Presentation
Spinal cord lesions: Upper motor neuron signs, sphincter dysfunction, and autonomic dysfunction may be present. A sensory level or loss of specific reflexes may help determine the segmental level the lesion. [sites.google.com]
Respiratory onset can present with: Dyspnoea and orthopnoea. [patient.info]
A 35-year-old woman presented with one month's history of progressive bilateral leg weakness and altered sensation. There had been no pain. She had noted urinary frequency and constipation in the previous two weeks. [ncbi.nlm.nih.gov]
It can also be presented as weakness affecting all extremities, meaning both arms and both legs simultaneously. [wisegeekhealth.com]
A description and images are presented, followed by the diagnosis and an explanation of how the diagnosis was determined. As always, your comments are welcome via email at [email protected] [healio.com]
Entire Body System
- Fatigue
There is a condition known as perceived bilateral weakness, meaning that the muscles feel weak and fatigued even when there is nothing wrong. [wisegeekhealth.com]
Functional Limb Weakness Functional Tremor Blackouts / Attacks Functional Dystonia/Spasm Sensory Symptoms Functional Walking Problems Pain Word Finding Difficulty Tiredness / Fatigue Slurred Speech Sleep Problems Bladder Symptoms Poor Memory / Concentration [neurosymptoms.org]
[…] patients with asthenia and fatigue more frequently than those with intrinsic muscle weakness. 1 Selected causes of asthenia and fatigue are listed in Table 1. 1 View/Print Table TABLE 1 Causes of Asthenia and Fatigue Addison’s disease Anemia Anxiety [aafp.org]
Complaints of "fatigue" may result from such diverse processes as sleep disorders or chronic fatigue and fibromyalgia syndrome. [dartmouth.edu]
Definite and early fatiguing. May have occasional arrests in movement. 3 = Severely impaired. Frequent hesitation in initiating movements or arrests in ongoing movement. 4 = Can barely perform the task. Seite 298 - Examinations: 18. [books.google.de]
- Chronic Fatigue Syndrome
C, tuberculosis) Medications Narcotics Paraneoplastic syndrome Pregnancy/postpartum Pulmonary disease Renal disease Sleep disorders TABLE 1 Causes of Asthenia and Fatigue Addison’s disease Anemia Anxiety Chemotherapy Chronic fatigue syndrome Chronic [aafp.org]
Cardiovascular
- Vascular Disease
This is the most common area for peripheral vascular disease. Peripheralart-fig22:A. [rjmatthewsmd.com]
disease Pain at rest or nocturnal pain Age greater than 60 years Reference : Williams CW et al. [thesgem.com]
Intermittent claudication is the term used to refer to pain in the legs that occurs while walking due to peripheral artery disease ( peripheral vascular disease ). This pain usually gets better with rest. [emedicinehealth.com]
Skin
- Ulcer
Ulceration and aneurysm can also be defined. [rjmatthewsmd.com]
[…] contractures ) or other deformities Blood clots ( deep vein thrombosis ) that form when the person with GBS is inactive or has to stay in bed Increased risk of infections Low or unstable blood pressure Paralysis that is permanent Pneumonia Skin damage ( ulcers [medlineplus.gov]
Complications of immobility such as skin infections/bedsores and ulcers. Cognitive deterioration is rare but is seen occasionally. [patient.info]
Lacerations and skin tears, ranging from trauma to ulcers caused by poor blood flow, are among the causes of pain from skin conditions. The skin has numerous nerve fibers that can sense pain, and anything that damages the skin can cause pain. [emedicinehealth.com]
YAMADA Takumi,IMUTA Hiromi Rigakuryoho Kagaku 30(5) 667-674 Oct 2015 [Refereed] シンポジウム 地域貢献を学生教育へ 山田 拓実 日本保健科学学会誌 17(4) 183-186 Mar 2015 Lifestyle risk factors for pressure ulcers in community-based patients with spinal cord injuries in Japan. [researchmap.jp]
- Skin Ulcer
Ulceration and aneurysm can also be defined. [rjmatthewsmd.com]
Musculoskeletal
- Bilateral Leg Weakness
Rarely, cervical cord tumors can initially cause bilateral leg weakness without involvement. Locations rule in: Bilateral leg areas of the primary motor cortex along the medial surface of the frontal lobes. [sites.google.com]
