grayanotoxin]],  [[Japanese andromeda poisoning]],  [[Jessamine poisoning]],  [[Lobelia poisoning]],  [[Marine toxins]],  [[Mayapple poisoning]],  [[Mercury poisoning]],  [[Monkshood poisoning]],  [[Monocrotophos]],  [[Mountain andromeda poisoning]],  [[Mountain laurel poisoning]],  [[Nicotiana tabacum]],  [[Organophosphate insecticide poisoning]],  [[Peach seed poisoning]],  [[Pernettya poisoning]],  [[Persian violet poisoning]],  [[Red buckeye poisoning]],  [[Rhodotoxin]],  [[Sea wasp poisoning]],  [[Sheep laurel poisoning]],  [[Staggerbush poisoning]],  [[Sweetshrub poisoning]],  [[Tacrine toxicity]],  [[Tambocor ]],  [[Tetraodon poisoning]],  [[Trumpet flower poisoning]],  [[Wild cherry seed poisoning]]
|-
|-bgcolor="LightSteelBlue"
| '''Dental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"| [[Leprosy]]
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"| [[Acetylandromedol]],  [[Amikacin sulfate]],  [[Andromedotoxin]],  [[Azinphos-methyl]],  [[Bromide]],  [[Cytisine]],  [[Flecainide ]],  [[Flecatab ]],  [[Iodixanol]],  [[Lobeline]],  [[Pergolide]],  [[Temodar ]],  [[Temozolomide ]],  [[Thiram]]
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"| [[Adrenal adenoma]],  [[Adrenal cancer]],  [[Adrenal gland hyperfunction]],  [[Adrenal incidentaloma]],  [[Adrenocortical carcinoma]],  [[Adrenoleukodystrophy]],  [[Hyperadrenalism]],  [[Primary hyperaldosteronism]]
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| [[Decompression sickness]],  [[Dysbarism]]
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"| [[Functioning pancreatic endocrine tumor]],  [[Insulinoma]],  [[Metastatic insulinoma]],  [[Schistosomiasis japonica]],  [[Schistosomiasis mansoni]],  [[Zellweger syndrome]]
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"| [[Cerebrotendinous xanthomatosis]],  [[Chediak-higashi syndrome]],  [[Chiari malformation]],  [[Congenital defects]],  [[Familial infantile metachromatic leukodystrophy ]],  [[Gm2-gangliosidosis]],  [[Homocystinuria syndrome]],  [[Juvenile paget's disease]],  [[Pelizaeus-merzbacher disease]],  [[Porphyria]],  [[Refsum disease]],  [[Tay sachs disease]]
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"| [[Adrenoleukodystrophy]],  [[Classical hodgkin disease]],  [[Familial infantile metachromatic leukodystrophy ]],  [[Hodgkin's disease]],  [[Intracranial hemorrhage]],  [[Lymphocyte depletion hodgkin's disease]],  [[Lymphocytic choriomeningitis]],  [[Metachromatic leukodystrophy]],  [[Mixed cellularity hodgkin's disease]],  [[Nodular sclerosing hodgkin's lymphoma]],  [[Potassium deficiency]],  [[Primary hyperaldosteronism]],  [[Subarachnoid hemorrhage]],  [[Subdural hematoma]]
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"| [[Post-vaccinial encephalitis]]
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| [[Arbovirosis]],  [[Encephalitis]],  [[Fungal meningitis]],  [[Hendra virus]],  [[Japanese encephalitis]],  [[Leprosy]],  [[Lyme disease]],  [[Lymphocytic choriomeningitis]],  [[Marburg multiple sclerosis]],  [[Mareck's disease ]],  [[Neurosyphilis ]],  [[Poliomyelitis]],  [[Post-polio syndrome]],  [[Progressive multifocal leukoencephalopathy]],  [[Rabies]],  [[Schistosomiasis japonica]],  [[Schistosomiasis mansoni]],  [[Simian b virus infection]],  [[Syphilis]],  [[Tetanus]],  [[Tetranortriterpene]],  [[Tick-borne encephalitis]],  [[Transverse myelitis]]
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal/Orthopedic'''
|bgcolor="Beige"| [[Alexander disease]],  [[Chronic inflammatory demyelinating polyneuropathy]],  [[Cutaneomeningospinal angiomatosis]],  [[Encephalomyelitis]],  [[Enterovirus antenatal infection]],  [[Juvenile paget's disease]],  [[Paget's disease of bone]],  [[Rib tumor]], [[Spinal cord injury]],  [[Spinal muscular atrophy]],  [[Spinal tumor]], [[Tetranortriterpene]]
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"| [[Acute disseminated encephalomyelitis]],  [[Acute fulminant multiple sclerosis]],  [[Adrenal cortex neoplasms]],  [[Adrenal gland hyperfunction]],  [[Alexander disease]], [[Amnesic shellfish poisoning]], [[Amyotrophic lateral sclerosis ]],  [[Ataxic cerebral palsy]],  [[Autoimmune diseases of the nervous system]],  [[Balo's concentric sclerosis]], [[Bell's palsy]],  [[Benign astrocytoma]],  [[Botulism]],  [[Brachial plexus injury]],  [[Calcification of basal ganglia ]],  [[California encephalitis]],  [[Canavan disease]],  [[Cerebral cavernous malformations]],  [[Cerebral palsy]],  [[Cerebral sarcoma]],  [[Cerebrotendinous xanthomatosis]],  [[Cerebrovascular accident]],  [[Chiari malformation]],  [[Chronic inflammatory demyelinating polyneuropathy]],  [[Compartment syndrome]],  [[Congenital defects]],  [[Conversion disorder]],  [[Cutaneomeningospinal angiomatosis]],  [[Decompression sickness]],  [[Desmoplastic cerebral astrocytoma of infancy]],  [[Desmoplastic infantile ganglioma]],  [[Dyskinetic cerebral palsy]],  [[Encephalitis]],  [[Encephalomyelitis]],  [[Fowl paralyses]],  [[Friedreich’s ataxia]],  [[Gm2-gangliosidosis]],  [[Guillain-barre syndrome]],  [[Hereditary peripheral nervous disorder]],  [[Hydrocephalus]],  [[Intercostal neuralgia]],  [[Intracranial hemorrhage]],  [[Japanese encephalitis]],  [[Krabbe disease]],  [[Leptomeningitis]],  [[Lyme disease]], [[Malignant astrocytoma]], [[Marburg multiple sclerosis]], [[Motor neurone disease]],  [[Movement disorders]],  [[Moyamoya syndrome]],  [[Multiple myeloma]],  [[Multiple sclerosis]],  [[Muscular dystrophy]],  [[Neuroblastoma]],  [[Neurofibromatosis]],  [[Neurosyphilis ]],  [[Nyssen-van bogaert syndrome]],  [[Pelizaeus-merzbacher disease]],  [[Peripheral neuritis]],  [[Poliomyelitis]],  [[Post-polio syndrome]],  [[Post-vaccinial encephalitis]],  [[Progressive multifocal leukoencephalopathy]],  [[Rasmussen's encephalitis]],  [[Selected encephalitides]],  [[Sleep]],  [[Spastic cerebral palsy]],  [[Spina bifida]],  [[Subarachnoid hemorrhage]],  [[Subdural hematoma]],  [[Syringomyelia]],  [[Tay sachs disease]],  [[Tick-borne encephalitis]],  [[Transverse myelitis]],  [[Vanishing white matter leukodystrophy]]
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional/Metabolic'''
|bgcolor="Beige"| [[Potassium deficiency]]
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| [[Spina bifida]]
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"| [[Adrenal adenoma]],  [[Adrenal cancer]],  [[Adrenocortical carcinoma]],  [[Back tumor]],  [[Cerebral sarcoma]],  [[Desmoplastic cerebral astrocytoma of infancy]],  [[Desmoplastic infantile ganglioma]],  [[Extradural hematoma]],  [[Functioning pancreatic endocrine tumor]],  [[Hip cancer]],  [[Malignant astrocytoma]],  [[Mesothelioma]],  [[Metastatic insulinoma]],  [[Multiple myeloma]],  [[Neuroblastoma]],  [[Neurofibromatosis]],  [[Nodular sclerosing hodgkin's lymphoma]],  [[Rib tumor]],  [[Spinal tumor]]
|-
|-bgcolor="LightSteelBlue"
| '''Ophthalmologic'''
|bgcolor="Beige"| [[Refsum disease]]
|-
|-bgcolor="LightSteelBlue"
| '''Overdose/Toxicity'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"| [[Asphyxia]]
|-
|-bgcolor="LightSteelBlue"
| '''Renal/Electrolyte'''
|bgcolor="Beige"| [[Hypokalemia]]
|-
|-bgcolor="LightSteelBlue"
| '''Rheumatology/Immunology/Allergy'''
|bgcolor="Beige"| [[Systemic lupus erythematosus ]]
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| [[Syphilis]]
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| [[Broken neck]],  [[Electrical burns]],  [[Fractures]], [[Pathological fracture]], [[Spinal cord injury]]
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| [[Zellweger syndrome]]
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"| No underlying causes
|-
|}
 
