APPROACH TO THE PATIENT WITH NEUROLOGICAL SYMPTOMS: MUSCLE WEAKNESS AND HEADACHE Flashcards
Two important questions to answer in neurological evaluation
Where is the lesion
What is causing the lesion
Muscle weakness VS fatigue VS asthenia
An inability to carry out a desired movement (at first repetition) with normal force because of a reduction in strength of the muscles necessary to carry out the movement
inability to continue performing a task after multiple repetitions; lack of energy
a sense of weariness or exhaustion in the absence of muscle weakness
The evaluation of the patient presenting with a complaint of “WEAKNESS” involves three steps:
_______________________________
_________________________________
_________________________________
Distinguishing true muscle weakness from lassitude or motor impairment not due to loss of muscle power.
Localizing the site of the lesion that is producing weakness.
Determining the possible aetiology (cause) of the lesion
Localizing the lesion
It could be in the :
Mention 7
Muscles
NMJ
peripheral nerves
Motor cortex
Anterior horn
Spinal nerve root
Corticospinal tracts
Localization of muscle weakness
_________- upper motor neuron
_________- lower motor neuron
__________ - neuromuscular junction
Brian
Spain cord
Muscle and nerve junction
Patterns of muscle weakness
Plegia: ___________
Paresis: _______ ,_________
complete paralysis
reduction of power, incomplete paralysis
Patterns of muscle weakness
The paresis or plegia can be :
- ___________
– Restricted to _______ or _______
– Restricted to a _________
Generalized
specific muscle or nerve
body region
Patterns of muscle weakness
The paresis or plegia can be Restricted to a body region. The following terms are used: ______,______,_______,_______
Mono
Hemi
Para
Quadri
Muscle weakness is being Unable to ___________ even at ___________
Not ___________
Not ___________
Not ___________
Not ___________ restricting movement
Not ‘___________’
perform movements ; first attempt
Not fatigue
Not asthenia
Not stiffness (or rigidity)
Not pain restricting movement
Not ‘apraxia’
Taking history of muscle weakness
Clarify what patient means by ‘weakness’
Determine the __________ of the muscle weakness
Determine the _______
Determine the ____________
Explore possible ____________
spatial distribution
associated symptoms
temporal characteristics
aetiologies
Temporal characteristics of muscle weakness
- ___________
– ___________ (neuromuscular junction)
– ___________ (NMJ)
– Tempo of ___________ and ___________
Persistent
– Fluctuating (neuromuscular junction)
– Fatigability (NMJ)
– Tempo of onset and progression:
Associated symptoms of muscle weakness
Other neurological symptoms
———- symptoms and distribution
_________ symptoms and distribution
____________ symptoms and distribution
Other systemic symptoms
_________,_________,__________ complaints
Other co-morbidities or systemic illness
Endocrine (______,________ , metabolic disorders) Vascular risk factors
Infections (on going or preceding)
Motor; Sensory; autonomic
Rheumatologic , dermatologic, endocrine
DM, thyroid disorders
In the patient with suspected myopathy, muscle tenderness suggests an _________ aetiology or a ________ myopathy such as _________ disease.
infectious
Metabolic
McArdle’s
In comparison, tenderness is an unusual finding in the idiopathic inflammatory myopathies such as __________ or __________
polymyositis or dermatomyositis.
Increased muscle tone or rigidity is present in _______ disease, a disorder in which weakness or decreased motor function may be an initial complaint.
Increased tone also occurs in ______ motor neuron lesions or in ________ diseases.
