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Lower limb weakness differential diagnosis

lower limb weakness differential diagnosis Causes leg numbness, coldness, shiny skin and sore toes. . While we typically regain normal function within minutes, there are conditions that cause numbness or weakness in the leg or knee for extended periods. Clinical signs and symptoms might be nonspecific, especially in the early stages; therefore, knowledge of predisposing risk factors can be helpful. The upper limb amyotrophy, with a predominance on the ulnar side of the hands, resembles that of ALS, and bulbar sign and symptoms (tongue atrophy and fasciculation) have led to the misdiagnosis of bulbar ALS. Bilateral lower limb LMN paresis Although an increasingly recognised and relatively benign MND phenotype can present as predominantly distal LMN weakness in the limbs and should be consid-ered in the differential, particularly as bulbar dysfunction often follows limb involvement by many years10 (Table 3). For isolated single leg weakness don’t forget stroke. Inflammatory causes of leg ulceration can be difficult to diagnose and difficult to treat. Venous insufficiency, chronic (leg veins with a problem returning blood to the heart) Leg swelling related to inflammation. Tumours of the third ventricle may present with sudden episodes of collapse. In a patient presenting with sudden onset paralysis and hypokalemia, the emergency physician should include thyrotoxic periodic paralysis in the differential diagnosis and focus on treating and working up the hypokalemia instead of the paralysis. It was associated with both lower limb weakness and decreased sensation. Differential diagnosis is important, as many other conditions can mimic ALI. See full list on aafp. The working differential diagnoses included left hip trochanteric bursitis, gluteus medius tear, and lumbar radiculopathy with pain to the posterior-lateral thigh. In the context of his family history, one should think of familial forms of motor neuron disease, such as familial amyotrophic lateral sclerosis (fALS). The patient also had hepatomegaly and bilateral lower extremity edema. , peroneal muscle weakness) often constitute the first sign of weakness of the distal lower extremity. physicians be aware of its occurrence when generating a differential diagnosis in the case of paresis. For the first, have the leg fully relaxed, hold the knee to fix the leg to the bed and roll the thigh left and right repeatedly. It is important to differentiate between ALI and CLI due to differences in urgency and management. See full list on physio-pedia. 1 It is characterised by acute areflexic paralysis with albuminocytologic dissociation and it is considered a neurological emergency. Differential Diagnosis of HSP vs. 2,10 There is no disease-modifying treatment; therapy includes the use of orthoses and mobility aids, physiotherapy a differential diagnosis. Its distal renal tubular acidosis. It affects both motor and sensory nerves. com IVVR of the lower limbs in ten healthy subjects was 0. Spinal cord compression (non-traumatic) Cauda equina syndrome; Conus medullaris syndrome; Epidural abscess (spinal) Epidural hematoma (spinal) The most common causes are disk herniation, spinal stenosis, infection or trauma. Sandy Aikara, MD* 2. Lower back and buttock pain may be expected after a fall, and potentially escalates traumatic injury on my differential diagnosis list. The incidence is 1 in 25000. The objective of the present study was to prospectively evaluate relationships linking age, respiratory function and locomotor function in 29 outpatients with late-onset Pompe’s disease and to retrospectively determine clinical outcomes. Most often, the negative form develops with acute deficiency of vitamins E and B12. Unilateral LMN (weakness depends on lesion) Work down (nerve root to peripheral nerve) Radiculopathy - disc herniation, cervical spondylosis with osteophytes, spinal stenosis, nerve sheath tumours, infection (polio, herpes zoster, CMV, borrelia), cervical rib → dermatomal sensory loss Conclusions The common differential diagnosis in Western patients with lower limb swelling is secondary lymphedema, venous disease, lipedema, and adverse reaction to ipsilateral limb surgery. This case report describes the clinical decision-making and differential diagnostic process for a patient with atypical bilateral lower limb pain due to a benign thoracic spinal tumor. Denies neck pain, chest pain, abdominal pain or extremity pain. and lower motor neurone signs affecting the same region, essential for a diagnosis of amyotrophic lateral sclerosis. Diagnosis of herpes zoster radiculopathy of the lower extremity can be challenging. This case report describes the clinical decision-making and differential diagnostic process for a patient with atypical bilateral lower limb pain due to a benign thoracic spinal tumor. The non-specific sural nerve biopsy findings are a common occurrence in CIDP; the lack of microvascular ischaemic changes in this case is important, as it makes the differential diagnosis of non-diabetic lumbosacral radiculoplexus neuropathy less likely. A diagnosis of spinal myoclonus was suggested and a treatment with clonazepam began. Baima J, Krivickas L. Childhood onset is common. CLI is caused by chronic arterial occlusion due to peripheral arterial disease with symptoms lasting longer than 2 weeks. They may arise from disease processes affecting the anterior horn cell or the motor axon and/or its surrounding myelin. The weakness usually subsides over several hours. The symptoms improve after a few days. google. A comparison of treatment options and outcome. Many are genetic. nlm. Distal myopathies comprise a rare and heterogeneous group of disorders that present with weakness of the distal muscles of the hands, feet, or both. Table 1 The differential diagnosis of acute bifacial weakness Causes Comments paralysis of the lower limbs, areflexia, proprioception impairment, and decreased sensation to light touch and pinprick. There are three techniques to use when assessing tone of the lower limbs. UMN signs: Anterior cord syndrome (compression, ischemia, demyelination) if contralateral pain and temperature sensory disturbance. com] A 35-year-old woman presented with one month's history of progressive bilateral leg weakness and altered sensation. Lower limb pain referred from the sacroiliac joint can be confirmed by diagnostic intra-articular anesthetic injections. A 16-year-old Korean boy presents to the emergency department with acute onset of lower-extremity weakness. Findings: A focal dorsal indentation of the thoracic spinal… Read more » Is there a bird in my head? Posted January 23, 2018 by by Daniel. The differential diagnosis of these should include Acute Inflammatory Demyelinating Polyneuropathy (Guillain-Barré syndrome). This finding should also be taken into account within the differential diagnosis in elderly patients who present with initial spinal dysfunction. Diagnosing HSP can be a challenge. Prognosis can be excellent, and early diagnosis and prompt Differential diagnoses. •Acute onset of flaccid limb weakness o Hypotonic, hyporeflexic o Asymmetric o Upper extremities more than lower extremities o Proximal more than distal o Wide spectrum of severity (1→4 limbs, 0/5→4/5 strength) •Cranial nerve dysfunction (> 30%) o Eye muscle weakness o Facial weakness o Bulbar weakness (e. There was no muscle pain. The first sign is usually weakness and wasting (atrophy) of a muscle in the lower leg called the tibialis anterior. HSP is characterized by insidiously progressive lower-extremity weakness and spasticity often presenting in other motor neuron diseases. He denied any pain or sensory symptoms, lower limb weakness, and bladder or bowel symptoms. When a patient presents with progressive, painless weakness, one must always consider the possibility of amyotrophic lateral sclerosis (ALS), particularly when muscle stretch reflexes are normal or hyperreflexic in the presence of lower motor neuron weakness. Hemiparesis: Weakness on one side of the body. The diagnosis of lower limb cellulitis requires careful and structured assessment. Case 5. Proximal myopathy presents as symmetrical weakness of proximal upper and/or lower limbs. Leg Weakness Case #2 Summarize the Case A 72 y. Symptoms can include pain, swelling, redness, and enlarged veins in the affected area, but some DVTs have no symptoms. Her symptoms started with sudden onset of horizontal diplopia six weeks before, followed by gradually worsening lower-extremity weakness, as well as ataxia and patchy and bilateral radicular burning leg pain that was more pronounced on the right. The muscles of the head, neck, throat, upper body can be involved in the pathological The common causes of distal limb numbness and asymmetrical distal lower limb weakness in an elderly patient like ours include polyradiculopathy, lumbosacral plexopathy, and polyneuropathy. MYOPATHY Evaluation and Diagnosis- Kirsten Gruis, MD 2010 Page 5 of 19 1. On the first two occasions he had no systemic symptoms, but on the third presentation he had fever and cough, starting from day 4 of weakness. Patients with cauda equina syndrome usually present with one or more of these red flags: 1) severe low back pain, 2) saddle paresthesia 3) bladder, bowel and sexual dysfunction, or 4) lower limb weakness. Prompt diagnosis is essential to avoid permanent functional restriction or even the loss of the affected limb. Differential Diagnosis of Shoulder Pain Followed by Progressive Weakness: A Case Report Michael D. In 3 months, muscle weakness in-volved the left leg. Differential Diagnosis of Foot Drop L5 nerve root Lumbar plexus Sciatic involvement Peroneal nerve Weakness of paraspinous muscles Weakness of gluteal muscles and sphincter Differential diagnoses. Avoid exposing the legs to direct heat or the hot air of the heater in a car. Proximal myopathy. Spinal cord vascular abnormalities may present with lower limb weakness leading to falls without impairment of awareness. unilateral & bilateral limb weakness , stroke approach 1. Acute myopathy; Guillain–Barré syndrome (GBS) Diabetic lumbosacral radiculoplexus neuropathy (DLRN) Myasthenia gravis; Lambert-Eaton myasthenic syndrome (LEMS) Distal Weakness. A construction worker in his 30s presented three times in 4 days with progressive upper and then lower limb weakness. A 13-year-old girl presented to the emergency department with acute onset of lower extremity weakness. Approach 4. The patient complained of bilateral lower-extremity weakness with her pain intensity at a minimal level in the region of the left sacroiliac joint and left buttock. However, between 38% and 52% of asympto- Neurological examination of the lower limbs demonstrated bilateral hypotonia and reduced power to 2/5 proximally and distally, absent reflexes, sensory level at L2 with paraesthesia (pins and needles) and dysaesthesia bilaterally. If the facial weakness involves both the upper and lower face, you must look for associated signs and The physician should ask about lower-limb symptoms when patients have neck pain and/ or upper-limb neurology. Proximal myopathy presents as symmetrical weakness of proximal upper and/or lower limbs. Myotonia lasts for seconds to minutes, but weakness may persist for hours and sometimes days. • It is a Lower motor neurone lesion 4. 10 The combination of possible CIDP on electrophysiology with at least two supportive criteria established the diagnosis of definite focal CIDP. To explore differential diagnosis value of dissociated lower-limb muscle impairment, we performed a retrospective analysis of clinical and electrophysiological features in 141 lower-limb involved Differential Diagnosis. g. General advice should include: Avoid and treat dry skin, using non-soap cleansers and thick simple emollients. It is where a build up of fatty deposits restricts blood flow to the leg muscles. In some cases, the pathology extends to involve cardiac muscle fibers, resulting in a hypertrophic or dilated cardiomyopathy. Case description: The patient had a sixteen-month insidious onset and Lower Back Pain. *Jersey Shore University Medical Center, Neptune, NJ. In General Myopathy will result in symmetrical proximal limb weakness. The differential diagnosis of true muscle weakness is extensive, including neurologic, rheumatologic, endocrine, genetic, medication- or toxin-related, and infectious etiologies. –Lower extremity weakness can be initial symptom –Acute or gradually progressive spastic paraparesis •Motor neuron diseases: –Amyotrophic lateral sclerosis (ALS): •rapidly progressive weakness with limb onset •Systemic diseases such as - Behçet's disease –Usually flaccid paralysis or incomplete paraplegic symptoms This is caused by atherosclerosis. Progressive proximal muscle weakness in 3rd to 5th decade of life. The differential diagnosis should include myelitis, intra- and extra-medullary spinal cord tumors, spinal cord trauma, syringomyelia, hemorrhagic or thrombotic lesions in the spinal cord, and progressive spinal muscular atrophy. Carotid sinus syndrome – syncope occurs upon stimulation of carotid baroreceptors in neck via neck massage or even shaving. Families have been reported in which some members develop Miyoshi myopathy and others LGMD2B. • Lower limb, upper limb, thoracic and cranial neuropathies can occur arm weakness while carrying a heavy backpack. Gower sign positive. Case: A 64-year-old male presents with a three-year history of progressive back pain, lower limb weakness and unstable gait. Physiotherapy 2017;103:81-9. On examination, she was afebrile, with flaccid lower limbs, weakness of proximal muscles of lower limb (1/5, Medical Research Council grading) and examination of upper limb was normal. Hip Flexor Weakness Differential Diagnosis It’s a common issue, says Prevention advisor Rob Danoff, director of family and emergency medicine residency programs at Aria Health in Philadelphia. Weakness of the anterior tibialis (front of a shinbone) , great toe (extensor hallicus longus), and hip abductors (moves a leg outward from the hip) Pain down the side of the leg S1 features which make the diagnosis clear (e. Clinical onset is characterized by limb pain, limb weakness, and in a few cases ataxia. The differential diagnosis with motor neuropathy is important. This muscle helps control up-and-down movement of the foot. If the facial weakness is isolated to the lower face, stroke is the most likely diagnosis. Hip Flexor Weakness Differential Diagnosis It’s a common issue, says Prevention advisor Rob Danoff, director of family and emergency medicine residency programs at Aria Health in Philadelphia. Leg