Where is the lesion in patients with spastic weakness of one leg?
The lesion may be localized to the spinal cord or the brain. Progression to involve the arm does not help to differentiate between the spinal cord or the brain. Similarly, spread to the opposite leg does not necessarily indicate that the lesion is the spinal cord. Full investigation would include radiography of the spine and CT, but if the latter is normal then myelography may be required. What do you know about hereditary spastic paraplegia? This is an autosomal dominant condition, first described by Seeligmuller and Strumpell, in which spasticity is more striking than muscular weakness. The age of onset is variable and the condition has a relatively benign course. When the onset is in childhood, there may be shortening of the Achilles tendon, often requiring surgical lengthening. There is usually no sensory disturbance. What do you know about tropical spastic paraplegia? This is seen in Japan, the Caribbean and parts of western Africaand South America where women, more often than men
