Hyperreflexia

Overview
Hyperreflexia suggests an upper motor neuron dysfunction. Hyperreflexia usually has a positive Babinkski's Sign and spasticity. Usually develops over a period of days to weeks (as opposed to immediate presentation)

Differential Diagnosis
In alphabetical order.


 * Alcohol withdrawal
 * Amyotrophic Lateral Sclerosis (ALS)
 * Anxiety
 * Apoplexy
 * Athetosis
 * Autonomic dystonia
 * Brainstem lesions
 * Cerebral lesions
 * Cervical or thoracic myelopathy
 * Compressive myelopathy
 * Drugs, toxins
 * Electrolyte disorders
 * Epidural abscess
 * Familial spastic paraparesis
 * General paralysis
 * Hepatic coma
 * Homocystinuria
 * Human T-lymphotropic virus type I (HTLV-I) associated myelopathy
 * Hydrocephalus
 * Hyperbaric liquor pressure
 * Hyperthyroidism
 * Hypocalcemia
 * Infantile diplegia
 * Intracranial bleeding
 * Lithium overdose
 * Maple syrup urine disease
 * Meningitis
 * Monoamine oxide inhibitor overdose
 * Multiple Sclerosis
 * Parkinsonism
 * Phenylketonuria
 * Poliomyelitis
 * Primary lateral sclerosis
 * Progressive alcoholic dementia
 * Rabies
 * Serotonin syndrome
 * Spastic spinal paralysis
 * Spinal cord infarction
 * Spinocerebellar ataxia
 * Syringobulbia
 * Tetanus
 * Thyrotoxicosis

Suggested Laboratory Evaluations

 * Calcium
 * Lithium
 * Drug screen
 * Magnesium
 * DNA testing
 * Serologies for:
 * HTLV-I
 * HIV
 * Rapid plasma reagin (RPR)

Electrolyte and Biomarker Studies

 * Electrolytes

MRI and CT

 * CT scan for suspected intracranial lesions
 * MRI is a better measure for hyperreflexia

Other Diagnostic Studies

 * Cerebrospinal fluid analysis (for suspected multiple sclerosis)

Treatment

 * Replace electrolytes

Acute Pharmacotherapies

 * Antispasicity agents
 * Steroids
 * Interferon
 * Glatiramer acetate
 * Mitoxantrone
 * Cyproheptadine
 * Antiretroviral therapy

Surgery and Device Based Therapy

 * Surgical intervention to relieve compression (in compressive myelopathies)
 * Syringomyelia may require surgical therapy
 * Some congenital conditions may require surgical intervention

Acknowledgements
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