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NEUROMUSCULAR DISEASE (PERIPHERAL NERVE / ROOT (VASCULITIS (EXCLUTION…
NEUROMUSCULAR DISEASE
PERIPHERAL NERVE / ROOT
GULLAIN-BARRE
Weakness
symmetrical
lower limbs
Proximal
unable to stand or walk
ophthalmoparesis
proprioception
acutely
day to weeks
CN
Facial droop
Diplopias
Dysarthria
Dysphagia
Ophthalmoplegia
Pupillary disturbances
MULTIFOCAL MOTOR NEUROPATHY
slowly progressive
Weakness
without sensory loss
2 or more nerves
conduction block
IgM anti-GM1
CSF PROTEIN INCR.
EXCLUSION CRITERIA
UMN
spasticity
clonus
bulbar
Sensory
MORE THEN VIBRATION LOSS
DIFFUSE SYMMETRIC WEAKNESS
PORPHYRIA
Abdominal pain
CNS
Seizures
Delirium
Cortical blindness
Coma
vomiting
hypertension
tachycardia
motor neuropathies
mimic GBS
VASCULITIS
Asymmetric
multifocal painful sensorimotor
8 ± 11 mo
weight loss
anorexia
fatigue
arthralgias- PAIN IN JOINT
myalgias- MUSLE PAIN
LEGS>ARMS
DISTAL>PROXIMAL
proximal symmetric
CN3-RARE
Peroneal nerve
foot dorsiflexion
foot drop
slapping gait
Sensory
Burning dysesthetic pain
Hyporeflexia / areflexia
asymmetric
EXCLUTION
Acute onset of symmetric motor weakness
Sharp sensory level
Bowel and bladder dysfunction
Spontaneous remission
Polyneuropathy
Axonal
Distal muscle wasting
Distal sensory loss
sensory symptoms > motor symptoms
Demyelinating
CHRONIC
motor symptoms = sensory symptoms
ACUTE
motor symptoms > sensory symptoms
muscle weakness
distal > proximal
Distal sensory loss
vibration / proprioception > pain / temperature
Diffusely
Diabetic
sensory loss
DISTAL
SYMMETRIC
CN
CN3
CN4
CLINICAL FEATURES
↓ fine touch
↓ VIBRATION
PAIN
PINS & NEEDLES
AROPHY
ATAXIA
PARESIS
↓ Deep tendon reflexes
SENSORY LOST
ALCOHOLIC
↓ perception
DISTAL
SYMMETRIC
ATROPHY
PARESIS
HEAVY METAL
Nausea
persistent vomiting
diarrhea
abdominal pain
Encephalopathy
cardiomyopathy
dysrhythmias
ATN
metabolic acidosis
Link Title
HIV
paresthesias
numbness
pain
Allodynia
weakness
LEGS / HANDS
DIPHTHERIA
acute demyelinating polyneuropathy
EARLY
weakness in bulbar
middle
weakness in trunk
late
weakness in extremities
2 to 6 weeks
LYME DISEASE
7–14 days
Erythema chronicum migrans
warm
painless
3–10 weeks
joint pain
from one joint to another
large joints
CN palsy
facial nerve palsy
radicular pain
paresthesia
paresis
PARAPROTEINEMIA
SODIUM IMBALANCE
MILD
Nausea
Vomiting
Headache
Muscle cramps
MODERATE
Muscle weakness
Lethargy
Confusion
SEVERE
Seizures
Altered consciousness
Coma
PARANEOPLASTIC
MUSCLE
INFLAMMATORY MYOPATHIES
DERMATOMYOSITIS
5-10 / >50 YEARS
Proximal and symmetrical muscle weakness
Weakness progresses (W. TO M.)
heliotrope rash
Gottron's papules
POLYMYOSITIS
20 YEARS
Proximal and symmetrical muscle weakness
Weakness progresses (W. TO M.)
NO SKIN
Inclusion-body myositis
50 YEARS
Proximal and distal
ASYMMETRICAL
WEAKNESS PROGRESSES (YEARS)
ACID MALTASE DEFICIENCY
Pompe Disease
Infantile-onset
muscle weaknes
hypotonia
motor delay
Late-onset
delayed motor milestones
muscle weakness
hypotonia
Intelligence is normal
adult-onset
proximal muscle weakness
orthopnea
somnolence
headaches
Diminished deep tendon reflexes
MITOCHONDRIAL MYOPATHIES
paralysis of extraocular muscles
ptosis
muscle weakness
exertion
CPEO
progressive ophthalmoplegia
LACTAT (SERUM, CSF)
Kearns-Sayre
ophthalmoplegia
Retinitis pigmentosa
impaired electrical activity of the heart
MELAS
muscle weakness
tonic-clonic
dementia
STROKES
MERRF
myoclonic jerks
generalized seizures
cerebellar ataxia
dementia
MYOTONIC DYSTROPHY
MUSCLE PAIN
ARRHYTHMIAS
CATARACTS
INFERTILITY
Frontal balding
TYPE 1
distal muscles
Myopathic facies
TYPE 2
proximal muscles
PERIODIC PARALYSIS
hyperkalemic
Proximal
myotonic lid lag
triggers
fasting
rest
K+
onset: <10
hypokalemic
before age 16 years
morning
exercise
carbohydrate meal
predominantly legs
Urinary output dec.
