Acute and chronic weakness

Question 1

What are the signs of an UMN problem?

Answer 1

Hypertonia
Hyperreflexia
Upgoing plantars
Clonus

Question 2

What are the signs of a LMN problem?

Answer 2

Hypotonia
Hyporeflexia
Wasting
Fasciclations

Question 3

What are the signs seen with an anterior horn cell problem?

Answer 3

Mixed upper and lower motor neurone signs

Mainly faciculations

Question 4

What are some of the causes of an anterior horn cell problem?

Answer 4

Polio or motor neurone disease

Question 5

What are the signs seen with a nerve root problem?

Answer 5

Loss of sensation and pain in the nerve root distribution

Question 6

What causes problems with a nerve root?

Answer 6

Commonly is a radiculopathy which means compression of the nerve. This can be from disc prolapse

Question 7

What are the signs of a nerve problem?

Answer 7

DISTAL neuropathy (weakness, numbness, pain)

Question 8

What are some causes of a nerve problem?

Answer 8

Diabetes, B12 deficiency due to drug or alcohol misuse

Question 9

What are the signs of a NMJ problem?

Answer 9

Fatiguable weakness, proximal (hips and shoulders)

Question 10

What are the causes of a NMJ problem?

Answer 10

Myasthenia gravis and Lambert Eaton Myesthenia

Question 11

What are the signs of a myopathy?

Answer 11

PROXIMAL myopathy

Question 12

What are the causes of myopathy?

Answer 12

Hypothyroidism, steroids and statins

Question 13

What will be the signs of cauda equina syndrome?

Answer 13

This is compression of the cauda equina so will cause combined upper and lower motor neurone signs

Question 14

What is syringomyelia and what signs does it have?

Answer 14

Typically caused by blocked CSF this causes formation of a slit like cavity in the cervical cord. This causes sensory loss and arm weakness

Question 15

What is the pathophysiology behind myesthenia gravis?

Answer 15

There is autoimmune attack of the AChR and the muscarinic receptors, this stops the neuromusclar junction from working.

Question 16

What are the investigations and treatment for myesthenia gravis?

Answer 16

Can look for anti-AchR antibodies
EMG - looks at muscle response to repetitive stimulation
CT imaging
Treatment:
-pyridostigmine - a cholinesterase inhibitor
-immunosupression - methotrexate, azathioprine

Question 17

What is gullian barre and how does it present?

Answer 17

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.

Question 18

How is gullian barre diagnosed and treated?

Answer 18

Slightly raised protein in CSF, nerve conduction slows later in condition
Treatment is with plasma exchage and resp function should be monitored

Question 19

How does chronic weakness tend to present?

Answer 19

With upper motor neurone signs

Question 20

What is charcot-marie-tooth?

Answer 20

Hereditary peripheral neuropathy

Question 21

What are the main causes of peripheral neuropathy?

Answer 21

• Metabolic e.g. B12 deficiency, uraemia
• Endocrine e.g. hypothyroidism
• Toxic e.g. alcohol, drugs
• Inflammatory e.g. Gullain-Barre, sarcoidosis, vasculitis
• Neoplastic
• Infective