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June 14, 2016: Cruciate paralysis

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June 14, 2016

Cruciate paralysis

First described by Bell in 1970, cruciate paralysis denotes selective bilateral upper extremity paralysis, without involvement of the lower extremities1. The neuroanatomical basis is the selective involvement of the corticalspinal fibers of the upper extremity decussating in the rostral pyramids, at the cervicomedullary junction. The corticospinal fibers of the lower extremities decussate more caudally, which explains the relative sparing of the lower extremities2. The lower cranial nerves may be involved, causing respiratory insufficiency, which helps differentiate cruciate paralysis from central cord syndrome. Reported etiologies include trauma, compressive tumors, congenital malformations, vascular, demyelinating and metabolic etiologies (eg diabetes)3. The prognosis depends on the cause with better outcome seen following early surgical decompression for compressive lesions 4.

  1. Bell HS. Paralysis of both arms from injury of the upper portion of the pyramidal decussation: 'cruciate paralysis. J Neurosurg 1970; 33: 376-80.
  2. Maretsis M, Adam D. Transient brachial diplegia (crossed paralysis): etiopathogeny and differential diagnosis. J Neurol Psychiat 1993; 31: 269-272. 
  3. Benglis D, Levi AD. Neurologic findings of craniovertebral junction disease. Neurosurgery 2010; 66: 13-21.
  4. Yayama T, Uchida K, Kobayashi S, et al. Cruciate paralysis and hemiplegia cruciata: report of three cases. Spinal Cord 2006; 44: 393-398.

Submitted by Sunil Munakomi, MD, Senior Resident, Department of Neurosurgery, College of Medical Sciences - Kathmandu University, Nepal.

Dr. Munakomi reports no disclosures.

For more clinical pearls and other articles of interest to neurology trainees, visit Neurology.  Listen to this week's Neurology Podcast.

 

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