===Causes in Alphabetical Order===
{{columns-list|
*[[Acetylandromedol]]
*[[Acute disseminated encephalomyelitis]]
*[[Acute fulminant multiple sclerosis]]
*[[Adrenal adenoma]]
*[[Adrenal cancer]]
*[[Adrenal cortex neoplasms]]
*[[Adrenal gland hyperfunction]]
*[[Adrenal incidentaloma]]
*[[Adrenocortical carcinoma]]
*[[Adrenoleukodystrophy]]
*[[Alexander disease]]
*[[Amikacin sulfate]]
*[[Amnesic shellfish poisoning]]
*[[Amyotrophic lateral sclerosis ]]
*[[Andromedotoxin]]
*[[Apricot seed poisoning]]
*[[Arachnoiditis]]
*[[Arbovirosis]]
*[[Arteriovenous malformation]]
*[[Asphyxia]]
*[[Ataxic cerebral palsy]]
*[[Autoimmune diseases of the nervous system]]
*[[Azinphos-methyl]]
*[[Back tumor]]
*[[Balo's concentric sclerosis]]
*[[Bell's palsy]]
*[[Benign astrocytoma]]
*[[Bird cherry seed poisoning]]
*[[Bitter almond seed poisoning]]
*[[Blue-ringed octopus poisoning]]
*[[Bog rosemary poisoning]]
*[[Bottlebrush buckeye poisoning]]
*[[Botulism]]
*[[Brachial plexus injury]]
*[[Broken neck]]
*[[Bromide]]
*[[Brown snake poisoning]]
*[[Buckeye poisoning]]
*[[Bush lily poisoning]]
*[[Calcification of basal ganglia ]]
*[[California buckeye poisoning]]
*[[California encephalitis]]
*[[Canavan disease]]
*[[Carbamate insecticide poisoning]]
*[[Cerebral cavernous malformations]]
*[[Cerebral palsy]]
*[[Cerebral sarcoma]]
*[[Cerebrotendinous xanthomatosis]]
*[[Cerebrovascular accident]]
*[[Chediak-higashi syndrome]]
*[[Cherry seed poisoning]]
*[[Chiari malformation]]
*[[China tree poisoning]]
*[[Chokecherry seed poisoning]]
*[[Chronic inflammatory demyelinating polyneuropathy]]
*[[Classical hodgkin disease]]
*[[Clupeotoxism]]
*[[Coastal leucothoe poisoning]]
*[[Cobra poisoning]]
*[[Compartment syndrome]]
*[[Congenital defects]]
*[[Conium maculatum]]
*[[Conversion disorder]]
*[[Corn lily poisoning]]
*[[Curare]]
*[[Cutaneomeningospinal angiomatosis]]
*[[Cytisine]]
*[[Decompression sickness]]
*[[Delphinium poisoning]]
*[[Desmoplastic cerebral astrocytoma of infancy]]
*[[Desmoplastic infantile ganglioma]]
*[[Dimethyl phthalate]]
*[[Donepezil toxicity]]
*[[Dysbarism]]
*[[Dyskinetic cerebral palsy]]
*[[Elapid poisoning]]
*[[Electrical burns]]
*[[Encephalitis]]
*[[Encephalomyelitis]]
*[[Enterovirus antenatal infection]]
*[[Everlasting pea poisoning]]
*[[Extradural hematoma]]
*[[Familial infantile metachromatic leukodystrophy ]]
*[[Fetterbush poisoning]]
*[[Flax poisoning]]
*[[Flecainide ]]
*[[Flecatab ]]
*[[Florida leucothoe poisoning]]
*[[Fowl paralyses]]
*[[Fractures]]
*[[Friedreich’s ataxia]]
*[[Functioning pancreatic endocrine tumor]]
*[[Fungal meningitis]]
*[[Gm2-gangliosidosis]]
*[[Golden chain tree poisoning]]
*[[Grayanotoxin]]
*[[Guillain-barre syndrome]]
*[[Hemorrhagic stroke]]
*[[Hendra virus]]
*[[Hereditary peripheral nervous disorder]]
*[[Hip cancer]]
*[[Hodgkin's disease]]
*[[Homocystinuria syndrome]]
*[[Hydrocephalus]]
*[[Hyperadrenalism]]
*[[Hypokalemia]]
*[[Insulinoma]]
*[[Intercostal neuralgia]]
*[[Intracranial hemorrhage]]
*[[Iodixanol]]
*[[Ischemic stroke]]
*[[Japanese andromeda poisoning]]
*[[Japanese encephalitis]]
*[[Jessamine poisoning]]
*[[Juvenile paget's disease]]
*[[Krabbe disease]]
*[[Leprosy]]
*[[Leptomeningitis]]
*[[Lobelia poisoning]]
*[[Lobeline]]
*[[Lyme disease]]
*[[Lymphocyte depletion hodgkin's disease]]
*[[Lymphocytic choriomeningitis]]
*[[Malignant astrocytoma]]
*[[Marburg multiple sclerosis]]
*[[Mareck's disease ]]
*[[Marine toxins]]
*[[Mayapple poisoning]]
*[[Mercury poisoning]]
*[[Mesothelioma]]
*[[Metachromatic leukodystrophy]]
*[[Metastatic insulinoma]]
*[[Mixed cellularity hodgkin's disease]]
*[[Monkshood poisoning]]
*[[Monocrotophos]]
*[[Motor neurone disease]]
*[[Mountain andromeda poisoning]]
*[[Mountain laurel poisoning]]
*[[Movement disorders]]
*[[Moyamoya syndrome]]
*[[Multiple myeloma]]
*[[Multiple sclerosis]]
*[[Muscular dystrophy]]
*[[Neuroblastoma]]
*[[Neurofibromatosis]]
*[[Neurosyphilis ]]
*[[Nicotiana tabacum]]
*[[Nodular sclerosing hodgkin's lymphoma]]
*[[Nyssen-van bogaert syndrome]]
*[[Organophosphate insecticide poisoning]]
*[[Paget's disease of bone]]
*[[Pathological fracture]]
*[[Peach seed poisoning]]
*[[Pelizaeus-merzbacher disease]]
*[[Pergolide]]
*[[Peripheral neuritis]]
*[[Pernettya poisoning]]
*[[Persian violet poisoning]]
*[[Poliomyelitis]]
*[[Porphyria]]
*[[Post-polio syndrome]]
*[[Post-vaccinial encephalitis]]
*[[Potassium deficiency]]
*[[Primary hyperaldosteronism]]
*[[Progressive multifocal leukoencephalopathy]]
*[[Rabies]]
*[[Rasmussen's encephalitis]]
*[[Red buckeye poisoning]]
*[[Refsum disease]]
*[[Rhodotoxin]]
*[[Rib tumor]]
*[[Schistosomiasis japonica]]
*[[Schistosomiasis mansoni]]
*[[Sea wasp poisoning]]
*[[Selected encephalitides]]
*[[Sheep laurel poisoning]]
*[[Simian b virus infection]]
*[[Sleep]]
*[[Spastic cerebral palsy]]
*[[Spina bifida]]
*[[Spinal cord injury]]
*[[Spinal muscular atrophy]]
*[[Spinal tumor]]
*[[Staggerbush poisoning]]
*[[Stroke]]
*[[Subarachnoid hemorrhage]]
*[[Subdural hematoma]]
*[[Sweetshrub poisoning]]
*[[Syphilis]]
*[[Syringomyelia]]
*[[Systemic lupus erythematosus ]]
*[[Tacrine toxicity]]
*[[Tambocor ]]
*[[Tay sachs disease]]
*[[Temodar ]]
*[[Temozolomide ]]
*[[Tetanus]]
*[[Tetranortriterpene]]
*[[Tetraodon poisoning]]
*[[Thiram]]
*[[Tick-borne encephalitis]]
*[[Transverse myelitis]]
*[[Trauma]]
*[[Trumpet flower poisoning]]
*[[Vanishing white matter leukodystrophy]]
*[[Wild cherry seed poisoning]]
*[[Zellweger syndrome]]
}}
 