swelling can also be caused by inflammation in leg joints or tissues — either a normal response to injury or disease or due to rheumatoid arthritis or another inflammatory disorder. Paroxysmal kinesogenic choreoathetosis may cause drop attacks if there is lower limb involvement. The children develop mild muscle weakness and pain in their lower extremities that can keep them from wanting to walk. Hip Flexor Weakness Differential Diagnosis It’s a common issue, says Prevention advisor Rob Danoff, director of family and emergency medicine residency programs at Aria Health in Philadelphia. Diagnosing leg and lower back pain begins with a detailed patient history and examination. Vasculitic neuropathy; Toxin induced peripheral neuropathy; Nerve compression syndromes Differential Diagnosis of Proximal Weakness. Flail-leg syndrome or lower limb diplegia is a form of motor neuron disease characterized by a slower progression rate. Patients with functional weakness experience symptoms of limb weakness which can be disabling and frightening such as problems walking or a ‘heaviness’ down one side, dropping things Some types of leg pain can be traced to problems in your lower spine. Treatment options include surgical and less invasive endovascular techniques. In a patient with normal tone the foot will flop in the opposite direction as the way the knee is moved. DIFFERENTIAL DIAGNOSIS OF LIMB LENGTH DISCREPANCIES To examine for structural limb length discrep- ancy, both heels should be placed in a perpen- dicular or neutral position with the arches of both feet as close to normal as possible in normal gait angle. Diabetes mellitus type 2 is an ailment involving hyperglycemia and insulin resistance. Thus, it should be considered as a rare differential diagnosis in patients with juvenile-onset ALS. , muscular dystrophy, late-onset congenital myopathy or metabolic myopathy) myopathic disorder. The differential diagnoses of a footdrop (from caudal to cranial) include: common peroneal and sciatic neuropathies, lower lumbosacral plexopathy, radiculopathy, hemi-conus or hemi-cord lesions, motor neurone disease, and parasagittal cortical or subcortical lesions. Genu varum, or lower extremity bowing, defined by a tibiofemoral angle of at least 10 degrees of varus, is normal during infancy and is more pronounced after standing age. First symptoms were developed in 2012 when patient noticed walking difficulty due to spasticity and weakness in the right leg. Symptoms localized to deficits in the anterior compartment (i. After more serious causes of paresis have been ruled out, treatment with corticosteroids and possible physical rehabilitation should be considered for treatment. Patients are observed movement disorders and severe weakness in the limbs. In addition to the detailed history, the differential diagnosis is mainly clinical based on the distinction at rest, postural and intention, activation condition, frequency, and topographical distribution. Upper limbs, cranial nerves and general examination were unremarkable. In 2014, she presented with lower limb myoclonus, confusion, hyperthermia and acute respiratory failure. Weakness may progress to upper limbs and there is often pain in the long lower limb and dorsal region muscles. Reflexes are usually lost but can be retained, and even brisk in up to 20% of cases. “For people who sit a long time at work, the hip flexors and rotators become tight, and the gluteal muscles become weak,” he says. org This 38-year-old woman likely has a myopathy given the symmetrical pattern of proximal weakness involving legs and arms. Tingling in the lower leg can also have the feeling of numbness or a burning sensation in the lower leg. Radiculopathy is characterised by pain referred from the neck distally and sensory disturbance and weakness with associated loss of tendon reflexes. Read about different disorders and treatments. To discuss a case of progressive lower extremity paresis and paresthesias in a patient found to have monoclonal gammopathy. Spastic hereditary disorder. Selective distal upper limb muscle weakness and atrophy with non-significant lower limb weakness during follow-up was the most frequent motor pattern, present in 18 patients [ncbi. &#91;1&#93; &#91;2&#93; &#91;3&#93;&#160; It is most commonly seen after injuries to the leg and forearm, but also occurs in the Most of the diseases discussed here lead to bilateral proximal weakness and symmetric atrophy (with the exception of proximal diabetic polyneuropathy, neuralgic amyotrophy and, in part, amyotrophic lateral sclerosis) on the arms and legs. Upper Limb Spasticity: in adults (≥2% of patients): seizure, nasopharyngitis, dry mouth, and upper respiratory tract infection. This case report describes a woman who was referred with a diagnosis of sciatica but who had signs and symptoms consistent with vascular stenosis. Late onset Pompe's disease needs to be considered as a differential diagnosis in cases presenting with proximal muscle weakness with respiratory muscle involvement. Loss of sphincter control and inability to void or defecate may develop later. Weakness can be confused with hypotonia or ataxia. gov] Diagnostic pointers in limb -onset MND [ 1 ] Asymmetrical distal weakness frequently occurs. Facial/Ocular and Extraocular muscle weakness Lower leg weakness, foot drop, leg sensory deficits; Superior gluteal. It is important to identify functional impairment and differential muscular anatomy associated with common patterns of limb deformities for treatment planning and to determine treatment goals Understanding the extent to which muscle overactivity, weakness, and soft-tissue changes contribute to each fixed limb posture also Additional forms of muscle disease (myopathy) are considered differential diagnoses for LGMD including metabolic myopathies such as Pompe disease; inflammatory myopathies such as dermatomyositis or polymyositis; and distinct congenital myopathies such as nemaline myopathy. Weakness of the anterior tibial and ankle evertor muscles often results in tripping, even over small obstacles, and an increased tendency to repeatedly sprain the ankle. We present two patients with a previous diagnosis of amyotrophic lateral sclerosis (ALS)-flail-leg syndrome, in whom neurophysiological studies suggested proximal Lower leg pain is common, but it can be tricky sorting out its many potential causes. Included in the differential are: Spinal nerve radiculopathy at L1-L3 4; Malignancy or metastasis to the iliac crest 5; Uterine fibroids or pelvic mass that compress the nerve 6 For example, electrolyte abnormalities (such as a low level of magnesium or calcium) can cause weakness that sometimes comes and goes, as well as muscle cramping and twitches. o. 2 In addition, prominent distal muscle weakness is also a feature of several of the On the fourth day post-op, the patient developed sudden onset, right leg weakness and paraesthesia, with right lower limb power 3/5, decreased tone and absent reflexes, leading to the diagnosis of a spinal haematoma post spinal anaesthesia. The giant aneurysm described here is unique in its kind by causing bilateral lower limb weakness, with only two more published cases of complicated aneurysms that generated initial neurologic signs. Lower Limb Syndrome vs. 29 Stalnaker and Goebel, MD: Post-Herpetic Paresis of the Lower Extremity An acute lesion of the spinal cord may be accompanied by ‘spinal shock’ which may obscure the distinction between an upper and a lower motor neuron lesion. one limb may be spastic with hyperactive reflexes while another limb has muscle atrophy and absent reflexes (Table 2). The differential diagnosis with motor neuropathy is important. Ancillary laboratory studies: The electrodiagnostic studies confirmed the diagnosis. High lesions in the spinal cord will likely affect the arms, whereas lesions in the thorax or lumbar spinal cord will spare the arms. There is a broad range of underlying causes including drugs, alcohol, thyroid disease, osteomalacia, idiopathic inflammatory myopathies (IIM), hereditary myopathies, malignancy, infections and sarcoidosis. Step 3. 