An Algorithm for the Initial Workup of a Pt with Weakness - Flowchart

An Algorithm for the Initial Workup of a Pt with Weakness - Flowchart

An Algorithm for the Initial Workup of a Pt with Weakness - Flowchart

«Flowchart»

Distribution of Weakness

Distribution of Weakness

Distribution of Weakness

Distribution of Weakness

Hemiparesis

Hemiparesis

Hemiparesis

Paraparesis

Paraparesis

Paraparesis

Quadriparesis

Quadriparesis

Quadriparesis

Monoparesis

Monoparesis

Monoparesis

Distal

Distal

Distal

Proximal

Proximal

Proximal

Restricted

Restricted

Restricted

Brain CT or MRI^†

Brain CT or MRI^†

Brain CT or MRI^†

Brain CT or MRI ^† †

Spinal MRI^‡

Spinal MRI^‡

Spinal MRI^‡

Spinal MRI^‡ ^‡ ‡

End

End

End

Cerebral signs

Cerebral signs

Cerebral signs

Yes

Yes

Yes

No

No

No

End

End

End

End

End

End

EMG and NCS

EMG and NCS

EMG and NCS

EMG and NCS

UMN pattern

UMN pattern

UMN pattern

LMN pattern

LMN pattern

LMN pattern

Myopathic pattern

Myopathic pattern

Myopathic pattern

Alert

Alert

Alert

Yes

Yes

Yes

No

No

No

Anterior horn, root, or peripheral nerve disease

Anterior horn, root, or peripheral nerve disease

Anterior horn, root, or peripheral nerve disease

Muscle or neuromuscular junction disease

Muscle or neuromuscular junction disease

Muscle or neuromuscular junction disease

^* Or signs of myopathy

^* Or signs of myopathy

^* Or signs of myopathy

^*

^† If no abnormality detected, consider spinal MRI.

^† If no abnormality detected, consider spinal MRI.

^† If no abnormality detected, consider spinal MRI.

^†

^‡ If no abnormality detected, consider myelogram or brain MRI.

^‡ If no abnormality detected, consider myelogram or brain MRI.

^‡ If no abnormality detected, consider myelogram or brain MRI.

^‡

UMN signs

UMN signs

UMN signs

LMN signs^*

LMN signs^*

^* * LMN signs

UMN signs

UMN signs

UMN signs

LMN signs^*

LMN signs^*

^* * LMN signs

UMN signs

UMN signs

UMN signs

LMN signs^*

LMN signs^*

^* * LMN signs

CT, computed tomography; EMG, electromyography; LMN, lower motor neuron; MRI, magnetic resonance imaging; NCS, nerve conduction studies; UMN, upper motor neuron.

CT, computed tomography; EMG, electromyography; LMN, lower motor neuron; MRI, magnetic resonance imaging; NCS, nerve conduction studies; UMN, upper motor neuron.

CT, computed tomography; EMG, electromyography; LMN, lower motor neuron; MRI, magnetic resonance imaging; NCS, nerve conduction studies; UMN, upper motor neuron.

Brain CT or MRI^†

Brain CT or MRI^†

Brain CT or MRI ^† ^† Brain CT or MRI

Spinal MRI ^‡

Spinal MRI ^‡

^‡ ‡ Spinal MRI