==Differential diagnosis==
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! rowspan="2" |<small>Diseases</small>
! colspan="8" |<small>History and Physical
! colspan="2" |<small>Diagnostic tests</small>
! rowspan="2" |<small>Other Findings</small>
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
!<small>Motor Deficit</small>
!<small>Sensory deficit</small>
!<small>Cranial nerve Involvement</small>
!<small>Autonomic dysfunction</small>
!<small>Proximal/Distal/Generalized</small>
!<small>Ascending/Descending/Systemic</small>
!<small>Unilateral (UL)
or Bilateral (BL)
 
or


==Variations==
No Lateralization (NL)</small>
!<small>Onset</small>
!<small>Lab or Imaging Findings</small>
!<small>Specific  test</small>
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" | Adult Botulism
| style="background: #F5F5F5; padding: 5px; text-align:center" | +
| style="background: #F5F5F5; padding: 5px; text-align:center" | -
| style="background: #F5F5F5; padding: 5px; text-align:center" | +
| style="background: #F5F5F5; padding: 5px; text-align:center" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px; text-align:center" |Generalized
| style="background: #F5F5F5; padding: 5px; text-align:center" |Descending
| style="background: #F5F5F5; padding: 5px; text-align:center" |BL
| style="background: #F5F5F5; padding: 5px; text-align:center" |Sudden
| style="background: #F5F5F5; padding: 5px; text-align:center" |Toxin test
| style="background: #F5F5F5; padding: 5px; text-align:center" |Blood, Wound, or Stool culture
| style="background: #F5F5F5; padding: 5px; text-align:center" |[[Diplopia]], [[Hyporeflexia|Hyporeflexia,]] [[Hypotonia]], possible respiratory paralysis
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Infant Botulism
| style="background: #F5F5F5; padding: 5px; text-align:center" |+
| style="background: #F5F5F5; padding: 5px; text-align:center" |-
| style="background: #F5F5F5; padding: 5px; text-align:center" |+
| style="background: #F5F5F5; padding: 5px; text-align:center" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px; text-align:center" |Generalized
| style="background: #F5F5F5; padding: 5px; text-align:center" |Descending
| style="background: #F5F5F5; padding: 5px; text-align:center" |BL
| style="background: #F5F5F5; padding: 5px; text-align:center" |Sudden
| style="background: #F5F5F5; padding: 5px; text-align:center" |Toxin test
| style="background: #F5F5F5; padding: 5px; text-align:center" |Blood, Wound, or Stool culture
| style="background: #F5F5F5; padding: 5px; text-align:center" |[[Flaccid paralysis]] ([[Floppy baby syndrome]]), possible respiratory paralysis
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" | [[Guillian-Barre syndrome]]<ref name="pmid22081202">{{cite journal| author=Talukder RK, Sutradhar SR, Rahman KM, Uddin MJ, Akhter H| title=Guillian-Barre syndrome. | journal=Mymensingh Med J | year= 2011 | volume= 20 | issue= 4 | pages= 748-56 | pmid=22081202 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22081202  }}</ref>
| style="background: #F5F5F5; padding: 5px; text-align:center" | +
| style="background: #F5F5F5; padding: 5px; text-align:center" | -
| style="background: #F5F5F5; padding: 5px; text-align:center" | -
| style="background: #F5F5F5; padding: 5px; text-align:center" |<nowiki>-</nowiki>
| style="background: #F5F5F5; padding: 5px; text-align:center" |Generalized
| style="background: #F5F5F5; padding: 5px; text-align:center" |Ascending
| style="background: #F5F5F5; padding: 5px; text-align:center" |BL
| style="background: #F5F5F5; padding: 5px; text-align:center" |Insidious
| style="background: #F5F5F5; padding: 5px; text-align:center" |CSF: ↑Protein


Paralysis may be localized, or generalized, or it may follow a certain pattern. For example, localized paralysis occurs in [[Bell's palsy]] where one side of the face may be paralyzed due to inflammation of the [[facial nerve]] on that side. Patients with [[stroke]] may be weak throughout their body (global paralysis) or have [[hemiplegia]] (weakness on one side of the body) or other patterns of paralysis depending on the area of damage in the brain.
↓Cells


