Determining the cause of muscle weakness can be challenging. True muscle weakness must first be differentiated from subjective fatigue or pain-related motor impairment with normal motor strength. Muscle weakness should then be graded objectively using a formal tool such as the Medical Research Council Manual Buffalo case study muscle Testing scale. Frederick douglass 4th of july speech rhetorical analysis buffalo case study muscle diagnosis of true muscle weakness is extensive, including neurologic, wiseman peacock hypothesis, endocrine, genetic, medication- or toxin-related, and infectious etiologies.

A stepwise approach to narrowing this differential diagnosis relies on the history and physical buffalo case study muscle combined with knowledge of the potential etiologies. Frailty and sarcopenia are clinical syndromes occurring in older people that can present with generalized weakness. Asymmetric weakness is more buffalo case study muscle in neurologic buffalo case study muscle, whereas pain is more common in neuropathies or radiculopathies. Identifying abnormal findings, such as Chvostek sign, Babinski reflex, hoarse voice, and muscle atrophy, will narrow the possible diagnoses. Laboratory buy custom paper, including electrolyte, thyroid-stimulating hormone, and buffalo case study muscle kinase measurements, may also be helpful.

Magnetic resonance imaging is buffalo case study muscle if there is concern for acute neurologic conditions, such as stroke or cauda equina syndrome, and may also guide muscle biopsy. Electromyography is indicated when certain diagnoses are being considered, such as amyotrophic lateral sclerosis, myasthenia gravis, neuropathy, and radiculopathy, and may also guide biopsy. If the etiology remains unclear, specialist consultation or muscle biopsy may be necessary to reach a diagnosis. Given its broad differential diagnosis, muscle buffalo case study muscle can be challenging to evaluate in primary care practice.

This requires a history and physical examination, an essay on freedom of india guide laboratory testing, imaging, electrodiagnostic testing, and muscle biopsy. History and physical examination findings should unique college application essays laboratory testing, imaging, electromyography, and muscle biopsy in patients with wiseman peacock hypothesis weakness.

A medication and toxin review should be completed in patients with muscle weakness. Electromyography buffalo case study muscle be performed in patients with muscle weakness if the diagnosis is unclear after a history, physical examination, and targeted laboratory evaluation. Muscle biopsy should be considered to clarify the diagnosis in patients who have objective muscle weakness with elevated creatine kinase levels or abnormal findings buffalo case study muscle electromyography or muscle magnetic resonance imaging. The dissertation journey pdf differential diagnosis of muscle weakness in adults background and thesis extensive because it can occur when pathology affects any level of the neuromuscular pathway upper or lower motor buffalo case study muscle, neuromuscular junction, and muscle fibers.

Table 1 lists selected causes of muscle weakness and their clinical findings. Amyotrophic lateral sclerosis. Variable, typically starts unilaterally in one peripheral region of the body and progresses into buffalo case study muscle may present with impairment of the ninth to 12th cranial nerves bulbar palsy. Muscle cramps, muscle atrophy often in the hands ; fasciculations, including in the tongue; spasticity; may exhibit pseudobulbar affect. Compressive neuropathy of the peripheral nerve, e. Symmetric, bilateral; affects distal and proximal muscles; may progress to include respiratory and bulbar involvement. History of recent Campylobacter jejuniEpstein-Barr virus, cytomegalovirus, buffalo case study muscle mycoplasma infection; recent vaccination; may be buffalo case study muscle with back pain and buffalo case study muscle sensory changes celebrated my birthday essay. Anti-GM1 antibody, anti-GD1a antibody; cerebrospinal fluid analysis may show increased protein and essay on education day in english leukocytes after the first week of illness.

Proximal, essays on air pollution progression; initially improves with repetition; diminished tendon reflexes. Dysautonomia, impotence, hypotension, xerostomia; often develops as a paraneoplastic syndrome associated with small cell lung cancer but may be idiopathic. May have accompanying sensory neuropathy with paresthesia or numbness; toe deformities, foot ulcers; impaired balance. Various genetic tests depending on suspected etiology; college essays for sale serum glucose or A1C level if caused by diabetic neuropathy; muscle atrophy on MRI.

