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Acute Hemiparesis (Main presenting symptom (72yo male; acute onset R…

- - - - Upper motor neuron lesions
        
        PE findings: Spastic tone, hyper-reflexive, +clonus, +babinski sign
        
        Either found in
        
        more likely
        
        Brain/Brainstem
        
        Location
        
        Brainstem
        
        2 more items...
        
        Brain
        
        2 more items...
        
        Etiologies
        
        assoc w raised intracranial pressure
        
        2 more items...
        
        Stroke
        
        3 more items...
        
        Infections
        
        2 more items...
        
        Spinal cord
        
        Usually bilateral symptoms w bowel/bladder sphincter involvement
        
        Etiologies
        
        Brown-sequard syndrome: usually due to trauma (stab wound)
      - less likely
        
        Lower motor neuron lesions
        
        If sensation is:
        
        Normal
        
        Myopathy
        
        Autoimmune
        
        1 more item...
        
        Muscular dystrophies
        
        NMJ defect (presents w episodic weakness)
        
        Myasthenia gravis
        
        Assoc w small cell lung carcinoma
        
        1 more item...
        
        Motor neuron disease
        
        ALS
        
        Abnormal
        
        Peripheral polyneuropathy: often symmetrical
        
        Diabetic Neuropathy
        
        Guillain-Barre syndrome: ascending weakness, may involve respiratory muscles + cranial nerves
        
        Radiculopathy: often painful; e.g prolapsed IV disc
        
        Plexus lesion: Erb's palsy (C5/6 lesion, waiter's tip), Klumpke's palsy (C8/T1 lesion, claw hand)
        
        PE findings: muscle atrophy, hyporeflexive, +/-fasciculations, flaccid tone, -clonus, -babinski sign
    - - Hemiplegic migraine
      - Todd's paresis - hx: seizures
- - - - hypoglycemia
      - electrolyte imbalance
      - Hypothyroidism
    - - Botulism
      - Organophosphate poisoning
      - Alcohol abuse
      - Illicit drug abuse
    - - Psychiatric
        
        Conversion disorder