2. Investigations were Differential diagnoses include adult Pompe disease, myofibrillar myopathies, limb-girdle muscular dystrophy, facioscapulohumeral muscular dystrophy, mitochondrial myopathies, myasthenia gravis, and amyotrophic lateral sclerosis. He woke up from sleep, had several episodes of emesis, and found he was unable to move his lower extremities. My initial guesses were Guillain-Barrѐ Compartment syndrome of the lower leg is a condition where the pressure increases within a non-extensible space within the limb. It is not caused by damage or disease of the nervous system. Hypotonia means decreased muscle tone. Lower motor neuron (LMN) syndromes typically present with muscle wasting and weakness and may arise from pathology affecting the distal motor nerve up to the level of the anterior horn cell. There are decreased or absent deep tendon reflexes in affected limbs. MUSTAFA F. Azhary H, Farooq MU, Bhanushali M, Majid A, Kassab MY. rophy of upper limb due to other diagnoses. • Brainstem, spinal or lower limb abnormalities There are usually fixed neurological signs. paralysis, facial numbness, contralateral lower extremity weakness. As for negative sensory symptoms, this is a decrease in sensitivity in the limbs and lower abdomen. Peripheral neuropathy: differential diagnosis and management. Management may include ventilatory support, immunoglobulin infusion or plasmapheresis. Symptoms include reduced lower limb sensation (often bilateral), bladder or bowel dysfunction, lower limb motor weakness, severe back pain, and impotence. [sites. Idiopathic transverse myelitis. UMN dysfunction manifests as weakness predominating in the arm extensors and leg flexors with evidence of hypertonia, hyper-reflexia and upgoing plantar responses; the bulbar muscles may also show spasticity with an exaggerated jaw jerk. While factors like what your pain feels like—stabbing, burning, or cramping, and so on—can provide insight, oftentimes, a detailed physical examination and/or an imaging test are needed to clinch the diagnosis. “For people who sit a long time at work, the hip flexors and rotators become tight, and the gluteal muscles become weak,” he says. Inflammatory causes of leg ulceration and vascular occlusion. Raised protein content in the absence of increased cell count at CSF analysis confirms the clinical diagnosis. Here, we review its pathogenesis, diagnosis and management. Deep vein thrombosis (DVT) is the formation of a blood clot in a deep vein, most commonly in the legs or pelvis. 5,6 Tendinosis could ultimately result in partial or even full-thickness tears if untreated or not detected soon enough, making conservative therapy an insufficient measure. A stepwise Bilateral weakness of lower extremities (paraparesis/plegia) Lesion: Spinal cord, peripheral nerve. Paraesthesias are abnormal sensory symptoms typically characterised as tingling, prickling, pins and needles, or burning sensations. Myositis can occur in several different forms. ● Lower motor neuron weakness – Lower motor neuron weakness results from lesions located in the anterior horn cell, peripheral nerve, neuromuscular junction, or muscle. Lymphedema can be confirmed by a lymphoscintigram, computed tomography, magnetic resonance imaging, or ultrasound. Myofibrillar myopathy is often misdiagnosed with these conditions and a correct diagnosis is often delayed. Spinal infarction. in pediatric patients (≥3% of patients): nasopharyngitis and bronchitis. Once your doctor diagnoses the cause of your weakness, they’ll discuss treatment options with you based on their diagnosis. Vasculitic Neuropathy. polyneuropathy: evaluation and differential Distal weakness: Weakness in the distal extremities (eg, foot drop). Paraparesis: Weakness of both legs. • Brainstem, spinal or lower limb abnormalities There are usually fixed neurological signs. DOI PubMed; 31. Atrophy, weakness, fasciculations, decreased tone, reduced reflexes (hyporeflexia) eg poliomyelitis. Ataxia refers to decreased muscular coordination. To test these muscles, there are two home techniques. 1. Physical examination usually shows a preserved mental status or irritability and decreased or abolished deep tendon reflexes in weak limbs. Introduction Acute compartment syndrome of the lower limb is a rare but severe intra- and post-partum complication. The main differential diagnosis to consider is critical limb ischaemia (CLI). Case presentation We A dermatome is a specific area in the lower extremity that has nerves going to it from a specific lumbar nerve. Student With Weakness and Numbness Peripheral polyneuropathies tend to be most noticeable in the longest nerves (ie, weakness is more prominent in the distal limb than the proximal and in legs more than arms) and produce signs of lower motor neuron dysfunction (eg, decreased reflexes and muscle tone). The mass, although rare, is more often found in the lower limbs and as with other space-occupying mass lesions can cause disease expansive compressive venous effect to mimic the symptoms of a DVT. Leg pain can also be caused by blood clots, varicose veins or poor circulation. The classic HMSN phenotype consists of weakness, wasting, and sensory loss that usually begins before the second decade, starting in the lower limbs and being more severe distally. Potassium replacement. Mononeuropathies of the lower extremities are commonly encountered in clinical practice. Charcot–Marie Tooth (CMT) is a primary congenital demyelinating peripheral neuropathy and is one of the most common inherited neuropathy. “For people who sit a long time at work, the hip flexors and rotators become tight, and the gluteal muscles become weak,” he says. Differential diagnosis for polyneuropathy is discussed in a later chapter though a table of possible causes is provided here. Pediatric acquired upper and lower limb deficiency more so when accompanied by leg weakness or foot drop. Tumours of the third ventricle may present with sudden episodes of collapse. Management of lower leg rashes. Causes include neurologic ailments and a range of non-neurologic conditions. 614, 0. He recalls eating half a dozen doughnuts If weakness of a limb is associated with lower facial weakness on the same side, the problem is above the brainstem, while if there is weakness of muscles on one side of the head and opposite limb, then a lesion in the brainstem is suggested. 