Abstract
The authors seek to clarify the nomenclature used to describe cervical spinal cord injuries, particularly the use of the terms “tetraplegia”, “quadriplegia”, “quadriparesis”, “tetraparesis”, “incomplete quadriplegia” or “incomplete tetraplegia” when applied to patients with lower cervical cord injuries. A review of the origin of the terms and nomenclature used currently to describe the neurological status of patients with SCI in the literature was performed. The terms “tetraplegia”, “quadriplegia”, “quadriparesis”, “tetraparesis”, “incomplete quadriplegia” or “incomplete tetraplegia” have been used very often to describe patients with complete lower cervical SCI despite the fact that the clinical scenario is all the same for most of these patients. Most of these patients have total loss of the motor voluntary movements of their lower trunk and inferior limbs, and partial impairment of movement of their superior limbs, preserving many motor functions of the proximal muscles of their arms (superior limbs). A potentially better descriptive term may be “paraplegia with brachial diparesis”. In using the most appropriate terminology, the patients with lower cervical SCI currently referred as presenting with “tetraplegia”, “quadriplegia”, “quadriparesis”, “tetraparesis”, “incomplete quadriplegia” or “incomplete tetraplegia”, might be better described as having “paraplegia with brachial diparesis”.
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References
Agard WR (1937) Medical Greek and Latin at a glance, 2nd edn. Paul B Hoeber, New York
Albert TJ, Vaccaro AR (2005) Physical examination of the spine. Thieme, New York
Barcelos AC, Scardino FZ, Patriota GC, Rotta JM, Botelho RV (2009) Paraparesis or incomplete paraplegia? How should we call it? Acta Neurochir 151:369–372
Brazis PW, Masdeu JC, Biller J (1996) Localization in clinical neurology, 3rd edn. Little, Brown and Co, New York
Brown JM (2011) Nerve transfers in tetraplegia I: background and technique. Surg Neurol Int 2:121
Campbell WW (2005) DeJong’s. The neurological examination, 6 edn. Lippincott Williams & Wilkins, Philadelphia
Campbell WW (2008) Pocket guide and toolkit to DeJong’s neurologic examination. Wolters Kluwer/Lippincott Williams & Wilkins, Philadelphia
Campbell WW (2005) DeJong, o exame neurológico, 6th edn. Guanabara Koogan, Philadelphia
Carpenter M (1995) Core text of neuroanatomy, 4th edn. William & Wilkins, Baltimore
Cohen ME, Ditunno JF Jr, Donovan WH, Maynard FM Jr (1998) A test of the 1992 international standards for neurological and functional classification of spinal cord injury. Spinal Cord 36:554–560
Curt BA, Kuntz C IV, Asghar FA (2011) Spine section. Approach to the patient. In: Winn HR (ed) Youmans neurological surgery, 6th edn. Elsevier Saunders, Philadelphia, pp 2773–2778
Curtin CM, Wagner JP, Gater DR, Chung KC (2007) Opinions on the treatment of people with tetraplegia: contrasting perceptions of physiatrists and hand surgeons. J Spinal Cord Med 30:256–262
Davidoff RA (1987) Handbook of the spinal cord. Marcel Dekker, New York
Davis LE (1925) Neurological diagnosis. WB Saunders, Philadelphia
DeJong RN (1992) Disorders of the spinal cord. In: DeJong RN (ed) DeJong’s. The neurological examination, 5 edn. Lippincott Williams & Wilkins, Philadelphia, pp 585–586
DeJong RN (1992) Motor strength and power. In: DeJong RN (ed) DeJong’s. The neurological examination, 5 edn. Lippincott Williams & Wilkins, Philadelphia, pp 335–339
Dorland (2011) Dorland’s illustrated medical dictionary, 32 edn. Elsevier, Philadelphia
Duus P (2005) Motor system. In: Peter Duus (ed) Duus’ topical diagnosis in neurology. Anatomy, physiology, signs and symptoms, 4 edn. Thieme, Stuttgart, pp 55–114
Figueroa JJ, Chapin JE (2010) Isolated facial diplegia and very late-onset myopathy in two siblings: atypical presentations of facioscapulohumeral dystrophy. J Neurol 257:444–446
Frenay AC (1989) Understanding medical terminology, 8th edn. The Catholic Health Association of the US, St. Louis
Gorson KC, Kolb DA, Marks DS, Hayes MT, Baquis GD (2011) Acute brachial diplegia due to Lyme disease. Neurologist 17:24–27
Gylys B (1999) Medical terminology: a systems approach, 4th edn. FA Davis, Philadelphia
Hamou C, Shah NR, DiPonio L, Curtin CM (2009) Pinch and elbow extension restoration in people with tetraplegia: a systematic review of the literature. J Hand Surg Am 34:692–699