Other patterns of paralysis arise due to different [[lesion]]s and their [[sequela]]e. For example, lower [[spinal cord]] damage from a severe back injury may result in [[paraplegia]], while an injury higher up on the [[spinal cord]], such as a neck injury, can cause [[quadriplegia]]. Patients with [[paraplegia]] or [[quadriplegia]] often use equipment such as a [[wheelchair]] or [[standing frame]] for mobility and to regain some independence.
| style="background: #F5F5F5; padding: 5px; text-align:center" |Clinical & Lumbar Puncture
| style="background: #F5F5F5; padding: 5px; text-align:center" |Progressive [[ascending paralysis]] following infection, possible respiratory paralysis
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" | [[Eaton lambert syndrome|Eaton Lambert syndrome]]<ref name="pmid27412406">{{cite journal| author=Merino-Ramírez MÁ, Bolton CF| title=Review of the Diagnostic Challenges of Lambert-Eaton Syndrome Revealed Through Three Case Reports. | journal=Can J Neurol Sci | year= 2016 | volume= 43 | issue= 5 | pages= 635-47 | pmid=27412406 | doi=10.1017/cjn.2016.268 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27412406  }}</ref>
| style="background: #F5F5F5; padding: 5px; text-align:center" | +
| style="background: #F5F5F5; padding: 5px; text-align:center" | -
| style="background: #F5F5F5; padding: 5px; text-align:center" | +
| style="background: #F5F5F5; padding: 5px; text-align:center" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px; text-align:center" |Generalized
| style="background: #F5F5F5; padding: 5px; text-align:center" |Systemic
| style="background: #F5F5F5; padding: 5px; text-align:center" |BL
| style="background: #F5F5F5; padding: 5px; text-align:center" |Intermittent
| style="background: #F5F5F5; padding: 5px; text-align:center" | [[EMG]], repetitive nerve stimulation test (RNS)
| style="background: #F5F5F5; padding: 5px; text-align:center" |[[Voltage gated calcium channel|Voltage gated calcium channe]]<nowiki/>l<nowiki/> (VGCC) antibody
| style="background: #F5F5F5; padding: 5px; text-align:center" |[[Diplopia]], [[ptosis]], improves with movement (as the day progresses)
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Myasthenia gravis]]<ref name="pmid28029925">{{cite journal| author=Gilhus NE| title=Myasthenia Gravis. | journal=N Engl J Med | year= 2016 | volume= 375 | issue= 26 | pages= 2570-2581 | pmid=28029925 | doi=10.1056/NEJMra1602678 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28029925  }}</ref>
| style="background: #F5F5F5; padding: 5px; text-align:center" | +
| style="background: #F5F5F5; padding: 5px; text-align:center" | -
| style="background: #F5F5F5; padding: 5px; text-align:center" | +
| style="background: #F5F5F5; padding: 5px; text-align:center" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px; text-align:center" |Generalized
| style="background: #F5F5F5; padding: 5px; text-align:center" |Systemic
| style="background: #F5F5F5; padding: 5px; text-align:center" |BL
| style="background: #F5F5F5; padding: 5px; text-align:center" |Intermittent
| style="background: #F5F5F5; padding: 5px; text-align:center" | [[Electromyography|EMG]], [[Edrophonium|Edrophonium test]]
| style="background: #F5F5F5; padding: 5px; text-align:center" |[[Acetylcholine receptor|Ach receptor]] antibody
| style="background: #F5F5F5; padding: 5px; text-align:center" |[[Diplopia]], [[ptosis]], worsening with movement (as the day progresses)
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Electrolyte disturbance]]<ref name="pmid26813501">{{cite journal| author=Ozono K| title=[Diagnostic criteria for vitamin D-deficient rickets and hypocalcemia-]. | journal=Clin Calcium | year= 2016 | volume= 26 | issue= 2 | pages= 215-22 | pmid=26813501 | doi=CliCa1602215222 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26813501  }}</ref>
| style="background: #F5F5F5; padding: 5px; text-align:center" | +
| style="background: #F5F5F5; padding: 5px; text-align:center" | +
| style="background: #F5F5F5; padding: 5px; text-align:center" | -
| style="background: #F5F5F5; padding: 5px; text-align:center" |<nowiki>-</nowiki>
| style="background: #F5F5F5; padding: 5px; text-align:center" |Generalized
| style="background: #F5F5F5; padding: 5px; text-align:center" |Systemic
| style="background: #F5F5F5; padding: 5px; text-align:center" |BL
| style="background: #F5F5F5; padding: 5px; text-align:center" |Insidious
| style="background: #F5F5F5; padding: 5px; text-align:center" | Electrolyte panel
| style="background: #F5F5F5; padding: 5px; text-align:center" |↓Ca++, ↓Mg++, ↓K+
| style="background: #F5F5F5; padding: 5px; text-align:center" |Possible [[arrhythmia]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Organophosphate poisoning|Organophosphate toxicity]]<ref name="pmid15020723">{{cite journal| author=Kamanyire R, Karalliedde L| title=Organophosphate toxicity and occupational exposure. | journal=Occup Med (Lond) | year= 2004 | volume= 54 | issue= 2 | pages= 69-75 | pmid=15020723 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15020723  }}</ref>
| style="background: #F5F5F5; padding: 5px; text-align:center" | +
| style="background: #F5F5F5; padding: 5px; text-align:center" | +
| style="background: #F5F5F5; padding: 5px; text-align:center" | -
| style="background: #F5F5F5; padding: 5px; text-align:center" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px; text-align:center" |Generalized
| style="background: #F5F5F5; padding: 5px; text-align:center" |Ascending
| style="background: #F5F5F5; padding: 5px; text-align:center" |BL
| style="background: #F5F5F5; padding: 5px; text-align:center" |Sudden
| style="background: #F5F5F5; padding: 5px; text-align:center" | Clinical diagnosis: physical exam & history
| style="background: #F5F5F5; padding: 5px; text-align:center" |Clinical suspicion confirmed with RBC AchE activity
| style="background: #F5F5F5; padding: 5px; text-align:center" |History of exposure to i[[Insecticide|nsecticide]] or living in farming environment. with : [[Diarrhea]], [[Urination]], [[Miosis]], [[Bradycardia]], [[Lacrimation]], [[Emesis]], [[Salivation]], [[Sweating]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Tick paralysis]] ([[Dermacentor andersoni|Dermacentor tick]])<ref name="pmid23677663">{{cite journal| author=Pecina CA| title=Tick paralysis. | journal=Semin Neurol | year= 2012 | volume= 32 | issue= 5 | pages= 531-2 | pmid=23677663 | doi=10.1055/s-0033-1334474 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23677663  }}</ref>
| style="background: #F5F5F5; padding: 5px; text-align:center" | +
| style="background: #F5F5F5; padding: 5px; text-align:center" | -
| style="background: #F5F5F5; padding: 5px; text-align:center" | -
| style="background: #F5F5F5; padding: 5px; text-align:center" |<nowiki>-</nowiki>
| style="background: #F5F5F5; padding: 5px; text-align:center" |Generalized
| style="background: #F5F5F5; padding: 5px; text-align:center" |Ascending
| style="background: #F5F5F5; padding: 5px; text-align:center" |BL
| style="background: #F5F5F5; padding: 5px; text-align:center" |Insidious
| style="background: #F5F5F5; padding: 5px; text-align:center" | Clinical diagnosis: physical exam & history
| style="background: #F5F5F5; padding: 5px; text-align:center" |-
| style="background: #F5F5F5; padding: 5px; text-align:center" |History of outdoor activity in Northeastern United States. The tick is often still latched to the patient at presentation (often in head and neck area)
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Tetrodotoxin]] poisoning<ref name="pmid24566728">{{cite journal| author=Bane V, Lehane M, Dikshit M, O'Riordan A, Furey A| title=Tetrodotoxin: chemistry, toxicity, source, distribution and detection. | journal=Toxins (Basel) | year= 2014 | volume= 6 | issue= 2 | pages= 693-755 | pmid=24566728 | doi=10.3390/toxins6020693 | pmc=3942760 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24566728  }}</ref>
| style="background: #F5F5F5; padding: 5px; text-align:center" | +
| style="background: #F5F5F5; padding: 5px; text-align:center" | -
| style="background: #F5F5F5; padding: 5px; text-align:center" | +
| style="background: #F5F5F5; padding: 5px; text-align:center" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px; text-align:center" |Generalized
| style="background: #F5F5F5; padding: 5px; text-align:center" |Systemic
| style="background: #F5F5F5; padding: 5px; text-align:center" |BL
| style="background: #F5F5F5; padding: 5px; text-align:center" |Sudden
| style="background: #F5F5F5; padding: 5px; text-align:center" | Clinical diagnosis: physical exam & dietary history
| style="background: #F5F5F5; padding: 5px; text-align:center" | -
| style="background: #F5F5F5; padding: 5px; text-align:center" | History of consumption of puffer fish species.
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Stroke]]<ref name="pmid8848683">{{cite journal| author=Kuntzer T, Hirt L, Bogousslavsky J| title=[Neuromuscular involvement and cerebrovascular accidents]. | journal=Rev Med Suisse Romande | year= 1996 | volume= 116 | issue= 8 | pages= 605-9 | pmid=8848683 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8848683  }}</ref>
| style="background: #F5F5F5; padding: 5px; text-align:center" | +/-
| style="background: #F5F5F5; padding: 5px; text-align:center" | +/-
| style="background: #F5F5F5; padding: 5px; text-align:center" | +/-
| style="background: #F5F5F5; padding: 5px; text-align:center" |<nowiki>+/-</nowiki>
| style="background: #F5F5F5; padding: 5px; text-align:center" |Generalized
| style="background: #F5F5F5; padding: 5px; text-align:center" |Systemic
| style="background: #F5F5F5; padding: 5px; text-align:center" |UL
| style="background: #F5F5F5; padding: 5px; text-align:center" |Sudden
| style="background: #F5F5F5; padding: 5px; text-align:center" | MRI +ve for ischemia or hemorrhage
| style="background: #F5F5F5; padding: 5px; text-align:center" |MRI
| style="background: #F5F5F5; padding: 5px; text-align:center" |Sudden unilateral motor and sensory deficit in a patient with a history of [[Atherosclerosis|atherosclero]]<nowiki/>tic risk factors (diabetes, hypertension, smoking) or [[Atrial fibrillation|atrial fibrillation.]]
|-
| style="background: #DCDCDC; padding: 5px; text-align:center;" | [[Poliomyelitis]]<ref name="pmid19944665">{{cite journal| author=Laffont I, Julia M, Tiffreau V, Yelnik A, Herisson C, Pelissier J| title=Aging and sequelae of poliomyelitis. | journal=Ann Phys Rehabil Med | year= 2010 | volume= 53 | issue= 1 | pages= 24-33 | pmid=19944665 | doi=10.1016/j.rehab.2009.10.002 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19944665  }}</ref>
| style="background: #F5F5F5; padding: 5px; text-align:center" |+
| style="background: #F5F5F5; padding: 5px; text-align:center" |+
| style="background: #F5F5F5; padding: 5px; text-align:center" |+
| style="background: #F5F5F5; padding: 5px; text-align:center" |+/-
| style="background: #F5F5F5; padding: 5px; text-align:center" |Proximal > Distal
| style="background: #F5F5F5; padding: 5px; text-align:center" |Systemic
| style="background: #F5F5F5; padding: 5px; text-align:center" |BL or UL
| style="background: #F5F5F5; padding: 5px; text-align:center" |Sudden
| style="background: #F5F5F5; padding: 5px; text-align:center" |
| style="background: #F5F5F5; padding: 5px; text-align:center" |PCR of CSF
| style="background: #F5F5F5; padding: 5px; text-align:center" |Asymmetric paralysis following a flu-like syndrome.
|-
| style="background: #DCDCDC; padding: 5px; text-align:center;" | [[Transverse myelitis]]<ref name="pmid24099672">{{cite journal| author=West TW| title=Transverse myelitis--a review of the presentation, diagnosis, and initial management. | journal=Discov Med | year= 2013 | volume= 16 | issue= 88 | pages= 167-77 | pmid=24099672 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24099672  }}</ref>
| style="background: #F5F5F5; padding: 5px; text-align:center" |+
| style="background: #F5F5F5; padding: 5px; text-align:center" |+
| style="background: #F5F5F5; padding: 5px; text-align:center" |+
| style="background: #F5F5F5; padding: 5px; text-align:center" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px; text-align:center" |Proximal > Distal
| style="background: #F5F5F5; padding: 5px; text-align:center" |Systemic
| style="background: #F5F5F5; padding: 5px; text-align:center" |BL or UL
| style="background: #F5F5F5; padding: 5px; text-align:center" |Sudden
| style="background: #F5F5F5; padding: 5px; text-align:center" |MRI & [[Lumbar puncture]]
| style="background: #F5F5F5; padding: 5px; text-align:center" |MRI
| style="background: #F5F5F5; padding: 5px; text-align:center" |History of chronic viral or autoimmune disease (e.g. [[HIV]])
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Neurosyphilis]]<ref name="pmid22482824">{{cite journal| author=Liu LL, Zheng WH, Tong ML, Liu GL, Zhang HL, Fu ZG et al.| title=Ischemic stroke as a primary symptom of neurosyphilis among HIV-negative emergency patients. | journal=J Neurol Sci | year= 2012 | volume= 317 | issue= 1-2 | pages= 35-9 | pmid=22482824 | doi=10.1016/j.jns.2012.03.003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22482824  }} </ref><ref name="pmid24365430">{{cite journal |vauthors=Berger JR, Dean D |title=Neurosyphilis |journal=Handb Clin Neurol |volume=121 |issue= |pages=1461–72 |year=2014 |pmid=24365430 |doi=10.1016/B978-0-7020-4088-7.00098-5 |url=}}</ref>
| style="background: #F5F5F5; padding: 5px; text-align:center" | +
| style="background: #F5F5F5; padding: 5px; text-align:center" | +
| style="background: #F5F5F5; padding: 5px; text-align:center" | -
| style="background: #F5F5F5; padding: 5px; text-align:center" |+/-
| style="background: #F5F5F5; padding: 5px; text-align:center" |Generalized
| style="background: #F5F5F5; padding: 5px; text-align:center" |Systemic
| style="background: #F5F5F5; padding: 5px; text-align:center" |BL
| style="background: #F5F5F5; padding: 5px; text-align:center" |Insidious<nowiki/>
| style="background: #F5F5F5; padding: 5px; text-align:center" |MRI & [[Lumbar puncture]]
| style="background: #F5F5F5; padding: 5px; text-align:center" |CSF [[VDRL]]-specifc
CSF [[FTA-ABS|FTA-Ab]] -sensitive<ref name="pmid22421697">{{cite journal| author=Ho EL, Marra CM| title=Treponemal tests for neurosyphilis--less accurate than what we thought? | journal=Sex Transm Dis | year= 2012 | volume= 39 | issue= 4 | pages= 298-9 | pmid=22421697 | doi=10.1097/OLQ.0b013e31824ee574 | pmc=3746559 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22421697  }}</ref>
| style="background: #F5F5F5; padding: 5px; text-align:center" |History of unprotected sex or multiple sexual partners.


