tetraplegia

Tetraplegia, also known as quadriplegia, is the impairment or loss of motor and/or sensory function in all four limbs and the trunk, caused by damage to the cervical spinal cord or brainstem. It differs from paraplegia, which primarily affects the legs and trunk.

Most cases arise from traumatic cervical spinal cord injury, such as a car crash or fall. Non-traumatic causes include cervical tumors, infections, inflammatory disorders such as transverse myelitis, and degenerative conditions that compress the cervical cord.

Clinical presentation varies with the level and completeness of injury. High cervical injuries (C1–C4) may impair breathing and require ventilatory support, while lower cervical injuries may spare some arm function. Sensory loss, weakness or paralysis below the injury, reflex changes, bladder and bowel dysfunction, and autonomic dysreflexia in some patients may be present. Spasticity and chronic pain are common long-term issues.

Diagnosis relies on a detailed neurological examination and imaging studies, especially MRI of the spine. The American Spinal Injury Association (ASIA) impairment scale is used to classify severity and recoveries.

Management is multidisciplinary and time-sensitive. In the acute phase, stabilization, imaging, and prevention of further injury are priorities; surgical decompression or stabilization may be needed. Respiratory support may be required. Long-term care emphasizes rehabilitation with physical and occupational therapy, seating and wheelchair considerations, skin and pressure injury prevention, and secondary complication management. Medications may address spasticity, pain, and bladder/bowel dysfunction. Psychological and social support are important.

Prognosis depends on the injury level and whether the injury is complete or incomplete. Some motor and sensory recovery can occur, especially in incomplete injuries, but complete injuries often result in lasting impairment requiring ongoing assistive devices and care.