Numbness/Weakness Flashcards
Obtain key history Know key physical exams List differentials List workup for each
What history is key when a patient admits to numbness or weakness?
What is the distribution? (unilateral, bilateral, proximal, distal?
How long has the patient had it?
Has it progressed?
Is there pain associated with it? (headache, neck or back pain)
Any neurologic symptoms?
History of DM? alcoholism? atherosclerotic vascular disease?
What key physical exams should be performed when someone has numbness or weakness?
vital signs
neurologic and msk exams
relevant vascular exams (??)
68 yo M presents following a 20-minute episode of slurred speech, right facial drooping and numbness, and right hand weakness. His symptoms had totally resolved by the time he got to the ER. He has a history of HTN, DM and heavy smoking. What are the differentials?
TIA
Hypoglycemia
Seizure
68 yo M presents following a 20-minute episode of slurred speech, right facial drooping and numbness, and right hand weakness. His symptoms had totally resolved by the time he got to the ER. He has a history of HTN, DM and heavy smoking. Differentials: TIA, hypoglycemia, seizure. What workup would you do?
CBC Glucose Electrolytes CT - head without contrast MRI - brain Doppler U/S - carotid Echocardiography EEG
68 yo M presents with slurred speech, right facial drooping and numbness and right hand weakness. Babinski’s sign is present on the right. He has a history of HTN, DM and heaving smoking. What are the differentials?
Stroke TIA Seizure Intracranial tumor Subdural or epidural hematoma
68 yo M presents with slurred speech, right facial drooping and numbness and right hand weakness. Babinski’s sign is present on the right. He has a history of HTN, DM and heaving smoking. Differentials are stroke, TIA, seizure, intracranial tumor, subdural or epidural hematoma. What workup would you do?
CBC, electrolytes PT/PTT CT - head MRI - brain (preferred) Doppler U/S - carotid Echocardiography
33 yo F presents with ascending loss of strength in her lower legs over the past two weeks. She had a recent URI. Differentials?
Guillain-Barre syndrome Multiple sclerosis Polymyositis Myasthenia Gravis Peripheral neuropathy Tumor in vertebral canal
33 yo F presents with ascending loss of strength in her lower legs over the past two weeks. She had a recent URI. Differentials: Guillain-Barre syndrome, Multiple sclerosis, Polymyositis, Myasthenia Gravis, Peripheral neuropathy, Tumor in vertebral canal. What workup would you do?
CBC, eletrolytes CPK LP - CSF analysis MRI - spine EMG/nerve conduction study Serum B12
30 yo F presents with weakness, loss of sensation and tingling in her left leg that started this morning. She is also experiencing right eye pain, decreased vision and double vision. She reports feeling “electric shocks” down her spine upon flexing her head. Differentials?
Multiple sclerosis Stroke Conversion disorder Malingering CNS tumor Neurosyphilis Syringomyelia CNS vasculitis
55 yo M presents with tingling and numbness in the hands and feet (glove and stocking distribution) over the past two months. He has a history of DM, HTN and alcoholism. There is decreased soft touch, vibratory, and position sense in the feet. Differentials?
Diabetic peripheral neuropathy Alcoholic peripheral neuropathy B12 deficiency Hypocalcemia Hyperventilation Paraproteinemia/myeloma
55 yo M presents with tingling and numbness in the hands and feet (glove and stocking distribution) over the past two months. He has a history of DM, HTN and alcoholism. There is decreased soft touch, vibratory, and position sense in the feet. Differentials: diabetic peripheral neuropathy, alcoholic peripheral neuropathy, B12 deficiency, hypocalcemia, hyperventilation, paraproteinemia/myeloma. Workup?
ESR Calcium Serum B12 Glucose and hemoglobin A1C Serum and urine protein eletrophoresis
40 yo F presents with occasional double vision and droopy eyelids at night with normalization by morning. Differentials?
Myathenia gravis Horner's syndrome Multiple sclerosis Intracranial tumor compressing CN III, IV or VI Amyotrophic lateral sclerosis
40 yo F presents with occasional double vision and droopy eyelids at night with normalization by morning. Differentials: Myasthenia gravis, Horner’s syndrome, multiple sclerosis, intracranial tumor compressing CN III< IV or VI, amyotrophic lateral sclerosis. Workup?
Tensilon test ACh receptor antibodies (in serum) CXR CT - chest MRI - brain EMG
25 yo M present with hemiparesis (after a tonic-clonic seizure) that resolves over a few hours. Differentials?
Todd's paralysis TIA Stroke Complicated migraine Malingering
25 yo M present with hemiparesis (after a tonic-clonic seizure) that resolves over a few hours. Differentials: Todd’s paralysis, TIA, stroke, complicated migraine, malingering. Workup?
CBC, electrolytes
EEG
MRI - brain
Doppler U/S - carotid
