Neurolocalisation

Question 1

Geographical patterns of weakness

Answer 1

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Question 2

Flaccid paraparesis

Answer 2

Without sensory pattern of pinprick loss
> Proximal weakness
- NMJ
- muscle
(Exception distal weakness: myotonic dystrophy, distal myopathy)
(Mixed - inclusion body myositis)

> Distal weakness
- peripheral nerve
(Exception for more proximal weakness - AIDP, CIDP)
- anterior horn cell
(Exception for more proximal weakness: Kennedy, spinal muscular atrophy)

With sensory level pattern of pinprick loss
- Conus medullaries (mixed pattern UMN and LMN)
- Cauda equina

Spinal bifida - flaccid paraparesis, bilateral wasting, scar at the spinal area, urinary catheter

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Question 3

Spastic paraparesis

Answer 3

Without sensory loss
- Hereditary spastic paraparesis
- Cerebral palsy
- Primary lateral sclerosis
- Friedreich’s ataxia (so far no cases in Singhealth cluster as of 2024)

With sensory loss
- Cerebrum - parasagittal abnormalities
- Brainstem
- Spinal cord