True motor<unk>  (neuromuscular<unk> ? Bilateral or unilateral (distribution of<unk> ?
Bilateral<unk> :
Symmetric ascending paralysis? Guillain-Barre Syndrome<unk>  involving both central and peripheral nervous system? Inflammatory/Autoimmune or toxic/metabolic
Discrete sensory level and/or bladder dysfunction? Spinal Cord Lesion
Involvement of proximal > distal musculature? Myopathy
Unilateral<unk> : CVA, TIA
If non-neuromuscular<unk>  then BROAD differential, obtain:
ECG, CBC, Chem10, LFTs, blood cultures, UA/urine culture, drug levels, CXR, Consider Head CT (focal deficit, altered, history of cancer, anticoagulation<unk> ith minor trauma)
Onset of<unk>  sudden or gradual?
Sudden suggests vaso-occlusive etiology CVA/TIA
Gradual onset likely non-vascular
Significant event surrounding onset of<unk> ?
Seizure prior to<unk> ? Todd’s paralysis
Migraine headache? Complicated migraine
Sudden onset of severe headache? SAH
Trauma? Epidural or Subdural Hematoma
Severe migratory neck or chest pain? Arterial dissection syndromes
Temporal pattern to<unk> ? Fluctuating or fixed<unk> ?<unk> <unk> ith repetitive motions? Neuromuscular junction pathology like Myasthenia Gravis
Associated symptoms?
Headache: SAH, epidural/SDH, complicated migraines (young females), not usually stroke/TIA (unless high intracranial pressure)
Vision changes: Posterior circulation stroke, Myasthenia Gravis
Shortness of breath: cardiovascular etiology
Chest pain or neck pain: Acute carotid/vertebral/aortic dissection, AMI
Abdominal or back pain:<unk> ith alteration of bowel habits? Botulism, organophosphate poisoning, toxins, Guillain-Barre Syndrome, Electrolyte Imbalance.<unk> ith lower extremity<unk> ? AAA<unk> ith spinal cord infarction
Back pain<unk> ith unilateral<unk> ? Herniated disk<unk> ith nerve impingement
Bilateral<unk> <unk> ith sensory level s/p trauma? SCI, Cauda Equina Syndrome
Nausea/vomiting: sign of ↑ ICP, can lead to electrolyte imbalances
Rash: Dermatomyositis
Bilateral<unk> :
Symmetric ascending paralysis? Guillain-Barre Syndrome<unk>  involving both central and peripheral nervous system? Inflammatory/Autoimmune or toxic/metabolic
Discrete sensory level and/or bladder dysfunction? Spinal Cord Lesion
Involvement of proximal > distal musculature? Myopathy
Unilateral<unk> : CVA, TIA
Symmetric ascending paralysis? Guillain-Barre Syndrome<unk>  involving both central and peripheral nervous system? Inflammatory/Autoimmune or toxic/metabolic
Discrete sensory level and/or bladder dysfunction? Spinal Cord Lesion
Involvement of proximal > distal musculature? Myopathy
ECG, CBC, Chem10, LFTs, blood cultures, UA/urine culture, drug levels, CXR, Consider Head CT (focal deficit, altered, history of cancer, anticoagulation<unk> ith minor trauma)
Sudden suggests vaso-occlusive etiology CVA/TIA
Gradual onset likely non-vascular
Seizure prior to<unk> ? Todd’s paralysis
Migraine headache? Complicated migraine
Sudden onset of severe headache? SAH
Trauma? Epidural or Subdural Hematoma
Severe migratory neck or chest pain? Arterial dissection syndromes<unk> <unk> ith repetitive motions? Neuromuscular junction pathology like Myasthenia Gravis
Headache: SAH, epidural/SDH, complicated migraines (young females), not usually stroke/TIA (unless high intracranial pressure)
Vision changes: Posterior circulation stroke, Myasthenia Gravis
Shortness of breath: cardiovascular etiology
Chest pain or neck pain: Acute carotid/vertebral/aortic dissection, AMI
Abdominal or back pain:<unk> ith alteration of bowel habits? Botulism, organophosphate poisoning, toxins, Guillain-Barre Syndrome, Electrolyte Imbalance.<unk> ith lower extremity<unk> ? AAA<unk> ith spinal cord infarction
Back pain<unk> ith unilateral<unk> ? Herniated disk<unk> ith nerve impingement
Bilateral<unk> <unk> ith sensory level s/p trauma? SCI, Cauda Equina Syndrome
Nausea/vomiting: sign of ↑ ICP, can lead to electrolyte imbalances
Rash: Dermatomyositis<unk> ith alteration of bowel habits? Botulism, organophosphate poisoning, toxins, Guillain-Barre Syndrome, Electrolyte Imbalance.<unk> ith lower extremity<unk> ? AAA<unk> ith spinal cord infarction
Back pain<unk> ith unilateral<unk> ? Herniated disk<unk> ith nerve impingement
Bilateral<unk> <unk> ith sensory level s/p trauma? SCI, Cauda Equina Syndrome
Focus on clarifying if patient has true loss of strength and determining distribution of deficits. Check for trauma, carotid bruits, thyroid enlargement, irregular rhythm, unequal pulses, rashes or ticks.
Weakness
Neuromuscular weakness
Extrapyramidal reaction
Upper motor neuron:
Hallucinations
CVA
Numbness
Hemorrhagic stroke