Harvey LA, Dunlop SA, Churilov L, Hsueh YAH, Galea MP (2011) Early intensive hand rehabilitation after spinal cord injury (“Hands On”): a protocol for a randomised controlled trial. Trials 12:2–9
Haubrich WS (2003) Medical meanings. A glossary of word origins. ACP, Philadelphia
Henning F, Hewlett RH (2008) Brachial amyotrophic diplegia (segmental proximal spinal muscular atrophy) associated with HIV infection. J Neurol Neurosurg Psychiatry 79:1392–1394
Johnson EO, Vekris M, Demesticha T, Soucacos PN (2011) Neuroanatomy of the brachial plexus: normal and variant anatomy of its formation. Surg Radiol Anat 32:291–297
Leonard PC (2001) Building a medical vocabulary, 5th edn. WB Saunders, Philadelphia
Marino RJ, Burns S, Graves DE, Leiby BE, Kirshblum S, Lammertse DP (2011) Upper- and lower-extremity motor recovery after traumatic cervical spinal cord injury: an update from the national spinal cord injury database. Arch Phys Med Rehabil 92:369–375
Martin JH (1996) Neuroanatomy, text and atlas, 2nd edn. Appleton & Lange, Stamford
Mayo Clinic (1991) Motor function. In: Mayo Clinic (ed) Clinical examinations in neurology. Mosby Year Book, St. Louis, pp 150–239
Merriam-Webster Dictionary (2011) http://www.merriam-webster.com/. Accessed 31 Oct 2011
Michaelis LS, Braakman R (1976) Current terminology and classification of injuries of spine and spinal cord. In: Vinken PJ, Bruyn GW (eds) Handbook of clinical neurology. Elsevier, New York, pp 145–153
Morelli N, Mancuso M, Cafforio G, Gori S, Murri L (2007) Reversible brachial diplegia in a case treated with cyclosporine. Neurology 69:220
PMC. US National Library of Medicine: PubMed. http://www.ncbi.nlm.nih.gov/pmc. Accessed 1 Nov 2011
Santiago ME, Corbett FF (2002) The neurologic examination. In: Haines DE (ed) Fundamental neuroscience, 2nd edn. Churchill Livingstone, Philadelphia, pp 521–535
Scott RJE (1928) Gould’s medical dictionary, 2nd edn. P. Blakiston’s Son & Co, Philadelphia
Shevell MI (2010) The terms diplegia and quadriplegia should not be abandoned. Dev Med Child Neurol 52:508–509
Snell RS (2010) Clinical neuroanatomy, 7th edn. Lippincott Williams & Wilkins, Baltimore, pp 167–176
Snoek GJ, IJzerman MJ, Hermens HJ, Maxwell D, Biering-Sorensen F (2004) Survey of the needs of patients with spinal cord injury: impact and priority for improvement in hand function in tetraplegics. Spinal Cord 42:526–532
Stedman TL (2005) Stedman’s medical dictionary for the health professions and nursing, 5th edn. Lippincott Williams & Wilkins, Baltimore
Stedman TL (2006) Stedman’s medical dictionary, 28th edn. Lippincott Williams & Wilkins, Philadelphia
Stevenson A, Lindberg CA (2011) New Oxford American dictionary. Oxford University Press, New York
Susuki K, Koga M, Hirata K, Isogai E, Yuki N (2009) A Guillain–Barré syndrome variant with prominent facial diplegia. J Neurol 256:1899–1905
Taber KH, Maravilla K, Chiou-Tan F, Hayman LA (2000) Sectional neuroanatomy of the upper limb I: brachial plexus. Comput Assist Tomogr 24:983–986
Thomason P, Baker R, Dodd K, Taylor N, Selber P, Wolfe R, Graham HK (2011) Single-event multilevel surgery in children with spastic diplegia: a pilot randomized controlled trial. J Bone Jt Surg Am 93:451–460
Thompson N, Stebbins J, Seniorou M, Newham D (2011) Muscle strength and walking ability in diplegic cerebral palsy: implications for assessment and management. Gait Posture 33:321–325
Van Schie PE, Schothorst M, Dallmeijer AJ, Vermeulen RJ, van Ouwerkerk WJ, Strijers RL, Becher JG (2011) Short- and long-term effects of selective dorsal rhizotomy on gross motor function in ambulatory children with spastic diplegia. J Neurosurg Pediatr 7:557–562
Wikipedia: the free encyclopedia: Wikimedia foundation. http://en.wikipedia.org/wiki. Accessed 31 Oct 2011
Wyndaele M, Wyndaele JJ (2006) Incidence, prevalence and epidemiology of spinal cord injury: what learns a worldwide literature survey? Spinal Cord 44:523–529
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The authors gratefully acknowledge Dr. Lincoln Ramirez for assistance in reviewing this paper.
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Figueiredo, N., Figueiredo, I.E. & Resnick, D. Tetraplegia or paraplegia with brachial diparesis? What is the most appropriate designation for the motor deficit in patients with lower cervical spinal cord injury?. Neurol Sci 34, 143–147 (2013). https://doi.org/10.1007/s10072-012-1160-4
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DOI: https://doi.org/10.1007/s10072-012-1160-4