Thyrotoxic
20-40 years
Hyperinsulinemia
carbohydrate
last hours to days
NMJ
MYASTHENIA GRAVIS
triggers
increased muscle use
Medications
Stress
Infection
Pregnancy
Eye
Ptosis
Diplopia
Blurred vision
Bulbar
dysphonia
disarthria
disphagia
Proximal limbs
Rising from a chair
Climbing stairs
Brushing hair
LAMBERT-EATON SYNDROME
progress slowly
weakness
Proximal muscles
ptosis
diplopia
dysphagia
dysarthria
Autonomic
Constipation
urinary retention
sweating
OH
dry mouth/ eye/ skin
miosis
cachexia
improve after exercise
Reduced or absent reflexes
BOTULISM
CN
blurred vision
diplopia
ptosis
extraocular muscle weakness
fixed/dilated pupils
dysarthria
dysphagia
gag reflex
Respiratory
weakness to respiratory failure
autonomic
constipation
Gastric dilatation
urinary retention
OH
salivation ↓
↓ lacrimation
TICK PARALYSIS
2–7 days
LMN lesion
Muscle appearance
Atrophied
Fasciculations
Peripheral paresis
↓ Tone
↓ Power in single muscle fibers
↓ reflexes/areflexia
bladder
Overflow incontinence
No fever or rash
ORGANOPHOSPHATE TOXICITY
Muscarinic
Cardiovascular
Bradycardia
hypotension
Respiratory
Rhinorrhea
bronchorrhea
bronchospasm
cough
severe respiratory distress
Gastrointestinal
Hypersalivation
nausea / vomiting
abdominal pain
diarrhea
incontinence
Genitourinary
Incontinence
Ocular
Blurred vision
miosis
Glands
diaphoresis
lacrimation
Nicotinic
muscle
cramping
weakness
diaphragmatic failure
muscle fasciculations
Autonomic
hypertension
tachycardia
mydriasis
pallor
CNS
Anxiety
Emotional lability
Restlessness
Confusion
Ataxia
Tremors
Seizures
Coma
Apnea
CENTRAL NERVOUS SYSTEM
ACUTE MYELOPATHY
pain
Neck
shoulder
up. limb
low. limb
LMN symptoms
at the level of lesion
UMN symptoms
below the level of lesion
sensation
numbness
ataxia
proprioception ↓
MS
Classic
Sensory loss
paresthesias
Spinal cord
motor
cramping
autonomic
Bladder
bowel
sexual dysfunction
Cerebellar
Charcot triad
dysarthria
nystagmus
intention tremor
Optic neuritis
loss of vision / color vision
pain on movement
Trigeminal neuralgia
Facial myokymia
diplopia
Heat intolerance
dizziness
fatigue
Depression
Aphasia
Seizures
paroxysmal symptoms
ataxia
akinesia
paresthesias
pruritus
Syringomyelia
etiology
Chiari malformation
Posttraumatic SCI
Postinflammatory
Postinfectious
tumors
Intramedullary
clinical features
pain and temperature ↓
Fluctuating radicular pain
Muscle atrophy
fasciculations
areflexia
Spastic paraparesis
low. limb
Autonomic
Horner's synd.
anhydrosis
disturbances
bowel
bladder
erection ↓
Respiratory insufficiency
Syringobulbia
Tongue atrophy
CN5
pain and temperature ↓
Nystagmus
Dysphagia
Palatal and pharyngeal weaknes
ANTERIOR HORN
ALS
LMN
↓Muscle tone
flaccid
↓Tendon reflexes
Early atrophy
Fasciculations
cramps
UMN
Muscle tone ↑
spasticity
↑Tendon reflexes
Late atrophy
Babinski's sign
limb weakness
Asymmetric
Bulbar
dysarthria
dysphagia
LATE SYMPTOMS
Cognitive
Autonomic
constipation
Respiratory failure
POLIOMYELIRTIS
Nonparalytic
Fever
neck stiffness
headache
vomiting
muscle pain
head drop sign
Paralytic
Fever
back, neck, and muscle pain
severe
Flaccid paralysis
proximal muscles
deep tendon reflexes ↓
muscle weakness
asymmetrical