And this is where bilateral leg weakness -- described here as something that "may be caused by a malfunction of the brain, the spinal cord, or nerves" -- becomes a bilateral splitting headache. [startribune.com]
A 35-year-old woman presented with one month's history of progressive bilateral leg weakness and altered sensation. There had been no pain. She had noted urinary frequency and constipation in the previous two weeks. [ncbi.nlm.nih.gov]
A 9-year-old female developed bilateral leg weakness on the same day she received an influenza vaccination. Her condition had gradually worsened during the 5 months prior to her presentation. She had no family history of hereditary disease. [healio.com]
- Muscle Spasm
Muscle spasm, joint stiffness, restricted mobility, rapid hair and nail growth, and vasospasm (a constriction of the blood vessels) that affects color and temperature of the skin can also occur. [rjmatthewsmd.com]
Muscles will also go into spasm to help protect an injured site. For example, when a hipbone is broken, the muscles that move the hip will go into spasm to help minimize movement of the injury. [emedicinehealth.com]
Episodic muscle spasms, cramps, and weakness. In: Harrison TR, Fauci AS, eds. Harrison’s Principles of internal medicine. 14th ed. New York: McGraw-Hill, 1998:118–22. 3. Pignone MP, Gaynes BN, Rushton JL, Burchell CM, Orleans CT, Mulrow CD, et al. [aafp.org]
- Muscle Cramp
Muscles may also become inflamed for a variety of reasons (myositis: myo= muscle + itis=inflammation), including side effects of some cholesterol medications. Muscle cramps : Muscles may cramp, causing significant pain. [emedicinehealth.com]
Important diseases that can mimic MND [ 1 ] Benign cramp fasciculation syndrome: Fasciculation or cramps usually affecting large muscles (for example, calves). The fasciculation is more common after exercise or with lack of sleep. [patient.info]
They often have Raynaud's phenomenon (see page 136 in this chapter) and get muscle cramps, usually in the arches of their feet or in their legs but rarely in their hands, arms, or thighs. [rjmatthewsmd.com]
- Neck Pain
[…] osteoporosis pain, back pain, hip pain, joint pain, musculoskeletal pain, neck pain, pelvic pain in the arms pain neck/shoulder pancytopenia pelvic pain pelvic prolapse pseudoachondroplasia psoriatic arthritis reflex sympathetic dystrophy syndrome (RSDS [nyulangone.org]
Psychiatrical
- Fear
Although rare, many patients are both aware and fearful of it. [ 1 ] It is therefore important in primary care to understand the presentation and to be able confidently to reassure worried patients who are unlikely to have a diagnosis of MND. [patient.info]
Face, Head & Neck
- Facial Spasm
Bowel Symptoms Dissociation Low Mood Worry / Panic Swallowing Problems Dizziness Complex Regional Pain Headache Functional Jerks and Twitches Health Anxiety Facial Spasm I am very honoured that neurology, medical and nursing colleagues in a wide range [neurosymptoms.org]
Neurologic
- Headache
And this is where bilateral leg weakness -- described here as something that "may be caused by a malfunction of the brain, the spinal cord, or nerves" -- becomes a bilateral splitting headache. [startribune.com]
[…] on suddenly, particularly if it is felt on one side of the body or is accompanied by any serious symptoms, including blurred vision or double vision, loss of vision, or changes in vision; numbness ; paralysis or inability to move a body part; severe headache [healthgrades.com]
Philadelphia, pa: Wolters kluwer health, 2011.) p.502 table 69.1 differential diagnosis of an excruciating headache (thunderclap) during exertion that may persist for several minutes after the procedure. Isolate the chosen antibiotic. [smj.org.sa]
Functional Walking Problems Pain Word Finding Difficulty Tiredness / Fatigue Slurred Speech Sleep Problems Bladder Symptoms Poor Memory / Concentration Bowel Symptoms Dissociation Low Mood Worry / Panic Swallowing Problems Dizziness Complex Regional Pain Headache [neurosymptoms.org]
