Acute and chronic weakness Flashcards
What are the signs of an UMN problem?
Hypertonia
Hyperreflexia
Upgoing plantars
Clonus
What are the signs of a LMN problem?
Hypotonia
Hyporeflexia
Wasting
Fasciclations
What are the signs seen with an anterior horn cell problem?
Mixed upper and lower motor neurone signs
Mainly faciculations
What are some of the causes of an anterior horn cell problem?
Polio or motor neurone disease
What are the signs seen with a nerve root problem?
Loss of sensation and pain in the nerve root distribution
What causes problems with a nerve root?
Commonly is a radiculopathy which means compression of the nerve. This can be from disc prolapse
What are the signs of a nerve problem?
DISTAL neuropathy (weakness, numbness, pain)
What are some causes of a nerve problem?
Diabetes, B12 deficiency due to drug or alcohol misuse
What are the signs of a NMJ problem?
Fatiguable weakness, proximal (hips and shoulders)
What are the causes of a NMJ problem?
Myasthenia gravis and Lambert Eaton Myesthenia
What are the signs of a myopathy?
PROXIMAL myopathy
What are the causes of myopathy?
Hypothyroidism, steroids and statins
What will be the signs of cauda equina syndrome?
This is compression of the cauda equina so will cause combined upper and lower motor neurone signs
What is syringomyelia and what signs does it have?
Typically caused by blocked CSF this causes formation of a slit like cavity in the cervical cord. This causes sensory loss and arm weakness
What is the pathophysiology behind myesthenia gravis?
There is autoimmune attack of the AChR and the muscarinic receptors, this stops the neuromusclar junction from working.
What are the investigations and treatment for myesthenia gravis?
Can look for anti-AchR antibodies
EMG - looks at muscle response to repetitive stimulation
CT imaging
Treatment:
-pyridostigmine - a cholinesterase inhibitor
-immunosupression - methotrexate, azathioprine
What is gullian barre and how does it present?
It is an inflammatory polyradiculopathy, this results in ascending weakness. Most cases are preceded by campylobacter infection.
Proximal lower limb weakness and distal upper limb weakness.
How is gullian barre diagnosed and treated?
Slightly raised protein in CSF, nerve conduction slows later in condition
Treatment is with plasma exchage and resp function should be monitored
How does chronic weakness tend to present?
With upper motor neurone signs
What is charcot-marie-tooth?
Hereditary peripheral neuropathy
What are the main causes of peripheral neuropathy?
- Metabolic e.g. B12 deficiency, uraemia
- Endocrine e.g. hypothyroidism
- Toxic e.g. alcohol, drugs
- Inflammatory e.g. Gullain-Barre, sarcoidosis, vasculitis
- Neoplastic
- Infective