Most paralyses caused by nervous system damage are constant in nature; however, there are forms of [[periodic paralysis]], including [[sleep paralysis]], which are caused by other factors.
History of [[genital ulcer]] ([[chancre]]), diffuse [[Maculopapular rash|maculopapular ras]]<nowiki/>h.
|-
| style="background: #DCDCDC; padding: 5px; text-align:center;" |[[Muscular dystrophy]]<ref name="pmid26457695">{{cite journal| author=Falzarano MS, Scotton C, Passarelli C, Ferlini A| title=Duchenne Muscular Dystrophy: From Diagnosis to Therapy. | journal=Molecules | year= 2015 | volume= 20 | issue= 10 | pages= 18168-84 | pmid=26457695 | doi=10.3390/molecules201018168 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26457695  }}</ref>
| style="background: #F5F5F5; padding: 5px; text-align:center" | +
| style="background: #F5F5F5; padding: 5px; text-align:center" | -
| style="background: #F5F5F5; padding: 5px; text-align:center" | -
| style="background: #F5F5F5; padding: 5px; text-align:center" |<nowiki>-</nowiki>
| style="background: #F5F5F5; padding: 5px; text-align:center" |Proximal > Distal
| style="background: #F5F5F5; padding: 5px; text-align:center" |Systemic
| style="background: #F5F5F5; padding: 5px; text-align:center" |BL
| style="background: #F5F5F5; padding: 5px; text-align:center" |Insidious
| style="background: #F5F5F5; padding: 5px; text-align:center" | Genetic testing
| style="background: #F5F5F5; padding: 5px; text-align:center" |[[Muscle biopsy]]
| style="background: #F5F5F5; padding: 5px; text-align:center" |Progressive proximal lower limb weakness with calf pseudohypertrophy in early childhood. [[Gowers' sign|Gower sign]] positive.
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Multiple sclerosis]] exacerbation<ref name="pmid27432676">{{cite journal| author=Filippi M, Preziosa P, Rocca MA| title=Multiple sclerosis. | journal=Handb Clin Neurol | year= 2016 | volume= 135 | issue=  | pages= 399-423 | pmid=27432676 | doi=10.1016/B978-0-444-53485-9.00020-9 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27432676  }}</ref>
| style="background: #F5F5F5; padding: 5px; text-align:center" | +
| style="background: #F5F5F5; padding: 5px; text-align:center" | +
| style="background: #F5F5F5; padding: 5px; text-align:center" | +
| style="background: #F5F5F5; padding: 5px; text-align:center" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px; text-align:center" |Generalized
| style="background: #F5F5F5; padding: 5px; text-align:center" |Systemic
| style="background: #F5F5F5; padding: 5px; text-align:center" |NL
| style="background: #F5F5F5; padding: 5px; text-align:center" |Sudden
| style="background: #F5F5F5; padding: 5px; text-align:center" |'''[[CSF|↑]]'''[[CSF]] [[IgG]] levels
(monoclonal)
| style="background: #F5F5F5; padding: 5px; text-align:center" |Clinical assessment and [[MRI]] <ref name="pmid8274111">{{cite journal| author=Giang DW, Grow VM, Mooney C, Mushlin AI, Goodman AD, Mattson DH et al.| title=Clinical diagnosis of multiple sclerosis. The impact of magnetic resonance imaging and ancillary testing. Rochester-Toronto Magnetic Resonance Study Group. | journal=Arch Neurol | year= 1994 | volume= 51 | issue= 1 | pages= 61-6 | pmid=8274111 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8274111  }}</ref>
| style="background: #F5F5F5; padding: 5px; text-align:center" |[[Blurred vision|Blurry vision]], [[urinary incontinence]], [[fatigue]]
|-
| style="background: #DCDCDC; padding: 5px; text-align:center" |[[Amyotrophic lateral sclerosis]]<ref name="pmid27025851">{{cite journal| author=Riva N, Agosta F, Lunetta C, Filippi M, Quattrini A| title=Recent advances in amyotrophic lateral sclerosis. | journal=J Neurol | year= 2016 | volume= 263 | issue= 6 | pages= 1241-54 | pmid=27025851 | doi=10.1007/s00415-016-8091-6 | pmc=4893385 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27025851  }}</ref>
| style="background: #F5F5F5; padding: 5px; text-align:center" | +
| style="background: #F5F5F5; padding: 5px; text-align:center" | -
| style="background: #F5F5F5; padding: 5px; text-align:center" | -
| style="background: #F5F5F5; padding: 5px; text-align:center" |<nowiki>-</nowiki>
| style="background: #F5F5F5; padding: 5px; text-align:center" |Generalized
| style="background: #F5F5F5; padding: 5px; text-align:center" |Systemic
| style="background: #F5F5F5; padding: 5px; text-align:center" |BL
| style="background: #F5F5F5; padding: 5px; text-align:center" |Insidious
| style="background: #F5F5F5; padding: 5px; text-align:center" | Normal [[Lumbar puncture|LP]] (to rule out DDx)
| style="background: #F5F5F5; padding: 5px; text-align:center" |MRI & [[Lumbar puncture|LP]]
| style="background: #F5F5F5; padding: 5px; text-align:center" |Patient initially presents with [[upper motor neuron]] deficit ([[spasticity]]) followed by [[lower motor neuron]] deficit ([[flaccidity]]).
|-
| style="background: #DCDCDC; padding: 5px; text-align:center;" | [[Myositis|Inflammatory myopathy]]<ref name="pmid26290112">{{cite journal| author=Michelle EH, Mammen AL| title=Myositis Mimics. | journal=Curr Rheumatol Rep | year= 2015 | volume= 17 | issue= 10 | pages= 63 | pmid=26290112 | doi=10.1007/s11926-015-0541-0 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26290112  }}</ref>
| style="background: #F5F5F5; padding: 5px; text-align:center" |+
| style="background: #F5F5F5; padding: 5px; text-align:center" |-
| style="background: #F5F5F5; padding: 5px; text-align:center" | -
| style="background: #F5F5F5; padding: 5px; text-align:center" |<nowiki>-</nowiki>
| style="background: #F5F5F5; padding: 5px; text-align:center" |Proximal > Distal
| style="background: #F5F5F5; padding: 5px; text-align:center" |Systemic
| style="background: #F5F5F5; padding: 5px; text-align:center" |UL or BL
| style="background: #F5F5F5; padding: 5px; text-align:center" |Insidious
| style="background: #F5F5F5; padding: 5px; text-align:center" |Elevated [[Creatine kinase|CK]] & [[Aldolase]]
| style="background: #F5F5F5; padding: 5px; text-align:center" |[[Muscle biopsy]]
| style="background: #F5F5F5; padding: 5px; text-align:center" |Progressive proximal muscle weakness in 3rd to 5th decade of life. With or without skin manifestations.
|-
|}


