Acute paralysis including hemiplegia

Patterns and definitions

Pathology affecting the upper motor neurone tends to produce spastic paralysis- i.e. stiff, weak limbs with increased reflexes. However, in the early stages, the affected limbs may be flaccid.

Pathology affecting the lower motor neurone tends to produce flaccid paralysis- i.e. floppy, weak limbs, with reduced or no reflexes. The muscles affected become atrophied, with visible loss of bulk.

Lesions in the brain are more likely to produce focal motor neurology (often a hemiplegia paralysing the arm extensors and leg flexors on the contralateral side. There may be associated symptoms and signs of raised intracranial pressure. Some lesions are associated with seizures (which may be focal). Lesions in the brain are also more likely to interfere with conscious level/ higher mental function. There may also be cranial nerve involvement.

Lesions affecting the spinal cord are more likely to produce symmetrical paralysis, usually spastic, below the level of the lesion, with sensory loss. There also may be associated sphincter dysfunction affecting bowel and bladder control.

In lesions affecting peripheral nerves the distal muscle groups are often affected first.

In myopathic paralysis, the pattern of paralysis is determined by affected muscles. There may be muscle wasting, (pseudohypertrophy suggests Duchenne's muscular dystrophy) or tenderness.

Causes of paralysis: (rare diagnoses in [brackets])

Cerebral pathology

Spinal cord pathology

Peripheral Neuropathies

Muscle pathology


Common Causes of Non-traumatic Paraplegia in Malawi

Important points in history

Development of paralysis

Current associated symptoms

Preceding health

Risk factors

Important points on examination


Indications for admission


Specific treatments depend on cause identified or suspected.

Supportive Care



When to discharge