Acute Paralysis (Acute Paresis): Or something else? Differential Diagnosis

Intracerebral hemorrhage (ICB; cerebral hemorrhage).

All differential diagnoses of transistor ischemic attack (TIA) and apoplexy are possible differential diagnoses of acute paresis. Only the most important differential diagnoses of acute paresis are discussed below. Endocrine, nutritional, and metabolic diseases (E00-E90).

  • Hypoglycemia (low blood sugar) due to diabetes mellitus.
  • Porphyria or acute intermittent porphyria (AIP); genetic disease with autosomal dominant inheritance; patients with this disease have a 50 percent reduction in the activity of the enzyme porphobilinogen deaminase (PBG-D), which is sufficient for porphyrin synthesis. Triggers of a porphyria attack, which can last a few days but also months, are infections, drugs or alcohol. The clinical picture of these attacks presents as acute abdomen or neurological deficits, which can take a lethal course. The leading symptoms of acute porphyria are intermittent neurologic and psychiatric disturbances. Autonomic neuropathy is often in the foreground, causing abdominal colic (acute abdomen), nausea (nausea), vomiting or constipation (constipation), as well as tachycardia (heartbeat too fast: > 100 beats per minute) and labile hypertension (high blood pressure).

Cardiovascular system (I00-I99).

  • Apoplexy (stroke)
  • Chronic subdural hematoma (cSDH) – hematoma (bruise) between the dura mater and the arachnoid membrane (spider membrane; middle meninges between the dura mater (hard meninges; outermost meninges) and the pia mater); symptoms: uncharacteristic complaints such as a feeling of pressure in the head, cephalgia (headache), vertigo (dizziness), restriction or loss of orientation and ability to concentrate
  • Intracerebral hemorrhage (ICB; cerebral hemorrhage) – in 1.24% of patients with suspected TIA.
  • Subarachnoid hemorrhage (SAB; hemorrhage between the spider tissue membrane and the soft meninges); incidence: 1-3%; symptomatology: proceed according to “Ottawa rule for subarachnoid hemorrhage”:
    • Age ≥ 40 years
    • Meningismus (symptom of painful neck stiffness in irritation and disease of the meninges).
    • Syncope (brief loss of consciousness) or impaired consciousness (somnolence, sopor and coma).
    • Onset of cephalgia (headache) during physical activity.
    • Thunderclap headache/destructive headache (about 50% of cases).
    • Restricted mobility of the cervical spine (Cervical spine).

Neoplasms – tumor diseases (C00-D48).

  • Brain metastases (metastasis of cancer cells (metastasis) to brain tissue).
  • Brain tumors, unspecified; symptomatology: slowly developing paresis, aphasia (speech disorders) and convulsions; rarely headache is an early symptom! (Present as the first and only symptom in only 2-8% of all patients).

Psyche – Nervous System (F00-F99; G00-G99).

  • Encephalitis (inflammation of the brain).
  • Epileptic seizure – as postictal paresis (paralysis “after one or more seizures”).
  • Guillain-Barré syndrome (GBS; synonyms: Idiopathic polyradiculoneuritis, Landry-Guillain-Barré-Strohl syndrome); two courses: acute inflammatory demyelinating polyneuropathy or chronic inflammatory demyelinating polyneuropathy (disease of the peripheral nervous system); idiopathic polyneuritis (diseases of multiple nerves) of spinal nerve roots and peripheral nerves with ascending paralysis and pain; usually occurs after infections [very rare].
  • Hysterical paralysis (dissociative disorders) – occur mostly in younger patients.
  • Meningitis (meningitis) – mostly affects children and adolescents; leading symptoms: headache, high fever, meningismus (unlike adults, does not have to occur in children).
  • Multiple sclerosis (MS) – inflammatory / demyelinating and degenerative disease of the central nervous system, which can lead to spasticity and paresis (paralysis); occurs predominantly between the 20th and 40th year of life; the peak of the disease is around the 30th year of life
  • Migraine – mostly patients in the younger middle age are affected; in about 60% of patients are unilateral headaches present
  • Psychogenic hemiparesis – hemiplegia due to mental disorders.
  • Transient ischemic attack (TIA) – corresponds to the symptoms of a stroke, but the symptoms regress after 24 hours at the latest.
  • Transverse myelitis (TM; English : “longitudinally extensive transverse myelitis”) – inflammatory disease of the spinal cord; primary or secondary (eg. with acute disseminated encephalomyelitis (ADEM; inflammation of the brain (encephalitis) and spinal cord (myelitis)), neuromyelitis optica (NMO), multiple sclerosis (MS)); symptomatology: usually acute onset of motor, sensory and autonomic disturbances; therapy: methylprednisolone, i. v.

Injuries, poisonings and other consequences of external causes (S00-T98).

Environmental stress – intoxications (poisoning).