Paralysis
Paralysis is loss of movement: a muscle or a whole group of muscles stops obeying, even though the person is awake and trying to move.
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On this page
- Sudden weakness is counted in minutes
- Both legs, the saddle area and the bladder
- Weakness that climbs from the feet up
- If there has been an injury to the head, neck or back
- Half a face: stroke or Bell's palsy
- What else causes paralysis
- Not every loss of movement is dangerous
- Tests and recovery
- Online consultation
Paralysis is loss of movement: a muscle or a whole group of muscles stops obeying, even though the person is awake and trying to move. Alongside it sits the word paresis, which means the same thing only partly — some strength is left, just not much. For practical decisions that difference hardly matters. What matters is how fast it all happened. Weakness that came on over minutes and weakness that built up over months are two completely different conversations, and the first one is not held with a doctor at an appointment but with an emergency dispatcher. This page is mainly about telling one from the other.
Sudden weakness is counted in minutes
Call an ambulance straight away if someone's face, arm or leg has suddenly gone weak — especially on one side — or their speech has become slurred. That is the picture of a stroke, and three simple checks will show it. Ask them to smile: one corner of the mouth lags behind. Ask them to raise both arms and hold them up: one drifts down or never gets there. Ask them to repeat an ordinary sentence: the words slur, come out in the wrong order, or the person cannot understand you. One of the three signs is enough. The same urgency applies to sudden loss of vision in one eye or half the field of view, sudden double vision, a sudden loss of balance that pulls the person sideways, and the worst headache of a lifetime that arrives like a blow.
The fourth thing needed from you is the time. Remember when the person was last seen well and tell the paramedics that hour: whether the clot can still be dissolved or pulled out depends on it. The window for those treatments is narrow, and it is counted from the onset, not from the phone call.
Waiting until morning is the commonest and most expensive mistake made with sudden weakness. A brain without blood flow loses cells every minute, and a night of waiting is the difference between someone walking a month later and someone who cannot sit up a month later. Nor should you wait when everything cleared up by itself in ten minutes: that episode is a transient ischaemic attack, and it does not mean the danger has passed — it means a full stroke is possible within days.
Do not take the person in yourself: breathing can fail or vomiting can start on the way, and an ambulance crew starts treating from the first minute. The single European emergency number is 112, which works in Spain, Italy, Portugal, Poland and Ukraine; if the ambulance number where you live is different, use that one.
Both legs, the saddle area and the bladder
There is a second situation counted in hours, and it is far less widely known than stroke: compression of the spinal cord, and cauda equina syndrome, which affects the bundle of nerve roots at the very bottom of the spine.
The combination to be alarmed by is weakness in both legs at once, numbness of the saddle area and inner thighs, and disturbance of passing urine and opening the bowels. The numbness is usually described as feeling frozen down there: the person cannot feel toilet paper, cannot tell whether the bladder is full, cannot start the stream, or the other way round, leaks urine without noticing. Abruptly appearing erection problems and severe back pain running down both legs are often part of it.
The cause may be a large disc herniation, a fractured vertebra, an abscess next to the cord, or a tumour deposit. Separately: if someone is being treated, or has been treated, for cancer and develops back pain with leg weakness, this is metastatic spinal cord compression until proved otherwise, and it is assessed today.
What counts here is not how bad the pain is but the clock. Nerve tissue squeezed for a day recovers poorly and incompletely; the same tissue relieved within hours often recovers fully. So with that set of signs a person goes to hospital immediately rather than booking a scan for next week.
Weakness that climbs from the feet up
Another dangerous course looks entirely undramatic at first. Over a few days tingling and numbness appear in the feet, then the legs start giving way on the stairs, then the weakness reaches the thighs and later the arms. This is Guillain-Barré syndrome, inflammation of the peripheral nerves, often one to three weeks after a stomach bug or a chest infection.
The main danger here is not walking but breathing and swallowing. The muscles that breathe and swallow weaken along with the rest, and they do it quietly. Warning signs: breathlessness when lying flat, not being able to finish a sentence on one breath, a quiet voice, a weak cough, choking on water, saliva pooling in the mouth. Any one of them justifies an ambulance rather than watchful waiting at home. Some patients need a ventilator, and that is temporary: with treatment started in time, most people recover.
Two other conditions unfold in a similar way and are worth knowing about. Botulism runs the other way, downwards: first double vision and drooping eyelids, a dry mouth, a nasal voice and difficulty swallowing, then weakness of the arms and of breathing. The usual link is home-preserved food, cured fish or sausage; in babies, honey. Waiting is not an option — the antitoxin works better the earlier it is given. Tick paralysis develops in a child a few days after a tick attaches and disappears once the tick is found and removed, so ascending weakness is a reason to search the whole skin and the scalp. Tick-borne encephalitis, by contrast, leaves lasting weakness in the arms and shoulders and needs hospital care.
If there has been an injury to the head, neck or back
Someone who has fallen, dived into water, been in a crash or taken a blow to the head is not moved. Do not sit them up, do not stand them up to see whether they can walk, do not take a helmet off, do not pull them out of a car by the arms. The only exceptions are fire, water and other immediate danger to life; then you drag them by their clothing along the line of the body, trying not to bend the neck.
Until the crew arrives, hold the head in your hands in line with the trunk so it cannot turn or tip back, and keep talking to the person so that they do not twist around themselves. If they are vomiting and unconscious, roll the whole body at once, never the head alone.
