quadriplegia

Quadriplegia, also known as tetraplegia, is paralysis that affects all four limbs and often the trunk, resulting from damage to the cervical spinal cord or brainstem. It is distinguished from paraplegia, which involves only the legs and trunk. Quadriplegia can be complete, with a total loss of voluntary movement and sensation below the level of injury, or incomplete, with some preserved function.

Most cases arise from traumatic spinal cord injury, such as motor vehicle crashes, falls, sports injuries, or violence. Nontraumatic causes include tumors, cervical stroke, inflammatory or infectious diseases (for example transverse myelitis), and congenital conditions that constrain the cervical spine.

Clinical presentation depends on the level and completeness of injury. Individuals may have loss of motor function and sensation below the injury, autonomic dysfunction, and impaired respiratory effort if the injury is high in the cervical cord. Bowel and bladder control and temperature regulation may also be affected.

Diagnosis relies on neurologic examination and imaging. Magnetic resonance imaging (MRI) and computed tomography (CT) assess the extent of injury, while X-rays may be used initially. The ASIA Impairment Scale is commonly used to classify injury as complete (A) or varying degrees of incomplete (B–D).

Treatment focuses on acute stabilization, airway protection, and prevention of secondary injury. Surgical decompression or stabilization may be required. Corticosteroids are no longer universally recommended. Rehabilitation with physical and occupational therapy, assistive devices, and strategies for respiration, nutrition, and bowel/bladder management are central. Complications include pressure ulcers, infections, deep venous thrombosis, autonomic dysreflexia (in injuries above T6), and pneumonia.

Prognosis varies widely with level and completeness of injury and with access to rehabilitation. Some recovery occurs in incomplete injuries; complete injuries carry a lower likelihood of significant motor improvement.