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Acute weakness (Aetiology (Trauma Cerebral: TBI Spinal: cord compression…
Acute weakness
Aetiology
Trauma
Cerebral:
TBI
Spinal
: cord compression
Muscle:
compartment syndrome
Autoimmune
Cerebral:
MS
Spinal:
MS
Peripheral nerve:
vasculitis, sarcoidosis
NMJ: MG
Muscle:
polymyositis, myositis
Infection
Cerebral:
meningitis, encephalitis
Spinal:
abscess, polio, transverse myelitis
Peripheral nerve:
GBS, polio, HIV
NMJ:
tetanus, botulinum
Vascular
Cerebral:
stroke, TIA, migraine
Spinal:
cord infarction
Metabolic
Cerebral:
encephalpathy
Peripheral nerve:
alcohol, DM, hypothyroidism, renal failure, B12 deficiency, pyridoxine deficiency, toxins
Muscle:
hypothyroidism, Cushing's, rhabdomyolysis, toxins
Neoplastic
Cerebral:
CNS malignancy, met
Spinal:
spinal tumour, met
Peripheral nerve:
paraneoplastic syndrome
NMJ:
Lambert Eaton Myasthenic Syndrome
Muscle:
paraneoplastic syndrome
Degenerative
Spinal:
syringomyelia
Diagnosis
Examination
Neuro limb exam
Tone, power (MRC scale), reflexes,
coordination, sensation
CN exam
Acuity, fields, reflexes, fundoscopy
Any weakness in CNs
PR
Anal tone,
saddle anaesthesia
Resp exam
Any breathing difficulty
due to muscular weakness
Investigations
Bloods
ABG (
resp failure
, electrolytes)
FBC, CRP/ESR (infection, inflammation)
U+E (electrolytes), LFTs, clotting
TFTs, bone profile (cancer), blood cultures
Immunology (ACh-R antibodies)
Micro screen (syphilis, HIV)
Muscle enzymes (CK, LDH, myoglobin)
Toxicology screen (alcohol)
CSF
Oligoclonal bands (MS)
Cytology, MCS
Imaging
CT head (SOLs etc.)
MRI spine (infarct, lesion)
Bladder scan (urinary retention)
Special tests
EEG
NCS, EMG
Tensilon test (MG)
Muscle biopsy
Bedside
Obs (sats, O2, HR, RR, temp)
BP (lying and standing)
ECG (arrhythmia e.g. AF)
FVC (resp weakness)
History
FH
Strokes, autoimmune disease,
malignancy, inherited disorders
DH
Meds, allergies
PMH
Known medical conditions,
previous cancers etc.
PC/HPC
Weakness (SOCRATES), associated symptoms
e.g. pain, syncope, loss ofsensation, headache, SOB,
dysphagia, blurred vision, bowel/bladder disturbance, confusion,
seizures, LOC, fever, weight loss, night sweats
Clinical
presentation
Weakness
Arms/legs
Proximal/distal
Stable/progressive
Associated
symptoms
Sensory change?
Muscle pain/tenderness?
Neuromuscular failure (SOB)?
Weak swallow (dysphagia)?
Ocular symptoms (blurred/double vision)?
Bladder/bowel involvement?
Management
Initial ABCDE
Especially breathing
Definitive
Per cause
Definition
Rapid onset reduced
power in one or more
muscle groups