2008 Jun 1;1(2):147-53. He experiences no bowel or bladder difficulty and there is no history of prior trauma or spinal surgery. For example hemispheric lesions will cause contralateral weakness, however spinal cord lesions and lower motor neuron lesions will cause ispilateral weakness. Physical examination revealed lower limb weakness with spasticity. Other than seizure, the main differential diagnosis is as follows; Cardiac causes of syncope include Aortic stenosis, Hypertrophic obstructive cardiomyopathy (HOCM) and arrhythmia. International Conference of Science and Medicine in Venous flow during manual lymphatic drainage applied to different regions of the lower extremity in people with and without chronic venous insufficiency: a cross-sectional study. 044 (mean, SEM). Hip Flexor Weakness Differential Diagnosis It’s a common issue, says Prevention advisor Rob Danoff, director of family and emergency medicine residency programs at Aria Health in Philadelphia. 1 The term distal myopathy is usually reserved for genetic disorders, although weakness of distal muscles is sometimes prominent in the acquired muscle diseases. 5 Weakness of these muscles can also be caused by common hip degeneration so the differential of weakness is somewhat more difficult for this self-test. Common causes of sudden leg weakness include drop attacks, the Guillain–Barr syndrome and nontraumatic spinal cord compression due to metastatic tumour or an epidural abscess. All are associated with cerebellar atrophy on neuroimaging. Intermittent claudication has a number of differential diagnoses, including: Nerve root compression — sharp lancinating pain, radiating down the leg, exacerbated by sitting, standing, or walking, and improved by change in position. org Denervation near the target muscle fibers (lower motor neuron disease) results in dampening of the efferent limb of spinal reflexes, resulting in hyporeflexia. Children with Friedreich ataxia typically have absent lower limb reflexes, distinguishing it from spastic diplegia. Figure 2 – The distribution of saddle anaesthesia Low cardiac output in conjunction with chronic lower extremity peripheral arterial disease. either lower or upper mnD may predominate in a patient and can vary between regions in the same patient, eg. Distinguishing the Cause of Muscle Weakness: Lower Motor Neuron Dysfunction vs Myopathy* Amyotrophic lateral sclerosis and other motor neuron diseases are characterized by steady, relentless, progressive degeneration of corticospinal tracts, anterior horn cells, bulbar motor nuclei, or a combination. For nephrocalcinosis citrate can be given because it is antagonist of calcium stone. In summer 2016, he noticed substantial weakness of his left arm after rowing 7 km, and sought medical attention. Read below for more information on causes and treatment options for tingling in the lower leg. Proximal Weakness. Differential Diagnosis. Start test. The weakness improved and he was able to play lacrosse during spring 2016. Spine related Acute ligamentous injury; Acute muscle strain; Disk herniation (Sciatica) Degenerative joint disease; Spondylolithesis; Epidural compression syndromes. Ischemia severity can be classified into three levels: viable; threatened, either marginally or immediately; and irreversible. 2010 Apr 1;81(7):887-92. Central nervous system and systemic inflammatory diseases such as MS, systemic lupus erythematosus, and Lyme disease need to be included in the differential diagnosis. 96 Maigne et al A’s recent viral illness, progressiveness of the bilateral lower-extremity weakness, and urinary urgency pointed toward a number of conditions to consider. Push with your hand to try and force the thigh back onto the seat. Probably a vasculitis aetiology with ischaemia followed by axonal degeneration and demyelination. One is to sit in a chair and simply lift your involved thigh off the seat. Muscle hypertrophy may be seen in 30% of patients. At this point, the differential diagnosis includes conditions that affect the motor neuron, the nerve, and the muscle. Difference between conus medularis and cauda equina syndrome • The conus medularis is Signs in conus terminal portion at medullaris while which cord ends and planter are flexor or cauda equina is bunch not elicitable with of roots. 1. Intoxication (see acute) Multiple sclerosis, consider this especially in young adults (history of relapse, other brainstem signs) Definition of AFP • sudden onset of weakness or paralysis in a previously normal limb over a period of 15 days in a patient aged less than 15 years age. Neuromuscular disorder - myaesthenia gravis, Lambert-Eaton myaesthenic syndrome. Whole Body • Diabetic Lumbosacral Radiculoplexus Neuropathy (DLRPN) vs. Assessment should include good skin examination as active skin disease, such as venous stasis eczema and athlete’s foot (tinea pedis), is often overlooked Neuromuscular disorders affect the nerves that control your voluntary muscles. Magnetic resonance imaging (MRI) is considered to be the cornerstone special investigation to confirm the diagnosis of a lumbar disc herniation. In an alert patient without any headache, the patient is unlikely to have a complex migraine with neurologic deficit or intracranial bleeding. The differential diagnosis for gradually worsening lower back pain with right lower extremity pain and weakness includes hemangioblastoma, ependymoma (myxopapillary), astrocytoma, lymphoma, and metastasis. COVID-19: LOW risk. The typical presentation is the occurrence of a fusiform mass one of the lower leg compartments after a long time after a traumatic event. Refined differential diagnosis (history): The slowly progressive subacute deterioration, particularly in the absence of sensory complaints or pain, is most indicative of a motor neuron disorder. Sensory abnormalities, involvement of cranial nerves, and paralysis of respiratory muscles also can occur. Physical examination revealed lower limb weakness with spasticity. This compromises the circulation and function of the tissues within that space as it compresses neural tissue, blood vessels and muscle. Monoplegia resulting from upper extremity impairments following a stroke occurs due to direct damage to the primary motor cortex, primary somatosensory cortex, secondary sensorimotor cortex, sensorimotor cortical areas, subcortical structures, and/or the corticospinal tract. Accurate di- Differential Diagnosis I. Differential Diagnoses Main differentials include degenerative joint disease, fractures, and ligamentous injury (especially following a history of trauma and relevant findings on examination) Normal cranial nerves and absence of cerebellar signs suggest that the lesion is at the spinal cord level. Difference Between Upper (UMNL) and Lower Motor Neurone (LMNL) Lesions: UMNL LMNL Sensory Loss Diffuse Dermatome Weakness Diffuse Individual muscles Muscle bulk Normal (some from disuse) Atrophy Lower extremity tone Usually spastic Flaccid Differential Diagnosis (Please select no more than 7. Am Fam Physician. Botulism is characterized not only by A 69-year-old woman was admitted to the hospital with double vision, weakness in the lower extremities, sensory loss, pain and falls. Patients will present with Tibial muscular dystrophy is a condition that affects the muscles at the front of the lower leg. sive muscle spasticity and weakness, more prominent in lower limbs, muscle hypotrophy, and speaking and swallow-ing disturbances. Characterised by unilateral weakness, wasting, and pain, commonly in the quadriceps, then spreading