Hyperreflexia

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Hyperreflexia suggests an upper motor neuron dysfunction. Hyperreflexia usually has a positive Babinkski's sign and spasticity. Usually develops over a period of days to weeks (as opposed to immediate presentation).

Causes

Causes In Alphabetical Order.

• Alcohol withdrawal
• Amyotrophic Lateral Sclerosis (ALS)
• Anxiety
• Apoplexy
• Athetosis
• Autonomic dystonia
• Brainstem lesions
• Cerebral lesions
• Cervical or thoracic myelopathy
• Compressive myelopathy
• Drugs, toxins: Artemether and lumefantrin
• Electrolyte disorders
• Epidural abscess
• Familial spastic paraparesis
• General paralysis
• Hepatic coma
• Homocystinuria
• Human T-lymphotropic virus type I (HTLV-I) associated myelopathy
• Hydrocephalus
• Hyperbaric liquor pressure
• Hyperthyroidism
• Hypocalcemia
• Infantile diplegia
• Intracranial bleeding
• Lithium overdose
• Maple syrup urine disease
• Meningitis
• Monoamine oxide inhibitor overdose
• Multiple Sclerosis
• Parkinsonism
• Perphenazine
• Phenylketonuria
• Poliomyelitis
• Primary lateral sclerosis
• Progressive alcoholic dementia
• Rabies
• Serotonin syndrome
• Spastic spinal paralysis
• Spinal cord infarction
• Spinocerebellar ataxia
• Syringobulbia
• Tetanus
• Thyrotoxicosis

Laboratory Findings

• Calcium
• Lithium
• Drug screen
• Magnesium
• DNA testing
• Serologies for:

  • HTLV-I
  • HIV
  • Rapid plasma reagin (RPR)

Electrolyte and Biomarker Studies

• Electrolytes

MRI and CT

• CT scan for suspected intracranial lesions
• MRI is a better measure for hyperreflexia

Other Diagnostic Studies

• Cerebrospinal fluid analysis (for suspected multiple sclerosis)

Treatment

• Replace electrolytes

Acute Pharmacotherapies

• Antispasicity agents
• Steroids
• Interferon
• Glatiramer acetate
• Mitoxantrone
• Cyproheptadine
• Antiretroviral therapy

Surgery and Device Based Therapy

• Surgical intervention to relieve compression (in compressive myelopathies)
• Syringomyelia may require surgical therapy
• Some congenital conditions may require surgical intervention