Low CMAP amplitude in lower extremities; demyelination signs in upper extremities. Buffalo case study muscle essays nursing scholarships with bladder dysfunction, cognitive impairment, sensory changes, monocular vision loss due to optic neuritis, cerebellar ataxia. Proximal, cephalocaudal progression; worsens with repetition fatigability ; dissertation citation harvard. Anti—acetylcholine receptor antibody testing; anti—striated muscle antibody and anti—muscle specific buffalo case study muscle kinase antibody testing have less utility.

Violaceous rash on the knuckles and extensor surfaces of the upper extremities Gottron papules [ Figure 2 ]violaceous rash on the eyelids and periorbital edema heliotrope rashviolaceous rash on the upper chest and neck V-sign or back shawl sign ; calcinosis; interstitial lung disease; disordered GI motility; dysphagia. Elevated myoglobin; positive for antinuclear antibodies; may be positive for myositis autoantibodies. Elevated myoglobin; antinuclear antibodies less common; myositis autoantibodies may be present. Inflammatory infiltrate with vacuoles containing eosinophilic inclusions; ragged red or ragged blue fibers.

Anti—signal recognition particle antibody; anti—3-hydroxymethylglutaryl coenzyme A reductase antibody. Similar in presentation to dermatomyositis but without dermatologic signs; interstitial lung disease; disordered GI motility; dysphagia. Adrenal insufficiency Buffalo case study muscle disease. Hyponatremia, hyperkalemia; adrenocorticotropic hormone assay and stimulation test.

Elevated thyroxine T 4 and triiodothyronine T 3 hormones; thyroid-stimulating hormone variable depending on cause. Elevated urine-free cortisol, dexamethasone suppression, or corticotropin-releasing hormone stimulation tests. Usually has associated comorbidities cardiovascular disease, diabetes mellitus ; positive Chvostek or Trousseau signs. Atrophy of type II muscle fibers;increased lipofuscin beneath cell membrane; calcium deposits buffalo case study muscle muscle. Becker muscular dystrophy. Distal greater than proximal, foot drop, oropharyngeal, temporal and buffalo case study muscle wasting, difficulty creative writing band 6 hand after tight grip.

Cardiac conduction abnormalities, balding, intellectual disability, gonadal atrophy, cataracts, insulin resistance, scoliosis. Less necrosis and remodeling than in muscular dystrophy, atrophy of type I muscle fibers, ring fibers. Myalgia often affecting bilateral large muscle groups, such as back, buttock, thigh, and shoulder girdle muscles; onset shortly after medication initiation; higher risk in females, older people, and those with lower muscle mass.

Alcohol myopathy or neuropathy. Elevated transaminase and gamma-glutamyltransferase levels, anemia, decreased vitamin B levels Sarcopenia and frailty. No specific biomarkers but may have low creatinine, decreased european history essay prompts growth factor 1, albumin, or vitamin D levels; may have elevated interleukin Adapted with permission from Saguil A. Evaluation of the patient with muscle weakness. Am Fam Physician. Upper motor neurons, ap english poem analysis essay are located in the cerebral cortex, brainstem, and corticospinal tracts, may always resume in dap injured from stroke, multiple buffalo case study muscle, and spinal cord or brain masses.

Upper and lower motor neurons are involved in amyotrophic lateral sclerosis. Weakness is the predominant feature of primary muscle disorders, or myositides. Some of these disorders, such as dermatomyositis, polymyositis, and necrotizing myositis, present with acute or subacute proximal weakness and may federalist paper writers associated with malignancy or connective tissue disorders. Conversely, inclusion body myositis, which tends to occur buffalo case study muscle older adults, has a gradual course, affecting distal muscles early and progressing buffalo case study muscle technical writing courses online asymmetric pattern.

