Weakness - Revision history

Danbot: Fix reference author name

2026-03-22T10:43:12Z

Fix reference author name

← Older revision		Revision as of 10:43, 22 March 2026
Line 1:		Line 1:
	==Background==		==Background==
	*Determine if patient has actual neuromuscular weakness (suggesting CNS dysfunction) or non-neuromuscular weakness.<ref>~~Hocker S~~. Muscle Weakness in Adults: Evaluation and Differential Diagnosis. Am Fam Physician. 2020;101(2):95-108. PMID 31939642</ref>		*Determine if patient has actual neuromuscular weakness (suggesting CNS dysfunction) or non-neuromuscular weakness.<ref>Larson ST, Wilbur J. Muscle Weakness in Adults: Evaluation and Differential Diagnosis. Am Fam Physician. 2020;101(2):95-108. PMID 31939642</ref>

	==Clinical Features==		==Clinical Features==

Danbot: Add verified PubMed reference (PMID 31939642)

2026-03-22T10:43:02Z

Add verified PubMed reference (PMID 31939642)

← Older revision		Revision as of 10:43, 22 March 2026
Line 1:		Line 1:
	==Background==		==Background==
	*Determine if patient has actual neuromuscular weakness (suggesting CNS dysfunction) or non-neuromuscular weakness.		*Determine if patient has actual neuromuscular weakness (suggesting CNS dysfunction) or non-neuromuscular weakness.<ref>Hocker S. Muscle Weakness in Adults: Evaluation and Differential Diagnosis. Am Fam Physician. 2020;101(2):95-108. PMID 31939642</ref>

	==Clinical Features==		==Clinical Features==

Danbot: Strip excess bold

2026-03-22T09:27:02Z

Strip excess bold

← Older revision		Revision as of 09:27, 22 March 2026
Line 4:		Line 4:
	==Clinical Features==		==Clinical Features==
	===History===		===History===
	*~~'''~~True motor weakness (neuromuscular weakness)? Bilateral or unilateral (distribution of weakness)?~~'''~~		*True motor weakness (neuromuscular weakness)? Bilateral or unilateral (distribution of weakness)?
	**Bilateral weakness:		**Bilateral weakness:
	***Symmetric ascending paralysis? [[Guillain-Barre Syndrome]]		***Symmetric ascending paralysis? [[Guillain-Barre Syndrome]]
Line 12:		Line 12:
	***Involvement of distal > proximal musculature? Neuropathy		***Involvement of distal > proximal musculature? Neuropathy
	**Unilateral weakness: [[CVA]], [[TIA]]		**Unilateral weakness: [[CVA]], [[TIA]]
	*~~'''~~If non-neuromuscular weakness~~'''~~ then BROAD differential, obtain:		*If non-neuromuscular weakness then BROAD differential, obtain:
	**[[ECG]], CBC, Chem10, [[LFTs]], blood cultures, [[UA]]/urine culture, drug levels, [[CXR]], Consider [[Head CT]] ([[focal deficit]], [[AMS\|altered]], history of cancer, [[anticoagulation]] with minor trauma)		**[[ECG]], CBC, Chem10, [[LFTs]], blood cultures, [[UA]]/urine culture, drug levels, [[CXR]], Consider [[Head CT]] ([[focal deficit]], [[AMS\|altered]], history of cancer, [[anticoagulation]] with minor trauma)
	*~~'''~~Onset of weakness sudden or gradual?~~'''~~		*Onset of weakness sudden or gradual?
	**Sudden suggests vaso-occlusive etiology [[CVA]]/[[TIA]]		**Sudden suggests vaso-occlusive etiology [[CVA]]/[[TIA]]
	**Gradual onset likely non-vascular		**Gradual onset likely non-vascular
	*~~'''~~Significant event surrounding onset of weakness?~~'''~~		*Significant event surrounding onset of weakness?
	**[[Seizure]] prior to weakness? Todd’s paralysis		**[[Seizure]] prior to weakness? Todd’s paralysis
	**Migraine headache? Complicated [[migraine]]		**Migraine headache? Complicated [[migraine]]
Line 23:		Line 23:
	**Trauma? Epidural or [[Subdural Hematoma]]		**Trauma? Epidural or [[Subdural Hematoma]]
	**Severe migratory neck or chest pain? [[vertebral and carotid artery dissection\|Arterial dissection syndromes]]		**Severe migratory neck or chest pain? [[vertebral and carotid artery dissection\|Arterial dissection syndromes]]
	*~~'''~~Temporal pattern to weakness? Fluctuating or fixed weakness?~~'''~~		*Temporal pattern to weakness? Fluctuating or fixed weakness?
	**Weakness with repetitive motions? Neuromuscular junction pathology like [[Myasthenia Gravis]]		**Weakness with repetitive motions? Neuromuscular junction pathology like [[Myasthenia Gravis]]
	*~~'''~~Associated symptoms?~~'''~~		*Associated symptoms?
	**[[Headache]]: [[SAH]], epidural/[[SDH]], complicated migraines (young females), not usually stroke/TIA (unless high intracranial pressure)		**[[Headache]]: [[SAH]], epidural/[[SDH]], complicated migraines (young females), not usually stroke/TIA (unless high intracranial pressure)
	**[[visual disturbances\|Vision changes]]: Posterior circulation [[stroke]], [[Myasthenia Gravis]]		**[[visual disturbances\|Vision changes]]: Posterior circulation [[stroke]], [[Myasthenia Gravis]]
Line 73:		Line 73:
	==Evaluation==		==Evaluation==
	===Workup===		===Workup===
	~~'''~~On all patients:~~'''~~		On all patients:
	*CBC (anemia)		*CBC (anemia)
	*Chem 10 ([[electrolyte disturbance]], [[hypoglycemia]], uremia, cardiac enzymes)		*Chem 10 ([[electrolyte disturbance]], [[hypoglycemia]], uremia, cardiac enzymes)
	*[[ECG]] ([[myocardial ischemia\|Ischemia]], [[hypokalemia\|hypo]]/[[hyperkalemia]])		*[[ECG]] ([[myocardial ischemia\|Ischemia]], [[hypokalemia\|hypo]]/[[hyperkalemia]])

