Differential Diagnosis For DCM

Question 1

Motor neurone disease

Symptoms
Diagnosis

Answer 1

Painless, Progressive weakness

Bulbar (lower brainstem) features (25% of patients present with these)
Dysarthria - quiet, hoarse or altered speech, dysphagia, tongue fasiculations
Impaired function of lower cranial nerves

Limb features (70%)
Falls, trips
Foot drop
Loss of dexterity
Muscle wasting
No sensory features

Respiratory symptoms (later stage)
Shortness of breath
Fatigue
Early morning headache

Cognitive features (rare)
Behavioural change
Emotional lability

Supporting features
Asymmetrical
Any age but 55-75 most common
Positive FH of MND or other neurodegenerative disease

NOT supportive features
Bladder bowel involvement
Prominent sensory features
Double vision ptosis

Diagnosis of exclusion