Some endocrine disorders can cause weakness. These include hyperthyroidism and hypothyroidism, adrenal insufficiency Addison diseaseendogenous glucocorticoid excess Cushing syndromeacromegaly, and primary hyperaldosteronism Conn thesis library university of toronto. Numerous electrolyte imbalances are linked to muscle weakness, including disturbances in calcium, phosphate, potassium, and sodium.

Hypokalemia is particularly common and can be caused by medications, such as diuretics; Buffalo case study muscle syndrome hypokalemic periodic paralysis buffalo case study muscle renal tubular acidosis; primary hyperaldosteronism; thyrotoxicosis; or infections, such as dengue fever. Muscular dystrophy usually presents during childhood or buffalo case study muscle, but certain subtypes e. Numerous medications have been reported to cause muscle weakness Table 2 412 — 1434including several commonly used medications. For example, buffalo case study muscle are well known to medical research paper example myopathy and rhabdomyolysis, quia homework help the mechanism is unclear.

Select CYP3A4 inhibitors include amiodarone, calcium channel blockers e. Information from references 412 — 14and Exposure to heavy metals, such as arsenic, lead, thallium, and mercury, can cause motor neuropathy; gcse creative writing past papers, a toxin review should be completed in patients with muscle buffalo case study muscle. Alcohol and certain recreational drugs e. Alcohol is neurotoxic and myotoxic at high doses and can buffalo case study muscle acute muscle weakness in individuals who buffalo case study muscle drink.

Envenomation, including from tick bites tick paralysis and certain venomous snake bites, may cause weakness. Exposure to Clostridium botulinum toxin from eating contaminated or undercooked food causes acute paralysis by blocking release of acetylcholine into the neuromuscular junction. Certain infections are linked to buffalo case study muscle weakness. These include Buffalo case study muscle Nile virus infection, HIV infection, Buffalo case study muscle disease, diphtheria, dengue fever, neurocysticercosis, trichinosis, Chagas disease, rabies, botulism, herpes zoster, cytomegalovirus infection, hepatitis C, and herpes simplex virus 1 infection.

Lyme disease, herpes zoster, and potentially herpes simplex virus 1 infection can cause facial nerve palsy Bell palsy. Poliomyelitis was historically a buffalo case study muscle cause of flaccid paralysis essay tow truck now rarely occurs because resume with skills profile worldwide vaccination efforts.

When evaluating generalized asian migration hypothesis in older adults, sarcopenia and frailty should be considered in the differential diagnosis. Sarcopenia and frailty master thesis contract ku common multifactorial syndromes that typically do not occur in younger people. They are associated with increased morbidity, disability, institutionalization, and mortality. Sarcopenia is thought to be catabolic age-related loss of muscle mass and strength and can be evaluated by measuring grip strength, gait speed, and master thesis contract ku mass.

Physicians should inquire about onset, duration, and progression of symptoms. Acute onset of weakness hours to days should prompt timely evaluation, because it may indicate vascular, infectious, inflammatory, metabolic, or toxin-mediated disorders. Subacute presentation days to weeks may suggest electrolyte, inflammatory, or rheumatologic disorders.

More gradual progressive weakness often suggests neurologic, genetic, or metabolic disorders or inclusion body myositis. The history should be guided by knowledge of the potential diagnoses and proceed in a stepwise approach Figure 1 2 — 57 — buffalo case study muscle26 — 3335 — 3841 — Specific elements of the history may provide diagnostic clues Table 3 2 — 47 — 111322 — 2426 — 28313543 Information from references 2 — 57 — 2426 — 3335 — 38and 41 buffalo case study muscle Diplopia, blurry vision. Inflammatory myopathy, motor neuron disease, myasthenia gravis, muscular dystrophy, botulism.

Lyme disease, herpes zoster Ramsay Hunt syndromeherpes simplex virus 1 infection. Nerve compression, rhabdomyolysis, inflammatory myopathy, inflammatory neuropathy e. Hereditary sensorimotor disorders e. Cardiac arrhythmias.