later to the contralateral side asymmetrically. Abdominal distension Abdominal pain Acute illness Anaesthetics Arm weakness ATLS Back pain Bleeding problems Cardiac arrest Chest pain Clinical cases Clinical presentations Collapse Cough Diarrhoea Differential diagnosis Dizziness Emergencies Examination Fatigue Gastroenterology cases GI bleeding Headache Itch Jaundice Joint problems Leg pain Differential diagnosis Cervical radiculopathy. Differential diagnoses at the time included NMS versus meningoencephalitis. Bilateral Leg Weakness. Key Questions: (1) What is the differential diagnosis of progressive lower extremity paresis and paresthesias? (2) How would one approach diagnostic testing for such a patient? Leg Weakness. Our case highlights the clinical findings of an adolescent with HD and the differential diagnosis. Differential diagnosis Similar acute weakness can result from myasthenia gravis, botulism, poliomyelitis (mainly outside the US), tick paralysis, West Nile virus infection, metabolic neuropathies, and transverse myelitis, but these disorders can usually be distinguished as follows: Myasthenia gravis is intermittent and worsened by exertion. Patients usually experience areflexia, flaccid motor paralysis, with intact sphincter tone and sensory function. If the lumbar plexus is involved, the patellar reflex is usually diminished, whereas if the sacral portion of the plexus is involved, the hamstrings and Achilles reflexes can be diminished. However, due to its varied phenotypic expression, the mere absence of overt respiratory muscle involvement does not point against Pompe's disease. ) Antiphospholipid syndrome. Similar patterns of weakness may be seen in demyelinating polyneuropathies. Management depends on making a correct diagnosis. Vertebrobasilar insufficiency and demyelinating diseases should be at the forefront of your differential diagnosis list in these patients. “For people who sit a long time at work, the hip flexors and rotators become tight, and the gluteal muscles become weak,” he says. 1 Monitoring Cauda equina syndrome results in lower motor neurone signs and symptoms. The disease slowly progressed, and the The culprit in this case, Guillain Barre Syndrome, he added, tends to have a wide range of presentations. It is imperative to differentiate MP symptoms from other causes of pain and nerve discomfort that can have similar clinical presentations. g. asymmetrical weakness and pain of the muscles of the proximal lower limbs. It is usually detected during infancy. Identifying signs or symptoms of abnormal neurology in the legs will help the physician not to miss a problem such as cervical myelopathy, which could require urgent surgery. Certain associated symptoms may help localize the part of the nervous system that The focal onset of weakness in a single limb (monomelic disease, typically LMN in character) is a common presentation of MND. They may be transient or persistent, limited in distribution or generalised, and may involve any portion of the body innervated by sensory or afferent nerve fibres . Causes: Cramping in the hips, thighs and calves. diagnosed sacroiliac joint (SIJ) pain with single intra-articular injections of anesthetic and found an incidence ranging from 13% to 30% in low back pain sufferers. Evaluation and treatment of peroneal neuropathy. In patients presenting with symptoms of ascending bilateral lower limb weakness, consider Guillain-Barre Syndrome early and monitor frequently for evidence of impending respiratory compromise. A sensory level or loss of specific reflexes may help determine the segmental level the lesion. Diagnosis requires progressive weakness in two or more limbs due to neuropathy, areflexia – the absence of neurologic reflexes – a disease course less than four weeks, and the catchall exclusion of other causes. Lower motor neuron (LMN) syndromes are clinically characterised by muscle atrophy, weakness and hyporeflexia without sensory involvement. This is not the only cause of leg weakness, so you must keep an open mind. more generalized Diabetic Radiculoplexus Neuropathy (DRPN). Examination identified weakness in all four limbs and areflexia, suggesting a peripheral neuromuscular disorder. Abnormalities of muscle cell structure and metabolism lead to various patterns of weakness and dysfunction. Pure motor show increased weakness in abduction and may develop a Trendelenburg gait pattern. Neurologic signs of lumbosacral plexus injuries consist of motor deficit with flaccid paralysis associated with sensory deficits to all types of stimulation in the territory of the damaged nerve roots: a lower motor neuron paralysis. Proximal weakness: Weakness in proximal muscles (eg, shoulder girdle, quadriceps) resulting in difficulty standing up from a seated position or raising arms above head. The signs and symptoms of this condition typically appear after age 35. In this setting, however, the differential diagnosis is broad and includes a number of potentially treatable or more benign conditions (such as multifocal motor neuropathy with conduction block 14) . The peripheral entrapment neuropathies are also quite common. Blackman P, Bradshaw C, Crossley K. 24 The hereditary spastic-ataxia syndromes comprise a rare group of disorders characterised by slowly progressive lower limb spasticity and ataxia. normalities are present in the lower extremities. nih. She first awoke with dizziness but soon developed severe back pain, bilateral lower extremity pain and numbness, slurred speech, and inability to move her lower extremities or ambulate. The natural history of normal lower extremity alignment progression shows maximum varus between 6-12 months, neutral alignment by 18-24 months, maximum valgus at 4 years, and The main differential diagnosis considered initially in both cases was Guillain-Barré syndrome (GBS), but the clinical and laboratory characteristics favoured a diagnosis of myositis for both patients. Neurological examination revealed lower limb weakness with power 3/5, exaggerated deep tendon reflexes, bilateral sustained clonus, impaired sensation below the umbilicus, spasticity, and a positive Babinski sign. Similar results were obtained from seven patients with genuine weakness and in the non-affected limbs of nine patients with "non-organic" mono- or hemiparesis. As with sensory loss, weakness begins in the toes, and as the polyneuropathy progresses, it ascends up the distal lower extremities to the level of the knees, at which time motor involvement in the hands may be observed. There is a broad range of underlying causes including drugs, alcohol, thyroid disease, osteomalacia, idiopathic inflammatory myopathies (IIM), hereditary myopathies, malignancy, infections and sarcoidosis. There was no history of bowel or bladder incontinence. International Society of Lymphology. Weakness with very little wasting is the general rule, certainly in early disease, and this should always prompt consideration of an alternative diagnosis to MND. 11 Causes of Sudden Leg Weakness. A mononeuropathy may result from pathology located anywhere along the course of the peripheral nerve, from the dorsal root ganglion through to the lumbosacral plexus and the terminal individual named nerves. Deep tendon reflexes of lower limb were brisk. A variety of hereditary causes are recognised, including spinal muscular