	~~'''~~Consider:~~'''~~		Consider:
	*CK (myopathies)		*CK (myopathies)
	*Thyroid studies		*Thyroid studies

WikiEMEditor at 20:00, 15 September 2022

2022-09-15T20:00:03Z

← Older revision		Revision as of 20:00, 15 September 2022
Line 79:		Line 79:

	'''Consider:'''		'''Consider:'''
	*CK (~~mypoathies~~)		*CK (myopathies)
	*Thyroid studies		*Thyroid studies
	*ESR		*ESR
Line 91:		Line 91:
	===[[Intubation]] Indications===		===[[Intubation]] Indications===
	*Severe fatigue		*Severe fatigue
	*Inability protect airway		*Inability to protect airway
	*Rapidly increasing PaCO2		*Rapidly increasing PaCO2
	*[[Hypoxemia]] despite O2		*[[Hypoxemia]] despite O2

Beren85: /* Workup */

2022-06-01T15:36:09Z

Workup

← Older revision		Revision as of 15:36, 1 June 2022
Line 75:		Line 75:
	'''On all patients:'''		'''On all patients:'''
	*CBC (anemia)		*CBC (anemia)
	*Chem 10 ([[electrolyte disturbance]], [[hypoglycemia]], uremia)		*Chem 10 ([[electrolyte disturbance]], [[hypoglycemia]], uremia, cardiac enzymes)
	*[[ECG]] ([[myocardial ischemia\|Ischemia]], [[hypokalemia\|hypo]]/[[hyperkalemia]])		*[[ECG]] ([[myocardial ischemia\|Ischemia]], [[hypokalemia\|hypo]]/[[hyperkalemia]])

	'''Consider:'''		'''Consider:'''
	*CK (mypoathies)		*CK (mypoathies)
			*Thyroid studies
	*ESR		*ESR
	*[[CXR]] and [[UA]] (if infectious symptoms or elderly)		*[[CXR]] and [[UA]] (if infectious symptoms or elderly)
	*FVC (if evidence of respiratory compromise, i.e. Myasthenia, GBS)		*FVC (if evidence of respiratory compromise, i.e. Myasthenia, GBS)
	*[[CT head]] (if focal findings, [[altered mental status]], history of cancer, history of any trauma in patient on anticoagulation)		*[[CT head]] (if focal findings, [[altered mental status]], history of cancer, history of any trauma in patient on anticoagulation)
			*MRI or CT with contrast (if a structural cord lesion is suspected)
	*[[LP]] (CNS infection, GBS)		*[[LP]] (CNS infection, GBS)

Beren85: /* History */

2022-06-01T15:32:50Z

History

← Older revision		Revision as of 15:32, 1 June 2022
Line 9:		Line 9:
	***Weakness involving both central and peripheral nervous system? Inflammatory/Autoimmune or toxic/metabolic		***Weakness involving both central and peripheral nervous system? Inflammatory/Autoimmune or toxic/metabolic
	***Discrete sensory level and/or bladder dysfunction? [[Spinal Cord Lesion]]		***Discrete sensory level and/or bladder dysfunction? [[Spinal Cord Lesion]]
	***Involvement of proximal > distal musculature? Myopathy		***Involvement of proximal > distal musculature? Myopathy, Polymyalgia Rheumatica
			***Involvement of distal > proximal musculature? Neuropathy
	**Unilateral weakness: [[CVA]], [[TIA]]		**Unilateral weakness: [[CVA]], [[TIA]]
	*'''If non-neuromuscular weakness''' then BROAD differential, obtain:		*'''If non-neuromuscular weakness''' then BROAD differential, obtain:

