Neurology – Weakness, Paralysis, Paresis and/or Loss of Motion: By Charles Kassardjian M.D.

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Neurology – Weakness, Paralysis, Paresis and/or Loss of Motion
Whiteboard Animation Transcript
with Charles Kassardjian, MD
https://medskl.com/Module/Index/weakness-paralysis-paresis-and-loss-of-motion

Weakness can be due to a large number of problems arising anywhere from the brain, to the spinal cord, to the peripheral nerves, to the neuromuscular junction and the muscles themselves. Weakness can develop acutely over hours to days, or more slowly over months to years.

Acute weakness is a medical emergency that can lead to disability or death, and some conditions have treatments that must be given within a short time window.

Here are 5 causes of acute weakness you cannot afford to miss.

1. Stroke: Time is brain, and minutes matter. Thrombolysis is given for ischemic stroke, and needs to be given within 4.5 hours of when the patient was last seen well. Think of this diagnosis when the weakness develops and peaks over minutes to a few hours, and there is unilateral weakness, unilateral sensory loss, dysarthria, aphasia, or ataxia. Patients need urgent CT imaging of the brain.

2. Myelopathy and cauda equina syndrome: Think of this in anyone presenting with a combination of paraparesis or quadriparesis, back pain, bowel and/or bladder dysfunction, or saddle anesthesia. Urgent MRI is needed to rule out disc herniation or mass, which may require urgent surgical decompression.

3. Guillain-Barré syndrome: Think of this in someone presenting with diffuse symmetric weakness developing over days to weeks, usually progressing from the legs up to the arms and face, mild sensory symptoms, and reduced or absent reflexes. Patients can develop swallowing and respiratory weakness that requires ICU care.

4. Myasthenia gravis: Think of this in someone who presents with diffuse weakness, no sensory symptoms, ptosis, ophthalmoparesis, and fluctuating weakness. Acute exacerbations of myasthenia gravis can lead to swallowing and respiratory weakness, and therefore needs emergent assessment.

5. West Nile Virus: Think of this in someone who presents during the summer or early fall with diffuse or patchy weakness without sensory symptoms. Patients might have a preceding febrile illness, gastrointestinal symptoms like nausea or diarrhea, or meningeal symptoms like headache or stiff neck.

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