More common if dura is breached Presents 1–3 days post partum with fever, headache, and neck stiffness Antibiotics. [academic.oup.com]
- Stroke
Leg weakness of sudden onset can be a sign of stroke, a potentially life-threatening situation. [healthgrades.com]
These include: stroke multiple sclerosis (MS) cerebral palsy Charcot-Marie- Tooth disease Muscle disorders. Conditions that cause the muscles to progressively weaken or deteriorate may cause foot drop. [webmd.com]
According to the National Institute of Neurological Disorders and Stroke, or NINDS, multiple sclerosis is an unpredictable nervous system disease that can range from mild to debilitating, depending on the level of disruption between the brain and other [livestrong.com]
Acute onset may indicate infection or stroke. Subacute onset may implicate drugs, electrolytes, or inflammatory or rheumatologic disease. Chronic progressive weakness is the classic presentation in genetic and metabolic myopathies. [aafp.org]
Stroke, vasculitis, infection, tumor, degenerative disease, seizure, hemisyndrome migraine, alternating hemiplegia of childhood Spinal cord. [pedclerk.bsd.uchicago.edu]
- Tremor
He is current or past member of numerous scientific and medical advisory boards of national foundations including the Worldwide Education and Awareness for Movement Disorders (WE MOVE), Dystonia Medical Research Foundation, International Tremor Foundation [books.google.de]
Common signs and symptoms associated with multiple sclerosis include pain, numbness, tingling and weakness in one or more of the extremities, vision problems, tremors, lack of coordination, dizziness, and fatigue. [livestrong.com]
Functional Limb Weakness Functional Tremor Blackouts / Attacks Functional Dystonia/Spasm Sensory Symptoms Functional Walking Problems Pain Word Finding Difficulty Tiredness / Fatigue Slurred Speech Sleep Problems Bladder Symptoms Poor Memory / Concentration [neurosymptoms.org]
[…] uremia Normal Myopathic MUAPs‡ Atrophy of type II muscle fibers; increased lipofuscin beneath cell membrane; calcium deposits in muscle Thyroid hormone (hyperthyroidism) Proximal, bulbar 40 to 49 years Weight loss; tachycardia; increased perspiration; tremor [aafp.org]
- Limb Weakness
Functional Limb Weakness Functional Tremor Blackouts / Attacks Functional Dystonia/Spasm Sensory Symptoms Functional Walking Problems Pain Word Finding Difficulty Tiredness / Fatigue Slurred Speech Sleep Problems Bladder Symptoms Poor Memory / Concentration [neurosymptoms.org]
Signs LMD dysfunction in the limbs manifests as weakness, atrophy, fasciculations and hyporeflexia. The thighs are often a site of marked fasciculation. [patient.info]
- Vertigo
Some people with an vestubular schwannoma get: Hearing loss, usually gradual — although in some cases sudden — and occurring on only one side or more pronounced on one side Ringing (tinnitus) in the affected ear Dizziness or vertigo, which is a feeling [healthjade.com]
Complaints of “numbness” or tingling, vision disturbance or vertigo suggest broader damage to the nervous system. [dartmouth.edu]
Workup
Workup If spinal cord disease is in the differential, an MRI of the cord is essential and should be done emergently. An LP is helpful in neuropathies and in spinal cord disease. [pedclerk.bsd.uchicago.edu]
A neurologic examination that shows deficits in a single nerve or radicular distribution indicates a possible mononeuritis, entrapment neuropathy, or radiculopathy, and calls for a different workup than that required for a limb paresis in a patient with [aafp.org]
Treatment
Patient reports she had treatment from a Korean medical practitioner, which ended 30 days prior to beginning treatment at the Vajra Varahi Medical Clinic. [acupuncturereliefproject.org]
Treatment for foot drop will depend on the cause. Early treatment may improve chances of recovery. Treatments may include: lightweight braces shoe inserts (orthotics) physical therapy surgery Lightweight braces are the most common treatment. [webmd.com]
