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NEUROPATHY. Subsection B3 Francisco – Go, Kerby + Laxamana September 16, 2009. NEUROPATHY CASE. General data: 22 year old, female Chief Complaint: Fatigue and Generalized weakness. NEUROPATHY CASE. SALIENT FEATURES. 22 year old Female Fatigue Generalized weakness

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neuropathy

NEUROPATHY

Subsection B3

Francisco – Go, Kerby + Laxamana

September 16, 2009

neuropathy case
NEUROPATHY CASE

General data: 22 year old, female

Chief Complaint: Fatigue and Generalized weakness

salient features
SALIENT FEATURES
  • 22 year old
  • Female
  • Fatigue
  • Generalized weakness
  • Mild fatigue after exercising
  • Change in voice after talking for several minutes
  • Intermittent double vision
  • Left eye drooping late in the day
salient features1
SALIENT FEATURES
  • Mild left ptosis-fatigued with one minute of upgaze
  • (-) weakness of extraocular or bulbofacialmuscles
  • Voice, muscle bulk and tone, DTR and sensation: normal.
  • Mild weakness of both upper and lower extremity proximal muscles including neck extensors
differential diagnosis
DIFFERENTIAL DIAGNOSIS

1. What is the most likely diagnosis?

a. Lambert-Eaton Myasthenic Syndrome

b. Myasthenia Gravis

c. Botulism

d. Organophosphate poisoning

botulism
Botulism

CLINICAL FEATURES

organophosphate poisoning
Organophosphate Poisoning

CLINICAL FEATURES

lambert eaton myasthenic syndrome
Lambert-Eaton Myasthenic Syndrome

CLINICAL FEATURES

  • progressive weakness – (-) involvement of respiratory and facial muscles
  • affected ocular and respiratory muscles - not as severe as MG
  • tend to be worse in the MORNING
  • IMPROVE with exercise and nerve stimulation
  • PROXIMAL parts of the legs and arms are predominantly affected
  • autonomic symptoms like dry mouth or impotence
  • reflexes are usually REDUCED OR ABSENT
myasthenia gravis
Myasthenia Gravis

CLINICAL FEATURES

  • CARDINAL FEATURE: weakness and fatigability of muscles
  • increased weakness – during REPEATED USE/EXERCISE
  • IMPROVED with rest or sleep
  • cranial muscle involvement (lids and EOM) – diplopia and ptosis
  • speech – nasal timbre – weakness of the palate
  • dysarthric “mushy” quality – weakness of the tongue
  • limb weakness – proximal and asymmetric
  • PRESERVED DTR
clinical impression
CLINICAL IMPRESSION

Neuromuscular disorder

secondary to Myasthenia Gravis