Muscle Weakness Flashcards
A 23-year-old female presents with insidious onset of weakness in her left arm. She had diplopia in the past which has since resolved. On examination, there is scanning speech, nystagmus and an intention tremor. MRI of her brain and spinal cord show patchy periventricular plaques. The CSF is positive for oligoclonal bands.
Multiple Sclerosis
A 65-year-old male presents with recent difficulty in walking and pain radiating into the back of his right leg. He also complains of urinary retention and has a history of prostate cancer. On examination, there is saddle anesthesia and an absent right ankle jerk. CT scan shows a large intrathecal mass in the lumbar canal.
Cauda equina syndrome secondary to spinal metastasis
A 58-year-old male presents with sudden onset of one-sided facial weakness. He also has ipsilateral hyperacusis. On examination, there is a lower motor neuron lesion of his left CN VII. Muscle strength and DTRs in the extremities are normal. EMG and NCV document a lesion in the left facial nerve.
Bell’s Palsy
A 48-year-old female presents with decreased grip in her left hand. She also has some difficulty in buttoning up her blouse with her left hand. On examination, there is a grade 3/5 grip between her thumb and index finger on the left side. The right side is normal. There is no sensory loss. Tinel and Phalen tests are negative. MRI shows a posterolateral disc bulge compressing the spinal cord at C5/6.
Cervical myelopathy secondary to disc herniation
A 2-month old infant presents with paralysis of the left upper limb. The mother had a difficult labor because of shoulder dystocia. On examination, the left upper limb is held with the arm internally rotated, the elbow extended and the forearm pronated. No tests were done.
Erb’s Palsy
A 51-year-old female vegan presents with numbness and muscle weakness. She had gastric bypass surgery 6 years ago. On examination, there is loss of proprioception and vibration sense. Pain and temperature sensation is intact, but fine touch is decreased. There is muscle weakness and hyporeflexia mainly in the lower limbs. CBC shows a microcytic normochromic anemia. There are numerous hypersegmented neutrophils. A decrease in the level of methylmalonic acid value is noted.
Subacute combined degeneration of the spine
An overweight 76-year-old male hypertensive smoker presents with sudden paralysis of his entire right side. There is also aphasia. On examination, there is hyperreflexia on the right side. He cannot smile on the same side. However, he could wrinkle his forehead on both sides. Babinski and Hoffman signs are present on the right side. CT scan shows a large intraparietal cerebral hemorrhage.
CVA