Parkinson
upper
demyelinating
Myotonia describes ________________ after ____________ and is typical of _____________.
abnormal lack of relaxation
muscle contraction
myotonic dystrophy
Myoedema is an unusual finding of localized “_____________” of the muscle where it has been ___________________
It is a sign of severe _______________ or ?
mounding-up
tapped by a reflex hammer.
hypothyroidism
MRC Grading of muscle power
Scale Muscle strength
0
1
2
3
4
5
No flicker of contraction
Flicker or trace of contraction
Active movement with gravity eliminated
Active movement against gravity
Active movement against gravity and with resistance
Normal power
CLINICAL INVESTIGATIONS
Laboratory studies
Chemistry and urinalysis – Elevations of plasma muscle enzymes ( ________,________,__________ , and the ____________ ) are highly suggestive of muscle diseases.
Elevated in motor neuron disease or can be induced by strenuous exercise, intramuscular injections, or muscle trauma in the absence of generalized muscle disease.
A positive test for urine blood, in the absence of red blood cells in the sediment, is suggestive of _________
creatine kinase, aldolase, lactate dehydrogenase
Aminotransferases
myoglobinuria
CLINICAL INVESTIGATIONS Electrophysiologic studies —
____________ and ___________ studies are used when the site of the lesion causing weakness is suspected to be in the __________ nervous system, the ___________, or the __________.
Nerve conduction and electromyographic (EMG)
peripheral ; neuromuscular junction; muscle itself
The EMG is also of value in directing the site of muscle biopsy
T/F
T
Magnetic resonance imaging (MRI) may be useful in selecting a muscle for biopsy.
T/F
T
Magnetic resonance imaging (MRI)
Has an advantage over EMG in cases of suspected _______________ in that the actual muscle to be biopsied can be identified,.
inflammatory myopathy
Probable Aetiology of headaches
Idiopathic (primary) headaches
Most common are _______,______,_______ headache
Recognizable by the core headache characteristics
Diagnosed when the characteristic HA is not attributable to any other condition
tension-type, migraine, cluster
Probable Aetiology of Headaches
Secondary
Characterized by the presence of additional features that point to a plausible cause for the HA
Includes intracranial, extracranial (systemic) causes of diverse.
Some secondary HA connote serious cause not to be missed
Okay🌚
________________ Headaches
Most common form of headache
Tension-Type
Tension-Type Headaches (TTH)
Features: HA lasts ___________-___________
30 minutes –7 days
Tension-Type Headaches (TTH)
At least 2 of these features:
____lateral location
___________ or ___________ (___________) quality
______ or _________ intensity (may inhibit but not prohibit activity)
Not aggravated by ____________________
Has both of these features:
no ___________ or ___________
not > one of either ___________ or ___________
Bilateral
Pressing or tightening (non-pulsating)
Mild or moderate
routine physical activity
nausea or vomiting
photophobia or phonophobia
Migraine Headaches: Diagnostic Criteria
5
4
3
2 of the following : ____lateral; _______ quality; ______ or ——— intensity ; aggravated by __________
1 of the following: ______ or ________ ; ______ or ______
5 episodes
4hrs to 3days duration
Uni; pulsating; moderate or severe; routin physical activity
Nausea or vomiting
Photophobia or phonophobia
___________ headaches may have an aura, last for ————, develop ________, and is completely (reversible or irreversible?)
May have an aura
Migraine
last no longer than 60 minutes
gradually
completely reversible
Migraine headaches has (male or female?) Preponderance
Female Preponderance
Simple, Accurate, Fast screener for migraine headaches
PIN diagnosis
Photophobia
Inability for a day or more in the last 3 month
Nausea
Cluster Headaches
Features: at least ___ episodes of headaches
Intensity: ________ or _________
Location: _______,______,_______ or ______
Duration: lasting ______ to ________ if untreated
–
5
Severe or very severe
unilateral, orbital, supraorbital, temporal pain
lasting 15 to 180 minutes
Indications of Secondary Headaches
Mnemonic: SNOOP4 red flags
Systemic Illness
Neurologic
Onset that is sudden
Onset after age 40
Progressive
Postural
Precipitation by valsalva or exertion
Previous headache history with new or different features
Investigations for headaches
___________
_____________
Further investigations dictated by suspected Aetiology
Neuroimaging
Lumbar puncture