==See also==
==Related Chapters==
* [[Spinal cord injury]]
* [[Spinal cord injury]]
* [[Paraplegia]]
* [[Paraplegia]]
Line 45: Line 621:
* [[Tonic immobility]]
* [[Tonic immobility]]
* [[Cerebral palsy]]
* [[Cerebral palsy]]
* [[Cobra Toxin]]
 


{{Cerebral palsy and other paralytic syndromes}}
{{Cerebral palsy and other paralytic syndromes}}
{{Symptoms and signs}}
{{Symptoms and signs}}
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[[bn:পক্ষাঘাত]]
[[de:Lähmung]]
[[es:Parálisis]]
[[es:Parálisis]]
[[fr:Paralysie]]
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[[hr:Paraliza]]
 
[[it:Paralisi]]
[[he:שיתוק]]
[[nl:Verlamming]]
[[ja:麻痺]]
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Latest revision as of 23:35, 29 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Luke Rusowicz-Orazem, B.S.

Overview

Paralysis is the complete loss of muscle function for one or more muscle groups. Paralysis often includes loss of feeling in the affected area.

Pathophysiology

Paralysis is most often caused by damage to the nervous system or brain, especially the spinal cord. Partial paralysis can also occur in the REM stage of sleep.

Paralysis may be localized, or generalized, or it may follow a certain pattern. For example, localized paralysis occurs in Bell's palsy where one side of the face may be paralyzed due to inflammation of the facial nerve on that side. Patients with stroke may be weak throughout their body (global paralysis) or have hemiplegia (weakness on one side of the body) or other patterns of paralysis depending on the area of damage in the brain.

Other patterns of paralysis arise due to different lesions and their sequelae. For example, lower spinal cord damage from a severe back injury may result in paraplegia, while an injury higher up on the spinal cord, such as a neck injury, can cause quadriplegia. Patients with paraplegia or quadriplegia often use equipment such as a wheelchair or standing frame for mobility and to regain some independence.

Most paralyses caused by nervous system damage are constant in nature; however, there are forms of periodic paralysis, including sleep paralysis, which are caused by other factors.

