Assessment of the Patient with Weakness or Paralysis - Flowchart

Assessment of the Patient with Weakness or Paralysis - Flowchart

Assessment of the Patient with Weakness or Paralysis - Flowchart Assessment of the Patient with Weakness or Paralysis Assessment of the Patient with Weakness or Paralysis

Flowchart

Weakness/paralysis

Weakness/paralysis

Weakness/paralysis

Manage as TIA (Chapter 66)

Manage as TIA (Chapter 66)

Manage as TIA (Chapter 66)

End

End

End

Key observations and appropriate assessment
Obtain history and perform focused examination

Key observations and appropriate assessment
Obtain history and perform focused examination

Key observations and appropriate assessment
Obtain history and perform focused examination

Urgent CT +/– CT-A
Consider thrombolysis
Manage as stroke (Chapter 65)

Urgent CT +/– CT-A
Consider thrombolysis
Manage as stroke (Chapter 65)

Urgent CT +/– CT-A
Consider thrombolysis
Manage as stroke (Chapter 65)

Chapter 65

Acute stroke syndrome?

Acute stroke syndrome?

Acute stroke syndrome?

Resolved (typically in mins)

Resolved (typically in mins)

Resolved

No

No

No

Ongoing

Ongoing

Ongoing

^* - typically in context of acute (polyradiculo-)neuropathy or myaesthenic syndrome

^* - typically in context of acute (polyradiculo-)neuropathy or myaesthenic syndrome

^* - typically in context of acute (polyradiculo-)neuropathy or myaesthenic syndrome

^*

^** - typically multiple, painful, mononeuropathies

^** - typically multiple, painful, mononeuropathies

^** - typically multiple, painful, mononeuropathies

^**

^*** - may require consevative management only

^*** - may require consevative management only

^*** - may require consevative management only

^***

Neuromuscular respiratory failure possible^*?

Neuromuscular respiratory failure possible^*?

Neuromuscular respiratory failure possible^*?

^* *

Yes

Yes

Yes

No

No

No

Contact ITU

Contact ITU

Contact ITU

Likely diagnosis is GBS (Chapter 71) or myasthenia gravis
Monitor closely
Obtain neurological opinion

Likely diagnosis is GBS (Chapter 71) or myasthenia gravis
Monitor closely
Obtain neurological opinion

Likely diagnosis is GBS (Chapter 71) or myasthenia gravis
Monitor closely
Obtain neurological opinion

Chapter 71

VC < 1.5 L or < 80% predicted?

VC < 1.5 L or < 80% predicted?

VC < 1.5 L or < 80% predicted?

Yes

Yes

Yes

No

No

No

Urgent MRI spine

Urgent MRI spine

Urgent MRI spine

Acute spinal cord (or cauda equina) syndrome?

Acute spinal cord (or cauda equina) syndrome?

Acute spinal cord (or cauda equina) syndrome?

Yes

Yes

Yes

No

No

No

Neurosurgical opinion
See spinal cord compression (Chapter 65)

Neurosurgical opinion
See spinal cord compression (Chapter 65)

Neurosurgical opinion
See spinal cord compression (Chapter 65)

spinal cord compression Chapter 65

Compression/tumour?

Compression/tumour?

Compression/tumour?

Yes

Yes

Yes

No

No

No

Inflammatory?

Inflammatory?

Inflammatory?

Consider aspirin
See stroke (Chapter 99)

Consider aspirin
See stroke (Chapter 99)

Consider aspirin
See stroke (Chapter 99)

stroke Chapter 99

Stroke?

Stroke?

Stroke?

Yes

Yes

Yes

No

No

No

Yes

Yes

Yes

Neurology opinion
Consider CSF analysis and steroids

Neurology opinion
Consider CSF analysis and steroids

Neurology opinion
Consider CSF analysis and steroids

Urgent vascultic screen (see p xx)
Consider steroids

Urgent vascultic screen (see p xx)
Consider steroids

Urgent vascultic screen (see p xx)
Consider steroids

Check CK
Monitor renal function (see Chapter 25)

Check CK
Monitor renal function (see Chapter 25)

Check CK
Monitor renal function (see Chapter 25)

Rhabdomyolysis?

Rhabdomyolysis?

Rhabdomyolysis?

Yes

Yes

Yes

No

No

No

Soon MRI

Soon MRI

Soon MRI

Other polyradicular, plexus, nerve or muscle syndrome?

Other polyradicular, plexus, nerve or muscle syndrome?

Other polyradicular, plexus, nerve or muscle syndrome?

Subacute CNS or monoradicular^*** syndrome?

Subacute CNS or monoradicular^*** syndrome?

Subacute CNS or monoradicular^*** syndrome?

^*** ***

Yes

Yes

Yes

No

No

No

Yes

Yes

Yes

Investigations dependent on syndrome/likely cause
Neurology opinion and specialist investigations likely to be required

Investigations dependent on syndrome/likely cause
Neurology opinion and specialist investigations likely to be required

Investigations dependent on syndrome/likely cause
Neurology opinion and specialist investigations likely to be required

Acute vasculitis possible^**?

Acute vasculitis possible^**?

Acute vasculitis possible^**?

^** **

Yes

Yes

Yes

No

No

No