Any complaint after an injury of numbness, pins and needles, electric shocks or weakness in the arms or legs means the spine must be treated as damaged, even if the person got up and walked. Weakness can also appear hours later, as swelling builds or a fragment shifts — the delay softens nothing and an ambulance is still needed. In older people with osteoporosis a fall from standing height is enough to break the neck, and sometimes a sharp backward jolt of the head with no fall at all.
Half a face: stroke or Bell's palsy
A drooping half of the face frightens everybody, but two very different things sit behind it, and what separates them is the forehead.
In Bell's palsy the whole half of the face switches off: the eyebrow does not lift, the forehead on that side does not wrinkle, the eye does not close fully, and water escapes from the corner of the mouth when drinking. Often for a day or two beforehand there is pain behind the ear, sounds on that side seem unpleasantly loud, and taste changes. This is damage to the facial nerve rather than to the brain, and in most people it settles.
In a stroke the forehead still works: the eyebrow lifts, the eye closes, and only the lower half of the face is pulled down. And there is almost always something else — weakness of the arm on the same side, slurred speech, unsteadiness.
The forehead test is useful, but nobody should decide on it alone: the first time a face droops acutely, call an ambulance and let a doctor work it out. If it does turn out to be Bell's palsy, two things matter. A short course of steroid tablets started in the first days clearly improves the outcome, so you go to a doctor at once rather than when it fails to clear by itself. And an eye that will not close has to be protected: lubricating drops by day, ointment and a pad at night, because a drying cornea eventually ulcerates. Separate reasons to be seen the same day: a blistering rash inside the ear alongside the drooping face, or a drooping face after a tick bite or a ring-shaped patch on the skin — in children that is often Lyme disease, sometimes affecting both sides.
What else causes paralysis
When weakness builds over weeks and months the range of causes is different. Multiple sclerosis produces bouts of weakness and numbness that turn up in different places, last weeks and then fade, and become more obvious in the heat. A brain or spinal tumour causes gradually increasing weakness on one side, headaches in the early hours, nausea, and seizures that were never there before. Motor neurone disease begins with painless weakness in one hand or foot, twitching under the skin and visible wasting of the muscle; slurred speech and choking join later. Myasthenia is recognised by weakness that grows towards evening and with effort: by the end of the day an eyelid droops, vision doubles and it becomes hard to finish chewing a meal.
Not every loss of movement is dangerous
A single nerve squashed for a while gives a dramatic but purely local picture: foot drop after long sitting with the legs crossed or after a cast, wrist drop after a night with the arm over the back of a chair. It looks like paralysis and usually resolves over weeks.
Muscular dystrophies and other muscle diseases show themselves from childhood or early adulthood as difficulty rising from a chair, climbing stairs or lifting the arms to the hair. Weakness and numbness in the legs also come from diabetes, vitamin B12 deficiency and thyroid disease. Attacks of profound weakness after a large carbohydrate meal, or during the rest that follows exercise, occur in periodic paralysis linked to a drop in potassium.
Sleep paralysis is a separate thing: on falling asleep or waking, a person spends seconds or a couple of minutes unable to move or make a sound while understanding everything, sometimes with frightening images. It is neither a stroke nor a brain disease, it does no harm, and it is usually tied to lack of sleep and a disrupted routine. There is also functional paralysis, in which nerves and brain are structurally intact yet the movement still will not come; the symptoms are genuine, not invented, and the condition is treatable — but the diagnosis is made by a neurologist after everything else has been excluded.
Tests and recovery
The doctor starts by pinning down exactly where the strength has gone, whether the face is involved, whether sensation is lost and at what level it cuts off, and how the reflexes behave. That alone narrows things considerably. Then come imaging of the brain or spine, studies of conduction along nerves and muscles, blood tests and, if inflammation of the nerves is suspected, examination of the spinal fluid.
Treatment depends on the cause and there is no common recipe: restoring blood flow and preventing the next event in stroke; surgery or radiotherapy for compression; intravenous immunoglobulin or plasma exchange in Guillain-Barré; a short steroid course in Bell's palsy. Painkillers and drugs for spasticity ease the accompanying problems but do not touch the cause.
Rehabilitation starts early, while still in hospital: physiotherapy holds on to strength and range of movement, occupational therapy re-teaches ordinary tasks, and a speech and language therapist works on speech and swallowing. At home, for someone confined to bed, the paralysis itself is less dangerous than what surrounds it: pressure sores over the sacrum and heels (change position every couple of hours and inspect the skin), deep vein thrombosis (one swollen, painful calf means a doctor the same day), choking on food, constipation and urinary retention, stiffening joints, and low mood, which almost nobody raises first. The fastest part of recovery falls in the first weeks, but the process runs for months and later work still pays off.
Online consultation
Let us be blunt: acutely developing weakness is not a matter for a remote appointment. If the face has drooped, the arm will not lift, speech has become slurred or both legs have given out, close this page and call an ambulance. Talking to a doctor here consumes exactly the minutes that decide the outcome.
Everything else around paralysis can and should be discussed online. An Oladoctor doctor will ask where precisely the strength is going, how that has changed week by week, what is happening to sensation, vision, speech and passing urine, and will advise which tests are genuinely needed and which specialist deals with this. After discharge from hospital they will explain the reports, help set up home care without pressure sores and choking, go through the prescribed medicines, and point out in good time the signs that mean going back to hospital.
This material is for information only and does not replace medical advice.
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