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Weakness and Sensory Loss - Coggle Diagram
Weakness and Sensory Loss
Pure Motor Presentation
Motor neuron disease
Myasthenia gravis
Pure Sensory Presentation
Sensory neuropathy
Localisation
Gross level of Lesion
CENTRAL
Upper motor neuron lesion
PERIPHERAL
Lower Motor Neuron lesion LMN
Distribution of the syndrome
Cranial only
Hemiparesis
Paraparesis
Single muscle group (peripheral nerve)
Single nerve root distribution
UML vs LML
UMN
Muscle bulk: Normal
Spontaneous activity: No
Tone ↑ Clonus (spasticity(
Power : ↓
Relflexes: Brisk
Plantar response: Up
LML
Muscle bulk: Wasting
Spontaneous activity : Fasiculations
Tone: Normal or ↓
Power: ↓
Reflexes: Depressed / abscent
Plantar responses: Down
Localising Lesions / Weakness
Brain Lesion
Examples
MS
Tumour
Stroke
Presentation
Contralateral signs
Cortical signs (aphasia , hemianopia, inattention)
Deep (Internal capsule, motor and sensory loss)
Brainstem Lesion
Signs
Crossed signs
Mutlifocal cranial findings
Impaired alertness
Destructive lesion - bilateral signs
Spinal Cord Lesions
Signs
Symmetrical bilateral
Bladder / bowel disturbance
Sensory level
Nerve Root Lesion
Signs
Localised to dermatome, myotome, reflexes
Radicular (shooting) pain eg sciatica
Context - known OA spine
Plexus Lesion
Signs
Patchy / incomplete weakness and sensory loss
Pain (if infiltration)
Outside specific roots
Context: Cancer / radiotherapy
Peripheral nerve
Signs
Sensory loss in a particular nerve pattern
Weakness in particular nerve pattern
Example
Carpal tunnel syndrome
Neuromuscular Junction
Signs
Fatigable weakness
repetition
end of day
Muscle Weakness
Signs
Proximal
weakness
Myalgis, tenderness
CK
Types
Congenital / genetic
Aquired
Drugs
Autoimmune
Endocrine
Electrolytes
Infection
Neuropathy
Patterns of Neuropathy
Mononeuritis multiplex
Plexopathy
Peripheral neropathy
Length dependant
Mononeuropathy
Issue with some or all of te peripheral nerves
Features
Most are legnth dependant
Subtypes
Motor
Sensory
demyelinating
Axonal
Stoke Localisation
Large Artery Occulsions
ACA
Leg > Arm weakness
Dysphasia
MCA
Arm > Leg weakness
Dysphagia
Hemianopia
Inattention
PCA
Hemianopia
Possible alexia without agraphia syndrome
Small Vessel Occlusions - Lacunar Syndromes
Pure motor
Postrior limb internal Capsule
Pons
Pure sensory
Posterior limb internal capsule
Dysarthria - Clumbsy hand
Genu internal capsule
Sensory - motor
Thalamus / internal capsule
Pons / medulla
Ataxia hemiparesis
Pons
Internal capsule