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General Disease Finder General Disease Finder This overview will help to fi nd neuromuscular disease patterns in the different sections Cushing’s disease, steroid myopathy; Addison’s disease, general muscle weakness Adrenal dysfunction Periodic paralysis Aldosteronism Tetanic muscles CN: VII AIDS Polyneuropathies: infl ammatory, immune mediated, treatment related Myopathies: infl ammatory, treatment related Neoplastic: lymphoma (direct invasion) Opportunistic infections: CMV, toxoplasmosis, Cryptococcus , HSV Candida, Varicella, Histoplasma, TBC, Aspergillus CMV polyradiculomyelopathy Herpes zoster radiculitis Syphilitic radiculopathy Treatment related: polyneuropathy/myopathy Ddl, ddC, foscarnet, isoniazid Zidovudine Polyneuropathy (distal, rarely proximal) Alcohol Mononeuropathy – radial nerve (compression) Myopathy Acute necrotizing myopathy and myoglobinuria Chronic proximal weakness Hypokalemic paralysis Myoglobinuria Compartment syndromes (prolonged compression) Familial amyloid polyneuropathies Amyloid Transthyretin Neuropathy Sensorimotor neuropathy Autonomic (continued) E.L. Feldman et al., Atlas of Neuromuscular Diseases, 299 DOI 10.1007/978-3-7091-1605-0, © Springer-Verlag Wien 2014 300 General Disease Finder Autonomic involvement Primary/secondary Apolipoprotein A-1 Polyneuropathy, painful, hearing loss Gelsolin type V, VII, and other CN Mild polyneuropathy Primary amyloidosis (AL) Deposition of immunoglobulin light chains in tissue Adrenal dysfunction Aldosteronism AIDS Alcoholism Amyloid Painful neuropathy Autonomic involvement Carpal tunnel syndrome Muscle amyloid – “muscle amyloidosis” Amyloidoma (trigeminal root) Secondary or reactive amyloidosis (AA) Chronic infl ammatory diseases, rheumatoid diseases, osteomyelitis Deposition of acute phase plasma protein, serum amyloid A Painful neuropathy Autonomic involvement Carpal tunnel syndrome Muscle amyloid Amyloidoma (trigeminal root) Secondary or reactive amyloidosis (AA) Chronic infl ammatory diseases, rheumatoid diseases, osteomyelitis Deposition of acute phase plasma protein, serum amyloid A: polyneuropathy Not signifi cant Cobalamin defi ciency, vitamin B12 polyneuropathy Anemia Lead poisoning polyneuropathy Thalassemia: muscle cramps, myalgia, muscle atrophy Pure red cell anemia: autoimmune disease associated with myasthenia gravis Malpositioning Anesthesia Upper extremity (70 %): mononeuropathies of brachial, radial, ulnar, or median nerves Lower extremity (30 %): mononeuropathies of peroneal, sciatic, or femoral nerves Regional: epidural or spinal anesthesia may cause cauda equina lesions Local : drug toxicity, local hematoma, vasoconstriction, needle injury, infection Cardiac bypass operations: nerve stretch, hypothermia, phrenic nerve lesions Tourniquet palsy Neuromuscular transmission disorders induced by muscle relaxants Peripheral: axillary or femoral artery puncture (brachial plexus and femoral nerve) Angiography Brachial artery: median nerve Cerebral angiography: femoral nerve lesions Femoral nerve lesion in inguinal arterial puncture or hematoma CIDP Bone marrow transplant Infl ammatory myopathies MG Polyneuropathy Local damage; sacral plexus General Disease Finder 301 Facial nerve lower branch Carotid surgery Hypoglossal nerve Vagal recurrent nerve Horner syndrome Cranial nerves (meningeal carcinomatosis, base of the skull metastasis, nerve infi ltrations, radiation injury) Cancer Mononeuropathies (pressure, toxic, following operations), rarely infi ltration, or metastasis Radiculopathies (meningeal carcinomatosis, compression or infi ltration of roots, multiple spinal metastasis), cauda equina syndrome Polyneuropathies: treatment related (CIPN), rarely autoimmune, paraneoplastic, rarely infi ltrative Myopathies: cachexia, dermatomyositis/polymyositis, necrotizing, neuromyotonia, amyloid deposition sarcopenia, type 2 fi ber atrophy Neuromuscular transmission: MG and thymoma, LEMS, and (lung) cancer Antineoplastic treatment-associated polyneuropathy: platinum derivates (cisplatinum carboplatin, oxaliplatin) Acute neurotoxicity, oxaliplatin Taxanes (suramin) Vinca alkaloids Thalidomide Bortezomib Epithelons Steroid myopathy Radiation: cranial nerve, optic nerve Plexopathies (brachial, lumbar, sacral) Aortic disease: left recurrent laryngeal nerve palsy; femoral nerve lesion (ruptured aneurysm, aortic surgery); Circulatory disorders obturator nerve, hematoma in psoas muscle; radiculopathies, compression of L4 and L5 and S1 and S2 by terminal aorta Ischemic monomelic: predominately sensory with causalgia-like pain Cholesterol-lowering drugs: myopathy, cramps (fenofi brate, bezafi brate, clofi brate, gemfi brozil, nicotinic acid lovastatin, simvastatin, pravastatin) Embolism – compartment syndrome Intermittent claudication Ischemic neuropathy, angiopathic