atrophy, distal hereditary motor neuropathy and LMN variants of Guillain-Barré syndrome (GBS), an acute inflammatory polyneuropathy, is currently considered the most frequent cause of flaccid paralysis in children. Hypotonia is a decreased resistance to passive range of motion. Chronic exertional compartment syndrome in the lower leg. She was admitted to the intensive care unit (ICU). Differential Diagnosis. Clinically isolated syndrome presenting as transverse myelitis. Specific patterns of weakness: asymmetry, distal weakness, respiratory weakness and facial/ocular weakness narrow the differential diagnosis. See full list on radiopaedia. Some common causes of leg pain include: Diagnosis: Biopsy; CSF examination Plexopathies Causes Nerve infiltration; Autoimmune disorders; Iatrogenic: Radiation Brachial plexus: Pain ± Lower plexus involvement MRI: May show thickened or enhancing nerves or roots Cauda equina syndrome: Neoplastic infiltration Pathology: Axonal loss ± segmental demyelination Onset: After diagnosis of tumor Epidemiology: Majority male & > 50 years Clinical Weakness Asymmetric; Arms > Legs Mild Lower motor neuron only Normal bulbar Cramps: Painful Painless in some patients Course: Progressive then stabilizes or improves Associated with Non-Hodgkin Lymphoma Symptoms are most pronounced in the face, tongue, and hand muscles with lesser involvement of lower limb. Cauda equina: Loss of perianal sensation, loss of rectal tone, or urinary retention. Laboratory Results: The lumbar puncture CSF, heavy metal, porphyria, and connective tissue screening were all normal. I3 The posterior pelvic spines should be Numbness and weakness in the leg or knee Most of us have had our leg “fall asleep,” where we experience numbness or weakness to the point of being unable to stand or walk. 84, 96 Schwarzer et al. Limb Weakness STROKE: APROACH AND MANAGEMENT BY DR. If there is weakness, it will affect the quadriceps (knee extension) and psoas (hip flexion) muscles. She reports having a 2-day history of headaches and back In monoplegia, the spine and the proximal portion of nerves are usually the abnormal sites of limb weakness. Myopathy refers to a clinical disorder of the skeletal muscles. Cause of Injury: Acetabular pelvic fracture; Trendelenburg’s gait, Trendelenburg’s sign; Inferior gluteal. Numbness, weakness in lower extremities, pain radiating to buttock and leg (especially if the pain radiates beyond the knees), and Wrist or finger drop are common initial symptoms, but a third of cases present in the lower limb. The craniofacial syndrome with assymmetric crying facies, congenital heart defects, and other factors may be confused with Möbius syndrome. g. Step 2. Radiation myelopathy. e. • Most of the published literature has focused on the lower limb form (DLRPN). Assess power, ask about pre-existing weakness & measure glucose. Ocular, sensory or autonomic dysregulation signs are usually late features of the disease. Cervical Dystonia in adults (≥5% of patients): dysphagia, neck pain, muscle weakness, injection site pain, and musculoskeletal pain. Minimally invasive diagnostic injections can also be utilized to evaluate other etiologies of lower limb pain in the differential diagnosis for lumbar radicular pain. The patient was diagnosed with thyrotoxic periodic paralysis. 2–4 Differential diagnosis of GBS offers a wide range of possibilities; the most important diseases to rule out are spinal canal compression, transverse myelitis, botulism, and cerebellar ataxia. asymmetric and involve only one side of the body or one limb. Monoparesis: Weakness of one limb. In people with a seizure disorder, one side of the body may become weak after a seizure stops (called Todd paralysis). Many other names have also been proposed, including Bruns-Garland syndrome, diabetic lumbosacral plexopathy and diabetic lumbosacral radiculoplexus neuropathies. Current reviews in musculoskeletal medicine. 6,11,12 Differential Diagnosis for Management of Lateral Hip Pain: A Case Report DISORDERS : LOWER LIMB Hip arthritis Trochanteric Bursitis Illiotibial Band Syndrome Patellofemoral Pain Pes Anserinus Bursitis Bakers Cyst Plantar Fasciitis Mortons Neuroma polyneuropathy characterised by progressive limb weak-ness and areflexia, commonly associated with CSFalbu-minocytological dissociation and neurophysiological Figure 1 Bifacial lower motor neurone weakness (see online supplementary video). Nonstructural causes include radiation therapy, diabetes, vasculitis, and perivasculitis. This 16-year-old male presents with a head injury. Management of distal RTA is oral bicarbonate. Patient initially presents with upper motor neuron deficit ( spasticity) followed by lower motor neuron deficit ( flaccidity ). The pain is usually distributed in a dermatomal pattern (Fig. The diagnosis of potentially life-threatening neurologic and neuromuscular processes requires a systematic, anatomic approach based upon a careful history, physical examination, and in some cases, imaging studies. Neurologic disorder - polyneuropathy, motor neurone disease. It can be a condition on its own, called benign congenital hypotonia, or it can be indicative of another problem where there is progressive loss of muscle tone, such as muscular dystrophy or cerebral palsy. Srividya Naganathan, MD* 3. Usually unilateral sensory loss over inner thigh and weak hip adduction and rotation. Lower Limbs Tone. Differential diagnosis would be gitelman syndrome and bartter syndrome. Pure Motor Hemiparesis, a form of hemiparesis characterized by sided weakness in the leg, arm, and face, is the most commonly diagnosed form of hemiparesis. • Cataplexy Differential diagnosis include muscular dystrophies (LGMD, Becker MD, scapuloperoneal MD), genetic metabolic diseases (glycogen storage diseases [debrancher deficiency, branching enzyme deficiency, myophosphorylase deficiency, phosphofructokinase deficiency) and mitochondrial disorders, and polymyositis. Presentation. Weakness is a common, nonspecific emergency department (ED) complaint that encompasses a broad differential diagnosis. Santhosh Eapen, MD* <!-- --> 1. Progressive proximal lower limb weakness with calf pseudohypertrophy in early childhood. Secondary hyperkalemic paralysis is characterized by vague muscle pain with subsequent muscle weakness, generally occurring in an ascending pattern, with facial and respiratory muscles affected last. In infants, botulism should be considered. The MRI findings of lumbosacral neuritis can easily be overlooked in the absence of a high index of suspicion. Causes of lower leg tingling include neurological issues of the back, restless leg syndrome, or diabetic neuropathy. Rosenthal, PT, DSc, ATC ABSTRACT Upper extremity weakness can be the result of a myriad of conditions ranging from contractile tissue injury, joint injury, or injury to central or peripheral nervous system components. CASE PRESENTATION A 17--yearold right-handed young man previously healthy presented to neurology clinic with progres-sively worsening right upper extremity weakness since past 9 months. If considering an inflammatory cause of leg ulceration, diagnostic tests may involve: Deep skin biopsy of ulcer edge for histology, fungal/mycobacterial culture, direct immunofluorescence Lower extremity weakness, numbness or paresthesias (usually bilateral) Decreased or absent lower