Causes

Common Causes

Causes by Organ System

Cardiovascular Arachnoiditis, Arteriovenous malformation, Cerebrovascular accident, Hemorrhagic stroke, Ischemic stroke, Stroke
Chemical/Poisoning Amnesic shellfish poisoning, Apricot seed poisoning, Bird cherry seed poisoning, Bitter almond seed poisoning, Blue-ringed octopus poisoning, Bog rosemary poisoning, Bottlebrush buckeye poisoning, Brown snake poisoning, Buckeye poisoning, Bush lily poisoning, California buckeye poisoning, Carbamate insecticide poisoning, Cherry seed poisoning, China tree poisoning, Chokecherry seed poisoning, Clupeotoxism, Coastal leucothoe poisoning, Cobra poisoning, Conium maculatum, Corn lily poisoning, Curare, Delphinium poisoning, Dimethyl phthalate, Donepezil toxicity, Elapid poisoning, Everlasting pea poisoning, Fetterbush poisoning, Flax poisoning, Florida leucothoe poisoning, Golden chain tree poisoning, Grayanotoxin, Japanese andromeda poisoning, Jessamine poisoning, Lobelia poisoning, Marine toxins, Mayapple poisoning, Mercury poisoning, Monkshood poisoning, Monocrotophos, Mountain andromeda poisoning, Mountain laurel poisoning, Nicotiana tabacum, Organophosphate insecticide poisoning, Peach seed poisoning, Pernettya poisoning, Persian violet poisoning, Red buckeye poisoning, Rhodotoxin, Sea wasp poisoning, Sheep laurel poisoning, Staggerbush poisoning, Sweetshrub poisoning, Tacrine toxicity, Tambocor , Tetraodon poisoning, Trumpet flower poisoning, Wild cherry seed poisoning
Dental No underlying causes
Dermatologic Leprosy
Drug Side Effect Acetylandromedol, Amikacin sulfate, Andromedotoxin, Azinphos-methyl, Bromide, Cytisine, Flecainide , Flecatab , Iodixanol, Lobeline, Pergolide, Temodar , Temozolomide , Thiram
Ear Nose Throat No underlying causes
Endocrine Adrenal adenoma, Adrenal cancer, Adrenal gland hyperfunction, Adrenal incidentaloma, Adrenocortical carcinoma, Adrenoleukodystrophy, Hyperadrenalism, Primary hyperaldosteronism
Environmental Decompression sickness, Dysbarism
Gastroenterologic Functioning pancreatic endocrine tumor, Insulinoma, Metastatic insulinoma, Schistosomiasis japonica, Schistosomiasis mansoni, Zellweger syndrome
Genetic Cerebrotendinous xanthomatosis, Chediak-higashi syndrome, Chiari malformation, Congenital defects, Familial infantile metachromatic leukodystrophy , Gm2-gangliosidosis, Homocystinuria syndrome, Juvenile paget's disease, Pelizaeus-merzbacher disease, Porphyria, Refsum disease, Tay sachs disease
Hematologic Adrenoleukodystrophy, Classical hodgkin disease, Familial infantile metachromatic leukodystrophy , Hodgkin's disease, Intracranial hemorrhage, Lymphocyte depletion hodgkin's disease, Lymphocytic choriomeningitis, Metachromatic leukodystrophy, Mixed cellularity hodgkin's disease, Nodular sclerosing hodgkin's lymphoma, Potassium deficiency, Primary hyperaldosteronism, Subarachnoid hemorrhage, Subdural hematoma
Iatrogenic Post-vaccinial encephalitis
Infectious Disease Arbovirosis, Encephalitis, Fungal meningitis, Hendra virus, Japanese encephalitis, Leprosy, Lyme disease, Lymphocytic choriomeningitis, Marburg multiple sclerosis, Mareck's disease , Neurosyphilis , Poliomyelitis, Post-polio syndrome, Progressive multifocal leukoencephalopathy, Rabies, Schistosomiasis japonica, Schistosomiasis mansoni, Simian b virus infection, Syphilis, Tetanus, Tetranortriterpene, Tick-borne encephalitis, Transverse myelitis
Musculoskeletal/Orthopedic Alexander disease, Chronic inflammatory demyelinating polyneuropathy, Cutaneomeningospinal angiomatosis, Encephalomyelitis, Enterovirus antenatal infection, Juvenile paget's disease, Paget's disease of bone, Rib tumor, Spinal cord injury, Spinal muscular atrophy, Spinal tumor, Tetranortriterpene
Neurologic Acute disseminated encephalomyelitis, Acute fulminant multiple sclerosis, Adrenal cortex neoplasms, Adrenal gland hyperfunction, Alexander disease, Amnesic shellfish poisoning, Amyotrophic lateral sclerosis , Ataxic cerebral palsy, Autoimmune diseases of the nervous system, Balo's concentric sclerosis, Bell's palsy, Benign astrocytoma, Botulism, Brachial plexus injury, Calcification of basal ganglia , California encephalitis, Canavan disease, Cerebral cavernous malformations, Cerebral palsy, Cerebral sarcoma, Cerebrotendinous xanthomatosis, Cerebrovascular accident, Chiari malformation, Chronic inflammatory demyelinating polyneuropathy, Compartment syndrome, Congenital defects, Conversion disorder, Cutaneomeningospinal angiomatosis, Decompression sickness, Desmoplastic cerebral astrocytoma of infancy, Desmoplastic infantile ganglioma, Dyskinetic cerebral palsy, Encephalitis, Encephalomyelitis, Fowl paralyses, Friedreich’s ataxia, Gm2-gangliosidosis, Guillain-barre syndrome, Hereditary peripheral nervous disorder, Hydrocephalus, Intercostal neuralgia, Intracranial hemorrhage, Japanese encephalitis, Krabbe disease, Leptomeningitis, Lyme disease, Malignant astrocytoma, Marburg multiple sclerosis, Motor neurone disease, Movement disorders, Moyamoya syndrome, Multiple myeloma, Multiple sclerosis, Muscular dystrophy, Neuroblastoma, Neurofibromatosis, Neurosyphilis , Nyssen-van bogaert syndrome, Pelizaeus-merzbacher disease, Peripheral neuritis, Poliomyelitis, Post-polio syndrome, Post-vaccinial encephalitis, Progressive multifocal leukoencephalopathy, Rasmussen's encephalitis, Selected encephalitides, Sleep, Spastic cerebral palsy, Spina bifida, Subarachnoid hemorrhage, Subdural hematoma, Syringomyelia, Tay sachs disease, Tick-borne encephalitis, Transverse myelitis, Vanishing white matter leukodystrophy
Nutritional/Metabolic Potassium deficiency
Obstetric/Gynecologic Spina bifida
Oncologic Adrenal adenoma, Adrenal cancer, Adrenocortical carcinoma, Back tumor, Cerebral sarcoma, Desmoplastic cerebral astrocytoma of infancy, Desmoplastic infantile ganglioma, Extradural hematoma, Functioning pancreatic endocrine tumor, Hip cancer, Malignant astrocytoma, Mesothelioma, Metastatic insulinoma, Multiple myeloma, Neuroblastoma, Neurofibromatosis, Nodular sclerosing hodgkin's lymphoma, Rib tumor, Spinal tumor
Ophthalmologic Refsum disease
Overdose/Toxicity No underlying causes
Psychiatric No underlying causes
Pulmonary Asphyxia
Renal/Electrolyte Hypokalemia
Rheumatology/Immunology/Allergy Systemic lupus erythematosus
Sexual Syphilis
Trauma Broken neck, Electrical burns, Fractures, Pathological fracture, Spinal cord injury
Urologic Zellweger syndrome
Miscellaneous No underlying causes

Causes in Alphabetical Order

Differential diagnosis

Diseases History and Physical Diagnostic tests Other Findings
Motor Deficit Sensory deficit Cranial nerve Involvement Autonomic dysfunction Proximal/Distal/Generalized Ascending/Descending/Systemic Unilateral (UL)

or Bilateral (BL)

or

No Lateralization (NL)

Onset Lab or Imaging Findings Specific test
Adult Botulism + - + + Generalized Descending BL Sudden Toxin test Blood, Wound, or Stool culture Diplopia, Hyporeflexia, Hypotonia, possible respiratory paralysis
Infant Botulism + - + + Generalized Descending BL Sudden Toxin test Blood, Wound, or Stool culture Flaccid paralysis (Floppy baby syndrome), possible respiratory paralysis
Guillian-Barre syndrome[1] + - - - Generalized Ascending BL Insidious CSF: ↑Protein

