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453 General disease finder 455 This overview will help to find neuromuscular disease patterns in the different sections Cushing‘s disease: steroid myopathy Adrenal dysfunction Addison’s disease: general muscle weakness Periodic paralysis Aldosteronism Tetanic muscles CN: VII AIDS Polyneuropathies: inflammatory, immune mediated, treatment related Myopathies: inflammatory, 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, rare ulcers) Alcoholism 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 Sensorimotor neuropathy Autonomic involvement 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 456 Painful neuropathy Autonomic involvement Carpal tunnel syndrome Muscle amyloid Amyloidoma (trigeminal root) Secondary or reactive amyloidosis (AA) Chronic inflammatory diseases, rheumatoid diseases, osteomyelitis Deposition of acute phase plasma protein, serum amyloid A: polyneuropathy not significant Anemia Cobalamin deficiency, vitamin B12 polyneuropathy Lead poisoning polyneuropathy Thalassemia: muscle cramps, myalgia, muscle atrophy Pure red cell anemia: autoimmune disease associated with myasthenia gravis Anesthesia Regional: Epidural or spinal anesthesia may cause cauda equina lesions Malpositioning Upper extremity (70%): Mononeuropathies of brachial, radial, ulnar, or median nerves Lower extremity (30%): Mononeuropathies of peroneal, sciatic, or femoral nerves Cardiac bypass operations: nerve stretch, hypothermia, phrenic nerve lesions Tourniquet palsy Neuromuscular transmission disorders induced by muscle relaxants Angiography Peripheral: Axillary or femoral artery puncture (brachial plexus and femoral nerve) Brachial artery: median nerve Cerebral angiography: femoral nerve lesions Anorexia nervosa Myopathy Polyneuropahty Asthma Acute ICU steroid myopathy (status asthmaticus) Steroid myopathy Entrapment neuropathies and compression (ulnar, peroneal nerves) Churg Strauss syndrome Auditory nerve Hearing loss: Refsum’s disease, Cockayne Syndrome, mitochondrial disorders, vasculitis, some types of amyloidosis and hereditary neuropathies Bone marrow CIDP transplantation Inflammatory myopathies MG Polyneuropathy 457 Facial nerve lower branch Carotid surgery Hypoglossal nerve Vagal recurrent nerve Cranial nerves (meningeal carcinomatosis, base of the skull metastasis) Cancer Mononeuropathies (pressure, toxic, following operations) Radiculopathies (meningeal carcinomatosis, compression or infiltration of roots, multiple spinal metastasis), cauda equina syndrome Polyneuropathies (treatment related and paraneoplastic, rarely infiltrative) Myopathies: cachexia, dermatomyositis/polymyositis, necrotizing, neuromyo- tonia Neuromuscular transmission: MG and thymoma, LEMS and (lung) cancer Antineoplastic treatment associated polyneuropathy: Cisplatinum (Carboplatin, Oxaliplatin) Podophyllin derivatives Procarbazine Taxanes Suramin Vinca alkaloids Radiation: Plexopathies (brachial, lumbar, sacral) Paraneoplastic disease Cranial nerve: Optic nerve Polyneuropathies (all types) LEMS Muscle: inflammatory and necrotizing myopathies Aortic disease: Circulatory disorders – Left recurrent laryngeal nerve palsy – Femoral nerve lesion (ruptured aneurysm, aortic surgery) – Obturator nerve: hematoma in psoas muscle – Radiculopathies: compression of L4,5 and S1, 2 by terminal aorta – Ischemic monomelic: predominately sensory with causaglia like pain Cholesterol lowering drugs: Myopathy, cramps (Fenofibrate, benzafibrate, clofibrate, gemfibrozil, nico- tinic acid lovastatin, simvastatin, pravastatin) Embolism-compartment syndrome Intermittent claudication Ischemic neuropathy, angiopathic neuropathies Muscle hemorrhage: hemophiliacs, anticoagulants: retroperitoneal, buttock, arm, calf Neuropathy by fistula- hemodialysis Monomelic neuropathy Nerve compression by hematoma (femoral nerve, lumbar plexus, sciatic nerve) 458 Temporary aortic occlusion (surgery) Venous occlusion-phlegmasia cerulea dolens Coma Cranial nerve lesions Critical illness myopathies Critical illness neuropathy Mononeuropathies (malpositioning) Steroid myopathy Thick filament myopathy Complications of medical Hip and joint surgery: sciatic, femoral nerve lesions and surgical treatment Hypothermia: