In this post, I link to and excerpt from The Curbsiders‘ [link is to the full episode list] #278 Neuro Mystery Case with The CPSolvers [link is to the podcast and show notes]. Neuro Ddx tips Drs. Reza Manesh and Rabih Geha.
All that follows is from the show notes of #278 Neuro Mystery Case with The CPSolvers:
Neuro Mystery Case
70F with h/o diabetes presents with a fall. She had several months of progressive bilateral lower extremity (LE) weakness, along with proximal muscle weakness of the upper extremities (UE). On exam we detect ptosis, bifacial weakness, and hyporeflexia.
- Intro, disclaimer, guest bio
- Weakness and Falls
- Localization on the neuraxis
- NM junction
- Lung Mass
- Cognitive Autopsy
Weakness Thought Train on CPSolvers site
CPSolvers schema on bilateral LE weakness https://clinicalproblemsolving.com/dx-schema-bilateral-lower-extremity-weakness/.
Localize the lesion to the brain, spinal cord, cauda equina, peripheral nerve, NM junction, or muscle. Often we assume a single “elegant lesion” that explains all neurologic symptoms. BUT, don’t forget to consider multiple lesions! Neurologist, Dr. Aaron Berkowitz, recommends that we localize the lesion, and then consider the time course to prioritize the differential diagnosis (Ddx).
Upper Motor Neuron (UMN) lesions usually cause hyperreflexia, spasticity, and upgoing toes. But, in the acute setting patients may have hyporeflexia.
Miller-Fisher Variant of Guillain-Barre: Acute onset of ataxia, hyporeflexia and ophthalmoplegia (Check out the NIH-NINDS summary).
Brain lesions often have cognitive symptoms along with bowel or bladder dysfunction.
Guillain-Barre – usually lacks bowel and bladder symptoms, which can differentiate it from other causes of bilateral weakness.