Neuro exam differentials Flashcards
What are causes of unilateral UMN weakness?
Think brain to cord
- Intracranial - Stroke, SOL
- Brainstem - Stroke, SOL
- Spinal Cord - MS, Infarct/haemorrhage, SOL, Trauma, syringomyelia
What are intracranial causes of unilateral UMN weakness?
Hemisensory loss
- Stroke
- SOL
What are Brainstem causes of unilateral UMN weakness?
- Stroke
- SOL
What are spinal cord causes of unilateral UMN weakness?
Sensory level/segmental sensory loss
- MS
- Infarction/Haemorrhage
- Trauma
- SOL
- Syringomyelia
- Congenital
What are causes of bilateral UMN pyramidal weakness?
3 Ms
- MS
- MND
- Myelopathy
- Other
What are causes of myelopathy which can present with Bilateral UMN pyramidal weakness?
Often with sensory level
- Cord compression - SOL, Disc prolapse, paraspinal infection, cervical
- Trauma
- Transverse myelitis
- Syringomyelia
- Congenital
Besides MS, MND and myelopathy, what are other causes of Bilateral UMN pyramidal weakness?
- Brainstem stroke
- Hereditary spastic paraplegia
- CP
- HTLV-1
- Syphilis
What is important to remember in the acute setting for those with stroke or transverse myelitis in terms of clinical signs?
May initially have hypotonia and hyporeflexia
What are causes of radiculopathy?
- Disc herniation
- Degenerative disc disease
- Spondylosis/OA with osteophytes
What are causes of brachial plexopathy?
- Brachial neuritis
- Trauma
- Congenital - erb’s palsy, Klumpkes
- Thoracic outlet syndrome
- Neoplastic infiltration
- Radiotherapy
What are causes of lumbosacral plexopathy?
- Trauma
- Congenital
- Neoplastic infiltration
- Radiotherapy
What sensory loss may occur with a brachial/lumbosacral plexopathy?
Vast dermatomal sensory loss
What are causes of median nerve palsy?
- Carpal tunnel syndrome
- Distal radius fracture
- Penetrating forearm injury
- Pronator Teres syndrome
What are causes of carpal tunnel syndrome?
- Idiopathic
- Pregnancy
- Obesity
- Local pressure
- Hypothyroidism
- Acromegaly
- Diabetes
What are causes of ulnar nerve palsy?
- Compression at the elbow/cubital tunnel
- Fractures
- Cubital tunnel syndrome
What are causes of radial nerve palsy?
- Trauma/compression at axilla - e.g. crutches, saturday night palsy
- Humeral shaft fracture
- Elbow fracture
- Elbow ganglion
- Elbow dislocation
What are causes of axillary nerve palsy?
- Shoulder dislocation
- Surgical neck of humerus fracture
What are causes of bilateral LMN distal weakness with abnormal sensation distally (sensorimotor polyneuropathy)?
ABCDE
- Alcohol
- B12/thiamine deficiency
- Charcot-Marie-Toorh, Carcinomas (paraneoplastic)
- Diabetes, Drugs
- Every vasculitis + some infections
What drugs can cause bilateral LMN distal weakness with abnormal sensation distally (sensorimotor polyneuropathy)?
- TB drugs
- Metranidazole
- Nitrofurantoin
- Vincristine
- Cisplatin
- Amiodarone
What are infectious causes of bilateral LMN distal weakness with abnormal sensation distally (sensorimotor polyneuropathy)?
- Herpes zoster
- HIV
- Leprosy
- Syphilis
What are causes of bilateral LMN distal weakness with normal sensation distally (distal motor polyneuropathy)?
- Chronic inflammatory demyelinating polyneuropathy
- Myotonic dystrophy
- Inclusion body myositis
- Progressive muscular strophy
- Lead poisoning
- Porphyria
What are causes of acute flaccid paralysis?
- Guillain-Barre syndrome
- Rare infections - polio, rabies, west nile
- Cauda equina syndrome
- Acute transverse myelitis
What are groups of causes of proximal muscle weakness with normal sensation?
- Dystrophies - DMD, Becker’s, Limb girdle
- Endocrine - Cushing’s hypo/hyperthyroid, diabetic amyotrophy
- Neuromuscular - myasthenia, Lamert eaton syndrome
- Inflammatory - dermato-/polymyositis, inclusion body myositis
- Metabolic/congenital/mitochondrial
What are groups of causes of mononeuritis multiplex?
- Vasculitis
- Autoimmune
- Infections
- Others - DM, sarcoid, amyloidosis
