TAILIEUCHUNG - Chapter 023. Weakness and Paralysis (Part 6)

Acute Monoparesis If the weakness is predominantly in distal and nonantigravity muscles and not associated with sensory impairment or pain, focal cortical ischemia is likely (Chap. 364); diagnostic possibilities are similar to those for acute hemiparesis. Sensory loss and pain usually accompany acute lower motor neuron weakness; the weakness is commonly localized to a single nerve root or peripheral nerve within the limb but occasionally reflects plexus involvement. If lower motor neuron weakness is suspected, or the pattern of weakness is uncertain, the clinical approach begins with an EMG and nerve conduction study. Subacute or Chronic Monoparesis Weakness and atrophy that develop over. | Chapter 023. Weakness and Paralysis Part 6 Acute Monoparesis If the weakness is predominantly in distal and nonantigravity muscles and not associated with sensory impairment or pain focal cortical ischemia is likely Chap. 364 diagnostic possibilities are similar to those for acute hemiparesis. Sensory loss and pain usually accompany acute lower motor neuron weakness the weakness is commonly localized to a single nerve root or peripheral nerve within the limb but occasionally reflects plexus involvement. If lower motor neuron weakness is suspected or the pattern of weakness is uncertain the clinical approach begins with an EMG and nerve conduction study. Subacute or Chronic Monoparesis Weakness and atrophy that develop over weeks or months are usually of lower motor neuron origin. If they are associated with sensory symptoms a peripheral cause nerve root or plexus is likely in the absence of such symptoms anterior horn cell disease should be considered. In either case an electrodiagnostic study is indicated. If weakness is of upper motor neuron type a discrete cortical precentral gyrus or cord lesion may be responsible and an imaging study is performed of the appropriate site. Distal Weakness Involvement of two or more limbs distally suggests lower motor neuron or peripheral nerve disease. Acute distal lower limb weakness occurs occasionally from an acute toxic polyneuropathy or cauda equina syndrome. Distal symmetric weakness usually develops over weeks months or years and when associated with numbness is due to metabolic toxic hereditary degenerative or inflammatory diseases of peripheral nerves Chap. 379 . Anterior horn cell disease may begin distally but is typically asymmetric and without accompanying numbness Chap. 369 . Rarely myopathies present with distal weakness Chap. 382 . Electrodiagnostic studies help to localize the disorder Fig. 23-3 . Proximal Weakness Myopathy often produces symmetric weakness of the pelvic or shoulder girdle muscles Chap. 382 . .

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