extremity reflexes Hypotonia/atrophy of the lower extremities (in chronic presentations) Urinary retention (increased post void residual) — viral cerebellitis, especially 2–10 years old (pyrexia, limb/gait ataxia, and dysarthria, with recovery over a period of weeks) — Postinfectious encephalomyelitis, especially varicella. There was no preceding fever, diarrhea, vaccination or drug intake. L3 root dysfunction: Pain radiates from the low back to upper leg. Abstract Tremor is one of the most common involuntary movement disorders seen in clinical practice. Leg pain is a common presenting symptom of lumbar disc herniation due to neurological compression. The differential diagnosis of GBS in childhood is primarily in the spectrum of progressive, symmetric weakness. The distribution of symptoms is the principal mode of recognition of the specific nerve injury, and the specific positions and activities that exacerbate The disorder is caused by mutations of a gene, dysferlin, that also causes limb-girdle muscular dystrophy type 2B (LGMD2B), a rare muscle disorder characterized by weakness of the proximal muscles of the of the hip and shoulder areas (limb-girdle area). One of the main symptoms is foot drop along with wasting of the lower leg muscles, giving a typical “stork leg” appearance. Rationale: The patient is presenting with fatigue and weight loss which may be indicative of diabetes mellitus type 2, and his blood glucose is abnormally high. Decreased muscle tone with absent or diminished lower extremity weakness on the affected side are usually seen in lumbosacral plexus injury (lower motor neuron signs). The lower extremity involvement is rare in shingles, and the skin rash is easily mistaken for various other forms of vesicular rash and infections. Cause of Injury: Acetabular pelvic fracture, s/p hip replacement; Abnormal gait, gluteus maximus weakness resulting in gluteus maximus lurch; Differential Diagnosis Differential Diagnosis. Deep vein thrombosis (DVT) is the formation of a blood clot in a deep vein, most commonly in the legs or pelvis. , inflammatory or toxic myopathy) or genetic (e. plantars extensor and symmetrical LMN • Conus leison • Cauda equina leion • Bilateral symmetrical • Asymmetrical of both lower limbs involvement of A differential diagnosis was performed at initial evaluation when the symptoms did not align with the typical presentation of trochanteric bursitis. Functional weakness is weakness of an arm or leg due to the nervous system not working properly. Differential Diagnosis The distribution of the facial weakness and lack of other associated palsies usually causes differentiated diagnosis. LMN signs in one or more limb). Viral myositis with weakness and an elevated CPK may develop after a respiratory infection and especially during a flu epidemic. , difficulty swallowing Differential Diagnosis: There are multiple causes of chronic heel pain in runners and it is important to be aware of other pathologies in this area, as outlined in the picture below: Key Differential diagnoses in the running population, include fat pad contusion in the heel, calcaneal fracture, and retrocalcaneal bursitis. AL BAGHDADI 2. Many of the other causes of leg weakness will be covered in other areas and are outside the scope of this resource. The key to the Flail-leg syndrome or lower limb diplegia is a form of motor neuron disease characterized by a slower progression rate. Copper deficiency. Sarcoidosis. Symptoms can include pain, swelling, redness, and enlarged veins in the affected area, but some DVTs have no symptoms. 1). Patient’s description of headaches, swelling of the lower extremities, consecutive uncontrolled hypertensive blood pressures, combined with the potential for chronic hypertensive damage leading to organ dysfunction, provides rationale for this differential diagnosis. If conser-vative management fails, a large number of these patients might undergo lumbar spine surgery. The differential diagnosis includes an acquired (e. This article looks at the assessment, diagnosis and management of cellulitis, focusing on the lower limb. The absence of nourishing stimulation leads to muscle atrophy and disorganized interpretation of proximal activity produces fasciculation. Can be asymptomatic, but can cause an ache on walking. Parkinson's disease). 7 , 8 Weakness progresses in a caudo-cranial direction, but there are exceptions to this pattern. superficial venous dilation, LE paralysis or immobilization, unilateral pitting edema, cancer, confinement to bed >3 days, localized tenderness, ortho surgery < 6 months ago, whole lower limb enlargement, calf enlargement >3 cm compared to contralateral An alternative diagnosis to DVT as likely or more is -2 points Spinal cord ischemia presents with acute onset back pain, bilateral weakness and paresthesia. The condition is commonly known as diabetic amyotrophy. Associated symptoms. This pain is caused by compression of the roots of the spinal nerves in the lumbar region of the spine. Approach 3. ” 11 To explore differential diagnosis value of dissociated lower-limb muscle impairment, we performed a retrospective analysis of clinical and electrophysiological features in 141 lower-limb involved ALS patients, 218 normal controls, 67 disease controls, and 32 lumbar spondylosis disease patients. Differential diagnoses include acute transverse myelopathy, myelitis, Gui The information on the differential diagnoses of leg cramps and their distinguishing clinical features is based on expert opinion in review articles [Monderer et al, 2010; Allen and Kirby, 2012; Hamlet, 2012; Berger, 2014; Brown, 2015] and a systematic review on the criteria in diagnosing nocturnal leg cramps [Hallegraeff et al, 2017]. g. Leg weakness is often caused by lesions in the spine. Spinal cord lesions: Upper motor neuron signs, sphincter dysfunction, and autonomic dysfunction may be present. The diagnosis and treatment of peripheral lymphedema. Hemiparesis with origin in the lower section of the brain creates a condition known as ataxia, a loss of both gross and fine motor skills, often manifesting as staggering and stumbling. man with a six week history of back pain, along with leg weakness and pain who, on exam, shows weakness affecting several leg muscles bilaterally as well as objective sensory deficits in the right leg and patchy saddle anesthesia. therefore the asymmetrical LMN main distinction paralysis in cauda between the two is the equina syndrome. Abstract. Using univariate regression analysis, vital capacity (VC) was weakly, but significantly, correlated to shoulder motility, Walton score and lower-limb Upper or lower limb weakness: Pyramidal distribution weakness: Partial myelitis affecting spinothalamic tract and posterior columns: Unilateral or bilateral limb numbness or paraesthesias L’Hermitte’s phenomenon (short electric shock-like sensation on neck movement) Sensory level: Brainstem distal limb weakness of myopathic origin is uncommon and, therefore, other neuromuscular disorders must be consid- ered, including motor neuron diseases and polyneuropathies. 3 7 9 11 This can be accompanied by the characteristic examination findings of “champagne bottle” pattern of lower limb wasting, absent Achilles tendon reflexes, finger flexion contractures, pes cavus, and “hammer toes. lower limb weakness differential diagnosis