neuropathies Muscle hemorrhage, hemophiliacs; anticoagulants, retroperitoneal, buttock, arm, calf Neuropathy by fi stula – hemodialysis and mononeuropathies Monomelic neuropathy Nerve compression by hematoma (femoral nerve, lumbar plexus, sciatic nerve) Carotid surgery Temporary aortic occlusion (surgery) Venous occlusion – phlegmasia cerulea dolens Cranial nerve lesions Coma Critical illness myopathy Critical illness neuropathy Compartment syndromes Mononeuropathies (malpositioning, pressure palsy) Steroid myopathy Thick fi lament myopathy (continued) 302 General Disease Finder Hip and joint surgery: sciatic and femoral nerve lesions Complications of medical and Hypothermia: polyneuropathy surgical treatment Injection into nerves: mononeuropathies Nerve blockade Intramuscular injections Knee surgery: peroneal nerve, ramus infrapatellaris Shoulder surgery Mononeuropathies due to body position: plexus, radial, ulnar, median, peroneal, femoral nerve lesions Muscle: drug-induced myopathy, acute hypokalemic paralysis, necrotizing myopathy, subacute and chronic myopathies, ischemic injury during surgery Neuromuscular transmission: drug-induced MG Neuromuscular blocking agents Postoperatively: GBS, postoperative apnea, malignant hyperthermia Radiation: spinal cord and nerve plexus (brachial, lumbar and sacral plexus) mononeuropathies Spinal anesthesia: nerve roots, epidural hemorrhage, abscess, paraplegia, sensory loss Adhesive arachnoiditis Surgical trauma: neck surgery, mastectomy (thoracodorsal, long thoracic, axillary nerve), median sternotomy, pelvic surgery (sciatic, obturator, femoral, ilioinguinal, iliohypogastric nerve) Tourniquet paralysis Autonomic neuropathy Diabetes mellitus Cranial mononeuropathies Mononeuropathies (carpal tunel syndrome) Muscle infarction Plexopathy (lumbar) Polyneuropathy, several distinct types Thoracic (truncal) radicular lesions Disuse myopathy Immobilization Muscle atrophy Mononeuropathies: pressure palsies Heroin: nerve compression (coma), trauma from injection, brachial and lumbosacral Drugs and addiction Plexopathies Compartment syndromes Phenylcyclidine: rhabdomyolysis Cocaine: rhabdomyolysis Hypercalcemia: muscle weakness Electrolyte disorders Hypocalcemia: tetany Hypokalemic paralysis Hypokalemic myopathy Hyperkalemic paralysis Hyperkalemia: potassium-retaining diuretics Hypermagnesemia muscle weakness Hypomagnesemia muscle weakness Hypernatremia: muscle weakness Hyponatremia: muscle weakness Churg-Strauss syndrome Eosinophilic syndromes Eosinophilic fasciitis Eosinophilic polymyositis Eosinophilia myalgia syndromes (parasitic infections) Acute abdomen: porphyria, lead poisoning – polyneuropathy Gastrointestinal disorders Chronic diarrhea: malabsorption neuropathies, Whipple’s disease, celiac disease Celiac disease: myopathy Crohn’s disease: polymyositis Whipple’s disease: macrophagic myofasciitis Vitamin B 12 defi ciency General Disease Finder 303 Compartment syndromes Ischemia/peripheral vascular Polyneuropathy occlusive Mononeuropathy GBS Hepatic disease Primary biliary cirrhosis: myopathy, neuropathy Hepatitis Polymyositis Polyneuropathy (hepatitis B, C) Panarteritis nodosa (hepatitis B) Demyelinating polyneuropathy Biliary cirrhosis Sensory polyneuropathy Hemophilia: Hematologic diseases Nerve compression (femoral nerve, hemorrhage into iliac muscle) Ulnar nerve compression Median nerve, radial nerve, sciatic nerve, peroneal nerve Complications of anticoagulation Brachial plexus lesions: hematomas in peripheral nerves (median nerve, femoral nerve, obturator nerve, sciatic nerve) Polyneuropathy: POEMS syndrome Castleman’s syndrome Waldenstrom’s Paraproteinemia IgM (MAG) Macroglobulinemia Lymphoma, HIV Median nerve mononeuropathy Hyperuricemia Polyneuropathy Radiculopathy Polyneuropathies: Hypnotic drugs Amitryptyline Glutethimide Imipramine Li+ carbonate Methaqualone Perazine Phenelzine Thalidomide Infl uenza, swine fl u: GBS Immunization Mumps: sensorineural deafness Oral polio: GBS Macrophagic myofasciitis (hepatitis A,B, tetanus) Rabies Serum sickness Toxoids: Diphtheria/tetanus: GBS Haemophilus infl uenzae: GBS Plasma-derived hepatitis B: GBS (continued) 304 General Disease Finder Bacterial meningitis: cranial nerve lesions Infections Hepatitis: A: GBS B: GBS, periarteritis nodosa C: Polyneuropathy (vasculitis) Herpes zoster: Cranial nerves: ophthalmic, trigeminal, Ramsay Hunt syndrome Postherpetic neuralgia Leprosy: Leprous neuritis Lepromatous leprosy Skin, superfi cial nerves Sensory loss (cool areas) Ulnar: proximal to ulnar groove Median: proximal to carpal tunnel Peroneal nerve Lyme disease: Cranial nerves: VII (possibly bilateral) Radiculoneuritis (Garin-Bujadoux-Bannwarth syndrome) Polyneuropathy (unclear) Root involvement Truncal muscle weakness Neurosyphilis: Cranial nerves: pupillary
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