Weakness Flashcards
Which of the following is NOT on the differential for BILATERAL muscle weakness? A. Guillain-Barre Syndrome B. Bells Palsy C. Lyme disease D. Myositis
B. Bells Palsy presents asymmetrically
Also asymmetric:
Stroke, nerve compression, trauma
Also bilateral:
Heavy metal, myasthenia
Botulism, diptheria, tetanus, heavy metal, Guillain Barre Syndrome present with (bilateral/asymmetric) (distal/proximal) weakness.
Bilateral distal
Myasthenia, polymyositis present with (bilateral/asymmetric) (distal/proximal) weakness.
Bilateral proximal
Stroke, CNS tumor with (bilateral/asymmetric) (UMN signs/LMN signs) weakness.
Asymmetric, UMN signs
Trauma, nerve compression presents with (bilateral/asymmetric) weakness.
asymmetric
MS presents with (bilateral/asymmetric) weakness.
asymmetric
T/F: Labs are highly telling of the etiology of weakness.
False. Labs aren’t very helpful.
Diagnose this!
72 female, right sided weakness both upper and lower extremities, left side moves normally, some left facial droop, weakness bad in morning has been improving, HTN, diabetes, high cholesterol, non-smoker
Exam: Left side facial weakness, CN intact, Reflexes (brisk in right side and normal on left side), sensory intact
ASSESSMENT: Focal, Asymmetric, UMN (brisk reflexes)
DX: Stroke
Diagnose this!
35 male, “feels weak all over” getting worse, numbness in both feet a few days ago, numb in hands and feet now, sharp electrical pains, can’t walk or lift legs. ASCENDING PARALYSIS
Exam: CN intact, Motor VERY weak in both lower and upper extremities 1/5), sensory loss in distal extremities, no reflexes, can’t assess gait/balance
ASSESSMENT: Started focal but now more generalized, Bilateral, LMN
DX: Guillain-Barre Syndrome
Diagnose this!
22 female, gradually increasing weakness over 2 weeks, feels ok when waking up in the morning but then is exhausted at end of day, last 2 days noted drooping eyelids and diplopia, trouble swallowing, mother has lupus. DESCENDING PARALYSIS
Exam: CN bilateral ptosis, can’t maintain upward gaze, Motor upper extremities 3/5 strength worse on repeated testing, proximal muscle groups more affected, reflexes are weak
ASSESSMENT: Focal, Bilateral, LMN with CN involvement
DX: Myasthenia Gravis
Descending paralysis is characteristic of ____
Myasthenia gravis
Ascending paralysis is characteristic of ____
Guillain-Barre Syndrome
Diagnose this!
68 male, 2 months low back pain, pain radiates down back of right leg, can’t lift right foot, urinary incontinence on/off for last 3 days, prostate cancer
Exam: CN intact, Motor weak right lower extremity (1/5) especially in ankle, Sensory decreased throughout perineum, Reflexes brisk on right side, Gait shows right foot drop, decreased rectal tone (saddle anesthesia)
ASSESSMENT: Focal, Asymmetric (mostly in RL), UMN (brisk reflexes)
DX: Herniated Lumbar Disk (pain radiating down one leg)
AND
Cauda-Equina Syndrome (incontinence, saddle anesthesia)
Diagnose this!
37 female, weakness in right leg and left hand, started in numbness in right thigh but now resolved, now has trouble lifting right leg for past week, keeps dropping keys
Exam: CN intact, Motor right lower extremity 3/5 at hip, unable to maintain finger grasp, Sensory decreased along left calf, Gait limp due to weakness on right leg but can stand
ASSESSMENT: Focal, Asymmetric, LMN (reflexes are normal)
DX: Multiple Sclerosis
Small diffuse plaques of white matter on MRI is characteristic of ____
Multiple Sclerosis
Diagnosis of exclusion, a psychiatric disorder, presents with neural complaint, patient senses dysfunction but its not there, they genuinely feel that something is wrong, when stress goes away, neural discomfort goes away =
Conversion disorder
Faking, trying to get something out of it, meds, they know they have a fake disease =
Malingering
Diagnose this!
83 male with difficulty walking progressively worse in last 2 months, difficulty alternating movements on right side, ataxia, mild weakness in right arm and leg.
Cerebellum mass
Diagnose this!
58 male with peripheral symmetric weakness, works at lead mine
Sensory exam will show stocking/glove neuropathy
Heavy metal?
Diagnose this!
35 female with joint pains and facial weakness, shooting back pains, face is “stuck” and can’t smile or raise eyebrows, went camping in Wisconsin 4 months ago
Lyme Disease
WISCONSIN!
Diagnose this!
45 male alcoholic, experienced loss of parent and other relative in the same week, last two days unable to stand, falls to right on gait exam, strength in all extremities normal, MRI is normal
Conversion Disorder, Folate Deficiency, Malingering
UMN or LMN?
Brisk reflex
UMN
UMN or LMN?
Weak reflex
LMN