↓Cells

Clinical & Lumbar Puncture Progressive ascending paralysis following infection, possible respiratory paralysis
Eaton Lambert syndrome[2] + - + + Generalized Systemic BL Intermittent EMG, repetitive nerve stimulation test (RNS) Voltage gated calcium channel (VGCC) antibody Diplopia, ptosis, improves with movement (as the day progresses)
Myasthenia gravis[3] + - + + Generalized Systemic BL Intermittent EMG, Edrophonium test Ach receptor antibody Diplopia, ptosis, worsening with movement (as the day progresses)
Electrolyte disturbance[4] + + - - Generalized Systemic BL Insidious Electrolyte panel ↓Ca++, ↓Mg++, ↓K+ Possible arrhythmia
Organophosphate toxicity[5] + + - + Generalized Ascending BL Sudden Clinical diagnosis: physical exam & history Clinical suspicion confirmed with RBC AchE activity History of exposure to insecticide or living in farming environment. with : Diarrhea, Urination, Miosis, Bradycardia, Lacrimation, Emesis, Salivation, Sweating
Tick paralysis (Dermacentor tick)[6] + - - - Generalized Ascending BL Insidious Clinical diagnosis: physical exam & history - History of outdoor activity in Northeastern United States. The tick is often still latched to the patient at presentation (often in head and neck area)
Tetrodotoxin poisoning[7] + - + + Generalized Systemic BL Sudden Clinical diagnosis: physical exam & dietary history - History of consumption of puffer fish species.
Stroke[8] +/- +/- +/- +/- Generalized Systemic UL Sudden MRI +ve for ischemia or hemorrhage MRI Sudden unilateral motor and sensory deficit in a patient with a history of atherosclerotic risk factors (diabetes, hypertension, smoking) or atrial fibrillation.
Poliomyelitis[9] + + + +/- Proximal > Distal Systemic BL or UL Sudden PCR of CSF Asymmetric paralysis following a flu-like syndrome.
Transverse myelitis[10] + + + + Proximal > Distal Systemic BL or UL Sudden MRI & Lumbar puncture MRI History of chronic viral or autoimmune disease (e.g. HIV)
Neurosyphilis[11][12] + + - +/- Generalized Systemic BL Insidious MRI & Lumbar puncture CSF VDRL-specifc

CSF FTA-Ab -sensitive[13]

History of unprotected sex or multiple sexual partners.

History of genital ulcer (chancre), diffuse maculopapular rash.

Muscular dystrophy[14] + - - - Proximal > Distal Systemic BL Insidious Genetic testing Muscle biopsy Progressive proximal lower limb weakness with calf pseudohypertrophy in early childhood. Gower sign positive.
Multiple sclerosis exacerbation[15] + + + + Generalized Systemic NL Sudden ↑CSF IgG levels

(monoclonal)

Clinical assessment and MRI [16] Blurry vision, urinary incontinence, fatigue
Amyotrophic lateral sclerosis[17] + - - - Generalized Systemic BL Insidious Normal LP (to rule out DDx) MRI & LP Patient initially presents with upper motor neuron deficit (spasticity) followed by lower motor neuron deficit (flaccidity).
Inflammatory myopathy[18] + - - - Proximal > Distal Systemic UL or BL Insidious Elevated CK & Aldolase Muscle biopsy Progressive proximal muscle weakness in 3rd to 5th decade of life. With or without skin manifestations.

Related Chapters


Template:Cerebral palsy and other paralytic syndromes

Template:Skin and subcutaneous tissue symptoms and signs Template:Nervous and musculoskeletal system symptoms and signs Template:Urinary system symptoms and signs Template:Cognition, perception, emotional state and behaviour symptoms and signs Template:Speech and voice symptoms and signs Template:General symptoms and signs

Template:WikiDoc Sources

  1. ↑ Talukder RK, Sutradhar SR, Rahman KM, Uddin MJ, Akhter H (2011). "Guillian-Barre syndrome". Mymensingh Med J. 20 (4): 748–56. PMID 22081202.
  2. ↑ Merino-Ramírez MÁ, Bolton CF (2016). "Review of the Diagnostic Challenges of Lambert-Eaton Syndrome Revealed Through Three Case Reports". Can J Neurol Sci. 43 (5): 635–47. doi:10.1017/cjn.2016.268. PMID 27412406.
  3. ↑ Gilhus NE (2016). "Myasthenia Gravis". N Engl J Med. 375 (26): 2570–2581. doi:10.1056/NEJMra1602678. PMID 28029925.
  4. ↑ Ozono K (2016). "[Diagnostic criteria for vitamin D-deficient rickets and hypocalcemia-]". Clin Calcium. 26 (2): 215–22. doi:CliCa1602215222 Check |doi= value (help). PMID 26813501.
  5. ↑ Kamanyire R, Karalliedde L (2004). "Organophosphate toxicity and occupational exposure". Occup Med (Lond). 54 (2): 69–75. PMID 15020723.
  6. ↑ Pecina CA (2012). "Tick paralysis". Semin Neurol. 32 (5): 531–2. doi:10.1055/s-0033-1334474. PMID 23677663.
  7. ↑ Bane V, Lehane M, Dikshit M, O'Riordan A, Furey A (2014). "Tetrodotoxin: chemistry, toxicity, source, distribution and detection". Toxins (Basel). 6 (2): 693–755. doi:10.3390/toxins6020693. PMC 3942760. PMID 24566728.
  8. ↑ Kuntzer T, Hirt L, Bogousslavsky J (1996). "[Neuromuscular involvement and cerebrovascular accidents]". Rev Med Suisse Romande. 116 (8): 605–9. PMID 8848683.
  9. ↑ Laffont I, Julia M, Tiffreau V, Yelnik A, Herisson C, Pelissier J (2010). "Aging and sequelae of poliomyelitis". Ann Phys Rehabil Med. 53 (1): 24–33. doi:10.1016/j.rehab.2009.10.002. PMID 19944665.
  10. ↑ West TW (2013). "Transverse myelitis--a review of the presentation, diagnosis, and initial management". Discov Med. 16 (88): 167–77. PMID 24099672.
  11. ↑ Liu LL, Zheng WH, Tong ML, Liu GL, Zhang HL, Fu ZG; et al. (2012). "Ischemic stroke as a primary symptom of neurosyphilis among HIV-negative emergency patients". J Neurol Sci. 317 (1–2): 35–9. doi:10.1016/j.jns.2012.03.003. PMID 22482824.
  12. ↑ Berger JR, Dean D (2014). "Neurosyphilis". Handb Clin Neurol. 121: 1461–72. doi:10.1016/B978-0-7020-4088-7.00098-5. PMID 24365430.
  13. ↑ Ho EL, Marra CM (2012). "Treponemal tests for neurosyphilis--less accurate than what we thought?". Sex Transm Dis. 39 (4): 298–9. doi:10.1097/OLQ.0b013e31824ee574. PMC 3746559. PMID 22421697.
  14. ↑ Falzarano MS, Scotton C, Passarelli C, Ferlini A (2015). "Duchenne Muscular Dystrophy: From Diagnosis to Therapy". Molecules. 20 (10): 18168–84. doi:10.3390/molecules201018168. PMID 26457695.
  15. ↑ Filippi M, Preziosa P, Rocca MA (2016). "Multiple sclerosis". Handb Clin Neurol. 135: 399–423. doi:10.1016/B978-0-444-53485-9.00020-9. PMID 27432676.
  16. ↑ Giang DW, Grow VM, Mooney C, Mushlin AI, Goodman AD, Mattson DH; et al. (1994). "Clinical diagnosis of multiple sclerosis. The impact of magnetic resonance imaging and ancillary testing. Rochester-Toronto Magnetic Resonance Study Group". Arch Neurol. 51 (1): 61–6. PMID 8274111.
  17. ↑ Riva N, Agosta F, Lunetta C, Filippi M, Quattrini A (2016). "Recent advances in amyotrophic lateral sclerosis". J Neurol. 263 (6): 1241–54. doi:10.1007/s00415-016-8091-6. PMC 4893385. PMID 27025851.
  18. ↑ Michelle EH, Mammen AL (2015). "Myositis Mimics". Curr Rheumatol Rep. 17 (10): 63. doi:10.1007/s11926-015-0541-0. PMID 26290112.
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