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NEUROPATHY

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

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  1. NEUROPATHY Subsection B3 Francisco – Go, Kerby + Laxamana September 16, 2009

  2. NEUROPATHY CASE General data: 22 year old, female Chief Complaint: Fatigue and Generalized weakness

  3. NEUROPATHY CASE

  4. 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

  5. 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

  6. DIFFERENTIAL DIAGNOSIS 1. What is the most likely diagnosis? a. Lambert-Eaton Myasthenic Syndrome b. Myasthenia Gravis c. Botulism d. Organophosphate poisoning

  7. Botulism CLINICAL FEATURES

  8. Organophosphate Poisoning CLINICAL FEATURES

  9. 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

  10. 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

  11. CLINICAL IMPRESSION Neuromuscular disorder secondary to Myasthenia Gravis

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