CanadiEM Podcasts: CRACKCast, ClerkCast, CarmsCast, First Year Diaries CRACKCast E013 - Weakness
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Mar 14, 2016 They break down how to tell true weakness from mimics and localize problems to UMN, LMN, or the neuromuscular junction. Critical diagnoses like stroke, spinal cord compression, Guillain-Barré, and rhabdomyolysis get focused attention. They flag signs of impending respiratory failure and list common non-emergent neuropathy and systemic causes to watch for.
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Weakness Can Hide Serious Diagnoses
- Adam Thomas describes walking into a night shift and feeling excited until seeing a triage complaint of 'weakness.'
- Tristan Jones counters with recent memorable cases of Guillain-Barré and Creutzfeldt-Jakob presenting as weakness.
Use Exam Patterns To Localize Weakness
- Differentiate UMN, LMN, and NMJ patterns on exam to localize weakness quickly.
- Look for UMN signs (spasticity, hyperreflexia, Babinski), LMN signs (flaccidity, fasciculations, atrophy), and NMJ clues (fluctuating/proximal, ocular/bulbar involvement).
Anatomy First Helps Prioritize Critical Causes
- Break neuromuscular causes by anatomical level to prioritize critical diagnoses in the ED.
- Prioritize vascular CNS insults, Guillain-Barré for peripheral nerves, and myasthenia/botulism/tick paralysis at the NMJ level.