369.2 𩺠åèç
369.2.1 é«é »èé»
369.2.1.1 MRC Strength Grading
- 0: no contraction
- 1: trace (visible)
- 2: movement without gravity
- 3: against gravity
- 4: against some resistance
- 5: normal
369.2.1.2 UMN vs LMN
- UMN: spastic, hyperreflexia, Babinski, late atrophy
- LMN: flaccid, hyporeflexia, fasciculations, early atrophy
369.2.1.3 ALS Features
- Combined UMN + LMN
- No sensory
- No autonomic
- No cognitive (most)
- Diagnosis: clinical + EMG
369.2.1.4 Guillain-Barré
- Ascending weakness
- Areflexia
- Often after viral/GI infection (Campylobacter)
- Albuminocytologic dissociation (â protein, normal cells)
- Treatment: IVIG or plasma exchange (NOT steroids)
- Monitor respiratory (PFTs, NIF)
369.2.1.5 MG
- Fatigable weakness (ocular, bulbar, generalized)
- AChR antibodies (85%), MuSK (5-10%), seronegative
- RNS decremental
- Ice pack test
- Treatment: pyridostigmine + immunosuppression + thymectomy
- Crisis: IVIG or plasma exchange
369.2.1.6 LEMS
- Proximal weakness, improves with use
- Autonomic (dry mouth)
- VGCC antibodies
- Paraneoplastic (SCLC) often
- Treatment: 3,4-DAP, IVIG, treat cancer
369.2.1.7 Polymyositis / Dermatomyositis
- Proximal symmetric weakness
- â CK
- Anti-Jo-1 (and other anti-synthetase)
- DM: skin (heliotrope, Gottron)
- Cancer risk in DM
- Steroids + IS
369.2.1.8 Periodic Paralysis
- Hypokalemic (autosomal dominant) â most common
- Hyperkalemic
- Triggered by carbs, exercise, stress
- Treatment: acetazolamide
369.2.1.9 Distinguishing Features
| Type | Tone | Reflexes | Atrophy | Fasciculations | Distribution |
|---|---|---|---|---|---|
| UMN | Spastic | â | Late | No | Hemi, para, quad |
| LMN | Flaccid | â | Yes | Yes | Variable |
| NMJ | Normal | Normal | Late | No | Ocular, bulbar, fatigable |
| Myopathy | Normal/flaccid | Normal/â | Variable | No | Proximal symmetric |
| Functional | Variable | Normal | No | No | Inconsistent |