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Table 53-2

Common Causes of Weakness

Upper Motor Neuron
Cortex: Ischemia; hemorrhage; intrinsic mass lesion (primary or metastatic cancer, abscess); extrinsic mass lesion (subdural hematoma); degenerative (amyotrophic lateral sclerosis)
Subcortical white matter/internal capsule: Ischemia; hemorrhage; intrinsic mass lesion (primary or metastatic cancer, abscess); immunologic (multiple sclerosis); infectious (progressive multifocal leukoencephalopathy)
Brainstem: Ischemia, immunologic (multiple sclerosis)
Spinal cord: Extrinsic compression (cervical spondylosis, metastatic cancer, epidural abscess); immunologic (multiple sclerosis, transverse myelitis); infectious (AIDS-associated myelopathy, HTLV-I-associated myelopathy, tabes dorsalis); nutritional deficiency (subacute combined degeneration)
Motor Unit
Spinal motor neuron: Degenerative (amyotrophic lateral sclerosis), infectious (poliomyelitis)
Spinal root: Compressive (degenerative disk disease); immunologic (Guillain-Barré syndrome); infectious (AIDS-associated polyradiculopathy, Lyme disease)
Peripheral nerve: Metabolic (diabetes mellitus, uremia, porphyria); toxic (ethanol, heavy metals, many drugs, diphtheria); nutritional (B12 deficiency); inflammatory (polyarteritis nodosa); hereditary (Charcot-Marie-Tooth); immunologic (paraneoplastic, paraproteinemia); infectious (AIDS-associated polyneuropathies and mononeuritis multiplex); compressive (entrapment)
Neuromuscular junction: Immunologic (myasthenia gravis); toxic (botulism, aminoglycosides)
Muscle: Inflammatory (polymyositis, inclusion body myositis); degenerative (muscular dystrophy); toxic (glucocorticoids, ethanol, AZT); infectious (trichinosis); metabolic (hypothyroid, periodic paralyses); congenital (central core disease)

Abbreviation: AZT, azidothymidine.