General Neurology

Weakness Workup

Localizing and working up acute and subacute weakness

Weakness: upper motor neuron (CNS: cortex, subcortex, cord) vs lower motor neuron (root, plexus, nerve, NMJ, muscle). Pattern and tempo narrow the cause.

1.Localization

UMN vs LMN. Pattern: hemibody (stroke), level (cord), distal symmetric (polyneuropathy), ascending (GBS), proximal (myopathy, MG), fatigable (MG).[+]

2.Acute Weakness

Sudden: stroke, cord. Ascending + areflexia: GBS. Known MG + worsening: crisis. Image (brain, spine), LP, EMG, MG antibodies, tox as needed.[+]

3.Subacute and Chronic

ALS: UMN and LMN. Myopathy: CK, EMG. Polyneuropathy: glucose, B12, SPEP, EtOH, tox. MG: AChR, MuSK, RNS.[+]

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