Rossdonaldson1: /* Physical Exam */

2022-05-14T11:18:15Z

Physical Exam

← Older revision		Revision as of 11:18, 14 May 2022
Line 38:		Line 38:

	===Physical Exam===		===Physical Exam===
	Focus on clarifying if patient has true loss of strength and determining distribution of deficits. Check for trauma, carotid bruits, thyroid enlargement, irregular rhythm, unequal pulses, rashes or ticks.		''Focus on clarifying if patient has true loss of strength and determining distribution of deficits. Check for trauma, carotid bruits, thyroid enlargement, irregular rhythm, unequal pulses, rashes or ticks.''

	{\| class="wikitable"		{\| class="wikitable"

Rossdonaldson1: /* Background */

2022-05-14T11:17:54Z

Background

← Older revision		Revision as of 11:17, 14 May 2022
Line 1:		Line 1:
	==Background==		==Background==
			*Determine if patient has actual neuromuscular weakness (suggesting CNS dysfunction) or non-neuromuscular weakness.
	Determine if patient has actual neuromuscular weakness (suggesting CNS dysfunction) or non-neuromuscular weakness.

	==Clinical Features==		==Clinical Features==

Josgood: /* Physical Exam */

2020-03-04T16:08:06Z

Physical Exam

← Older revision		Revision as of 16:08, 4 March 2020
Line 63:		Line 63:
	\| '''End-plate/muscle'''\|\|\|\|\|\|\|\|\|\|		\| '''End-plate/muscle'''\|\|\|\|\|\|\|\|\|\|
	\|-		\|-
	\| Motor end plate\|\|~~Ooccular~~,bulbar and descends, fatigable \|\|No\|\|Nl/diminished\|\|Nl/parethesias\|\|No		\| Motor end plate\|\|Ocular, bulbar and descends, fatigable \|\|No\|\|Nl/diminished\|\|Nl/parethesias\|\|No
	\|-		\|-
	\| Muscle\|\|Proximal > distal \|\|No\|\|Nl/diminished\|\|Normal\|\|+/-		\| Muscle\|\|Proximal > distal \|\|No\|\|Nl/diminished\|\|Normal\|\|+/-

ClaireLewis at 15:48, 23 October 2019

2019-10-23T15:48:48Z

← Older revision		Revision as of 15:48, 23 October 2019
Line 22:		Line 22:
	**Sudden onset of severe headache? [[SAH]]		**Sudden onset of severe headache? [[SAH]]
	**Trauma? Epidural or [[Subdural Hematoma]]		**Trauma? Epidural or [[Subdural Hematoma]]
	**Severe migratory neck or chest pain? [[vertebral and carotid dissection\|Arterial dissection syndromes]]		**Severe migratory neck or chest pain? [[vertebral and carotid artery dissection\|Arterial dissection syndromes]]
	*'''Temporal pattern to weakness? Fluctuating or fixed weakness?'''		*'''Temporal pattern to weakness? Fluctuating or fixed weakness?'''
	**Weakness with repetitive motions? Neuromuscular junction pathology like [[Myasthenia Gravis]]		**Weakness with repetitive motions? Neuromuscular junction pathology like [[Myasthenia Gravis]]
Line 29:		Line 29:
	**[[visual disturbances\|Vision changes]]: Posterior circulation [[stroke]], [[Myasthenia Gravis]]		**[[visual disturbances\|Vision changes]]: Posterior circulation [[stroke]], [[Myasthenia Gravis]]
	**[[Shortness of breath]]: cardiovascular etiology		**[[Shortness of breath]]: cardiovascular etiology
	**[[Chest pain]] or [[neck pain]]: Acute [[vertebral and carotid dissection\|carotid/vertebral]]/[[aortic dissection]], [[AMI]]		**[[Chest pain]] or [[neck pain]]: Acute [[vertebral and carotid artery dissection\|carotid/vertebral]]/[[aortic dissection]], [[AMI]]
	**[[abdominal pain\|Abdominal]] or [[back pain]]:		**[[abdominal pain\|Abdominal]] or [[back pain]]:
	***with alteration of bowel habits? [[Botulism]], organophosphate poisoning, toxins, [[Guillain-Barre Syndrome]], [[Electrolyte Imbalance]].		***with alteration of bowel habits? [[Botulism]], organophosphate poisoning, toxins, [[Guillain-Barre Syndrome]], [[Electrolyte Imbalance]].