TAILIEUCHUNG - Chapter 023. Weakness and Paralysis (Part 5)

Quadriparesis or Generalized Weakness Generalized weakness may be due to disorders of the CNS or of the motor unit. Although the terms quadriparesis and generalized weakness are often used interchangeably, quadriparesis is commonly used when an upper motor neuron cause is suspected, and generalized weakness when a disease of the motor unit is likely. Weakness from CNS disorders is usually associated with changes in consciousness or cognition, with spasticity and brisk stretch reflexes, and with alterations of sensation. Most neuromuscular causes of generalized weakness are associated with normal mental function, hypotonia, and hypoactive muscle stretch reflexes. The major causes of intermittent weakness. | Chapter 023. Weakness and Paralysis Part 5 Quadriparesis or Generalized Weakness Generalized weakness may be due to disorders of the CNS or of the motor unit. Although the terms quadriparesis and generalized weakness are often used interchangeably quadriparesis is commonly used when an upper motor neuron cause is suspected and generalized weakness when a disease of the motor unit is likely. Weakness from CNS disorders is usually associated with changes in consciousness or cognition with spasticity and brisk stretch reflexes and with alterations of sensation. Most neuromuscular causes of generalized weakness are associated with normal mental function hypotonia and hypoactive muscle stretch reflexes. The major causes of intermittent weakness are listed in Table 23-2. A patient with generalized fatigability without objective weakness may have the chronic fatigue syndrome Chap. 384 . Table 23-2 Causes of Episodic Generalized Weakness 1. Electrolyte disturbances . hypokalemia hyperkalemia hypercalcemia hypernatremia hyponatremia hypophosphatemia hypermagnesemia 2. Muscle disorders a. Channelopathies periodic paralyses b. Metabolic defects of muscle impaired carbohydrate or fatty acid utilization abnormal mitochondrial function 3. Neuromuscular junction disorders a. Myasthenia gravis b. Lambert-Eaton myasthenic syndrome 4. Central nervous system disorders a. Transient ischemic attacks of the brainstem b. Transient global cerebral ischemia c. Multiple sclerosis Acute Quadriparesis Acute quadriparesis with onset over minutes may result from disorders of upper motor neurons . anoxia hypotension brainstem or cervical cord ischemia trauma and systemic metabolic abnormalities or muscle electrolyte disturbances certain inborn errors of muscle energy metabolism toxins or periodic paralyses . Onset over hours to weeks may in addition to the above be due to lower motor neuron disorders. Guillain-Barre syndrome Chap. 380 is the most common lower motor neuron weakness that .

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