Patterns of Weakness

Question 1

Bilateral Lower Extremities

Answer 1

GBS (dec reflexes + autonomic dysfunction)

Cauda equina (bowel and bladder anesthesia)

Anterior Cord Compression (dec motor, pain, light touch and temp sensation)

Question 2

Bilateral Upper Extremities

Answer 2

Central cord syndrome

Syringomyelia (fluid in SC cavity, associated w/ Chiari malformation)

Question 3

All 4 Extremities w/o Facial Involvement

Answer 3

Cervical SC injury (no brainstem, but no motor below level)

Question 4

Proximal Extremities

Answer 4

Rhabdo (tea-colored urine)

Polymyositis

Dermatomyositis (Gottron’s papules, heliotrope rash, shawl sign)

Question 5

Distal Extremities

Answer 5

GBS

peripheral neuropathy

Question 6

Unilateral Extremities + Ipsilateral Face

Answer 6

Stroke or pathology in contralateral cortex

Question 7

Unilateral Extremities + Contralateral Face

Answer 7

Stroke or injury in BRAINSTEM (check cranial nerves)

Question 8

Unilateral Extremities + no Facial Involvement

Answer 8

Brown-Sequard (SC hemisection) - lose ipsilateral motor/vibration/proprioception and contralateral pain and temp sensation

Internal Capsule (pure motor) stroke

Question 9

Single Limb

Answer 9

SC or peripheral nerve lesion

Question 10

Unilateral Facial Droop

Answer 10

Bell’s palsy (peripheral lesion - whole face involved)

Central facial nerve palsy (forehead spared)

Mastoiditis or parotitis

Lyme (facial palsy)

Question 11

Non- CN VII Facial Weakness

Answer 11

brainstem lesion

NMJ problem (myasthenia)

Miller-Fischer variant of GBS