Neurology Exam Prep Podcast Morning Report: Progressive weakness and numbness
Apr 1, 2020
Chris Traynor, a PGY-4 neurology resident, discusses a compelling case of a 67-year-old woman experiencing progressive leg numbness. The conversation dives into her complex medical history and the significance of differential diagnoses, including Guillain-Barré syndrome. Traynor emphasizes the importance of thorough clinical evaluations and the risks associated with lumbar punctures in potential spinal conditions. He also examines neurological complexities linked to immunosuppression, shedding light on the intricate connections between various conditions and treatment responses.
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Temporal Progression Aids Localization
- Evaluate the temporal onset and progression of neurological symptoms carefully.
- Assess sensory, motor, and autonomic involvement to localize the lesion effectively.
Sensory Symptoms Exclude Pure Myopathy
- Neuromuscular junction disorders typically cause episodic fatigue, not steadily progressive weakness.
- Involvement of sensation early on usually excludes pure muscle disease.
Consider Compressive Myelopathy
- Always consider compressive spinal cord lesions such as tumors or infections in progressive, ascending weakness and numbness.
- Early compression damages lateral corticospinal and spinothalamic tracts affecting legs before arms, mimicking ascending sensory symptoms.