polyneuropathy Injection into nerves: Mononeuropathies Nerve blockade Intramuscular injections Knee surgery: peroneal nerve, ramus infrapatellaris Mononeuropathies due to body position: plexus, radial, ulnar, median, pero- neal, 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) mononeuro- pathies Spinal anesthesia: nerve roots, epidural hemorrhage, paraplegia, sensory loss, adhesive arachnoiditis Surgical trauma: neck surgery, mastectomy, (thoracodorsal, long thoracic, axil- lary nerve), median sternotomy, pelvic surgery (sciatic, obturator, femoral, ilioinguinal, iliohypogastric nerve) Tourniquet paralysis Diabetes mellitus Autonomic neuropathy Cranial mononeuropathies Mononeuropathies Muscle infarction Plexopathy Polyneuropathy; several distinct types Thoracic (truncal) radicular lesions Immobilization Disuse myopathy Mononeuropathies: pressure palsies 459 Heroin: nerve compression (coma), trauma from injection, brachial and lum- Drugs and addiction bosacral plexopathies Phenylcyclidine: rhabdomyolysis Cocaine: rhabdomyolysis Hypercalcemia: muscle weakness Electrolyte disorders Hypocalcemia: tetany Hypokalemic paralysis Hypokalemic myopathy Hyperkalemia: potassium retaining diuretics Hypermagnesemia muscle weakness Hypomagnesemia muscle weakness Hypernatremia: muscle weakness Churg Strauss syndrome Eosinophilic syndromes Eosinophilic fasciitis Eosinophilic polymyositis Eosinophilia myalgia syndromes Acute abdomen: porphyria, lead poisoning-polyneuropathy Gastrointestinal disorders Chronic diarrhea: malabsorption neuropathies, Whipple’s disease, celiac dis- ease Celiac disease: myopathy Crohn’s disease: polymyositis Compartment syndromes Ischemia/peripheral Polyneuropathy vascular occlusive Hepatic disease GBS Hepatitis Primary biliary cirrhosis: myopathy, neuropathy Polymyositis Polyneuropathy (hepatitis B, C) Panarteritis nodosa (hepatitis B) Demyelinating polyneuropathy Biliary cirrhosis Sensory polyneuropathy Hepatic myelopathy Acquired hepatocerebral degeneration Polyneuropathy Chronic liver disease Hemophilia: Hematologic diseases Nerve compression (femoral nerve, hemorrhage into iliac muscle) Ulnar nerve compression Median nerve, radial nerve, sciatic nerve, peroneal nerve Thrombocytopenia: Rarely affects peripheral nerves 460 Complications of anticoagulation: Brachial plexus lesions Median nerve Femoral nerve Obturator nerve Sciatic nerve Polyneuropathy: POEMS syndrome Castleman’s syndrome Waldenstrom’s macroglobulinemia Lymphoma, HIV Hyperuricemia Median nerve mononeuropathy Polyneuropathy Radiculopathy Hypnotic drugs Polyneuropathies: Amitryptiline Gluthethimide Imipramine Li+ carbonate Metaqualone Perazine Phenelzine Thalidomide Immunization Influenza, swine flu: GBS Mumps: sensorineural deafness Oral polio: GBS Macrophagic microfasciitis (hepatitis A,B, tetanus) Toxoids: Diphtheria/tetanus: GBS Hemophilus influenzae: GBS Plasma derived hepatitis B: GBS Infections Bacterial meningitis: cranial nerve lesions 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, superficial nerves 461 Sensory loss (cool areas) Ulnar: proximal to ulnar groove Median: proximal to carpal tunnel Peroneal nerve Tuberculoid: Mixed nerve near the tubercle Ulnar, median, peroneal, facial nerve Enlarged superficial cutaneous, radial nerve Digital, sural nerves Lyme disease: Cranial nerves: VII (possibly bilateral) Radiculoneuritis (Garin-Bujadoux-Bannwarth syndrome) Polyneuropathy (unclear) Root involvement Truncal muscle weakness Neurosyphilis: Cranial nerves: pupillary abnormality Tabes dorsalis (“Lightning pain”) Posterior nerve root, ataxia, bladder and sexual dysfunction Tuberculosis: Cranial nerves (meningitis): VI, III, IV Retrobulbar with Myelitis Tuberculous arachnoiditis: radiculomyelopathy Tuberculomas Typhoid fever: multifocal neuropathy Parasitic infections: Amebic meningoencephalitis: olfactory nerve, smell Angiostrongyliasis: radiculomyeloneuritis Eosinophilic meningitis: cranial neuropathies, paresthesias Onchocerciasis: blindness Paragonimus: optic atrophy Poliomyelitis: Muscle weakness Laryngeal and pharyngeal Facial diplegia “Postpolio syndrome” Trichinosis-muscle, respiration, and cardial and skeletal muscles Viral meningitis:
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