Module 4: Weakness 3

Question 0

Subacute hemiparesis – localization? Etiologies? Work up?

Answer 0

UMN

#subdural hematoma
#abscess
#Neoplasm
#Demyelinating lesion

Brain imaging, C-spine imaging

Question 1

Acute hemiparesis – localization? Etiologies? Work up?

Answer 1

UMN (brainstem contralateral, cervical spine if ipsilateral)

CVA, hemorrhage into tumor

Brain imaging

Question 2

Chronic hemiparesis – localization? Etiologies? Work up?

Answer 2

UMN

#Subdural hematoma
#benign neoplasm

Brain imaging and C-spine imaging

Question 3

Acute paraparesis – localizations?

Answer 3

UMN (will have sensory level)
Vs LMN (cauda equina syndrome)

Question 4

Acute paraparesis localized to UMN – etiologies? Work up?

Answer 4

#Spinal trauma
#Epidural hematoma/metastasis/abscess
#Transverse myelitis
#ACA infarcts
#Sagittal sinus thrombosis
#acute hydrocephalus

MRI of the thoracic spine or brain

Question 5

Subacute/chronic paraparesis localized to the UMN – etiologies? Work up?

Answer 5

#B12 deficiency
#Interspinal tumor
#Slow compression by degenerative disc disease
#MS
#tabes dorsalis

MRI of spine, B12, RPR

Question 6

Acute paraparesis localized to the LMN – Etiologies? Work up?

Answer 6

#Lumbar disc herniation
#Lumbar epidural metastasis

MRI of lumbosacral spine

Question 7

Acute quadriparesis localized to UMN – etiologies? Work up?

Answer 7

#Cervical spine compression due to tumors/abscess/hematoma
#Basilar artery occlusion
#global anoxic injury

#Intubation if respiratory paralysis
#If comatose, head CT
#If awake, MRI

Question 8

Chronic quadriparesis localized to UMN – etiologies? Work up?

Answer 8

#Meningioma with cord compression
#B12 deficiency
#tabes dorsalis

MRI of brain/C-spine
#B 12
#RPR

Question 9

Acute/subacute quadriparesis localized to LMN – etiologies? Work up?

Answer 9

GBS

#EMG/NCS
#LT

Question 10

Chronic quadriparesis localized to LMN – etiologies? Work up?

Answer 10

ALS

EMG

Question 11

Acute quadriparesis localized to muscle – etiologies? Work up?

Answer 11

Periodic paralysis (Myoplegia paroxysmalis familiaris - genetic disorder)

Serum potassium

Question 12

Subacute quadriparesis due to muscle disease – etiologies? Work up?

Answer 12

#Critical illness myopathy
#Statins

#CPK
#EMG
#Biopsy

Question 13

Acute monoparesis localized to UMN – etiologies? Work up?

Answer 13

Small distal cortical infarct

MRI

Question 14

Acute monoparesis localized to LMN – etiologies? Work up?

Answer 14

#Diabetic 
#Vasculitic – polyarthritis, Wegner's 

#EMG/NCS
#Hemoglobin A1c
#pANCA and cANCA
#ESR

Question 15

Subacute monoparesis localized to LMN – etiologies? Work up?

Answer 15

#Myeloma
#Amyloidosis
#Leprosy
#Acute causes of monoparesis (diabetes, polyarteritis, Wegener's)

SPEP
serum light chains
EMG/NCS
Hemoglobin A1c
pANCA, cANCA

Question 16

Acute/subacute weakness in the hands and feet – etiologies? Work up?

Answer 16

#GBS
#Chemotherapy
#Isoniazid

EMG/NCS

Question 17

Chronic weakness in the hands and feet – etiologies? Work up?

Answer 17

#Diabetes
#Alcoholism
#Hereditary neuropathy (Charcot Marie Tooth)
#Uremia

EMG/NCS

Question 18

Subacute/chronic weakness in the shoulders and hips – etiologies? Work up?

Answer 18

#Muscular dystrophy
#Myotonic dystrophy
#Polymyositis/dermatomyositis/inclusion body myositis
#Endocrine myopathies

CPK
EMG
Muscle biopsy