[…] events, treatment satisfaction and patient masking. [thesgem.com]
Another treatment is intravenous immunoglobulin (IVIg). Both treatments lead to faster improvement, and both are equally effective. But there is no advantage to using both treatments at the same time. Other treatments help reduce inflammation. [medlineplus.gov]
See Stiff Neck Causes, Symptoms, and Treatment Treatment of cervical radiculopathy Treatment for cervical radiculopathy typically needs to be tailored toward the specific underlying cause of your symptoms. [spine-health.com]
Prognosis
This cautious approach is understandable, given the prognosis of the illness and the devastation that being given the diagnosis may cause to a person's life. [patient.info]
[…] neurologic deficits. 1,2 Acute low back pain is often mechanical (97%); however, other causes, including infection, may be to blame ( TABLE ). 1 Most acute back pain will improve with conservative treatment and patients need only reassurance of a favorable prognosis [mdedge.com]
TCM DX: Kidney yang deficiency, cold stagnating the DU channel PROGNOSIS: Due to the fact that she has been untreated for 12 years, it is unlikely this patient will fully recover from acupuncture alone. [acupuncturereliefproject.org]
Prognosis, sequelae, diagnosis, differential diagnosis, especially when the patient supine. [smj.org.sa]
Other immunosuppressive therapies such as cyclophosphamide, cyclosporine, and azathioprine have been tried with variable response but there are no double-blind, randomized, placebo-controlled studies to support the use of these medications. 4 The prognosis [n.neurology.org]
Etiology
It is very difficult to implicate with certainty an etiologic role for a preceding vaccine in a patient who develops a polyneuropathy. In this case, we can not be certain that influenza vaccination was the cause of the polyneuropathy. [healio.com]
Introduction Neurologists focus on identifying the location of the pathologic lesion as the first step in determining etiology. [pedclerk.bsd.uchicago.edu]
Other etiologies are less likely because of the absence of systemic symptoms, toxin exposure, or prior medical history, but still need to be ruled out as neuropathy can be the first or only manifestation of these conditions. [n.neurology.org]
Muscle disease often results in an increase in creatine kinase levels in the blood, although this is quite nonspecific in terms of etiologic diagnosis. [dartmouth.edu]
Diagnosis begins with a patient history distinguishing weakness from fatigue or asthenia, separate conditions with different etiologies that can coexist with, or be confused for, weakness. [aafp.org]
Epidemiology
There may be several causes for such oxidative damage to motor neurons and the disease may just represent an end-stage phenotypic expression of these abnormalities. [ 4 ] Epidemiology MND is relatively uncommon with an annual incidence of about 2 cases [patient.info]
Idiopathic inflammatory myopathies: epidemiology, classification, and diagnostic criteria. Rheum Dis Clin North Am. 2002;28:723–41. 23. Targoff IN. Laboratory testing in the diagnosis and management of idiopathic inflammatory myopathies. [aafp.org]
Pathophysiology
Pathophysiology This is a degenerative condition that affects motor neurons, namely the anterior horn cells of the spinal cord and the motor cranial nuclei. [patient.info]
Prevention
Other treatments in the hospital focus on preventing complications. [medlineplus.gov]
Is It Possible to Prevent Leg Pain? There is a school of thought that says that all injuries are preventable, but in the real world, accidents happen and injuries are the result. [emedicinehealth.com]
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Early diagnosis of CIDP with early treatment can prevent loss of nerve axons. It is very difficult to implicate with certainty an etiologic role for a preceding vaccine in a patient who develops a polyneuropathy. [healio.com]
Prevention of hip fracture in elderly people with use of a hip protector. [books.google.de]