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Motor and Sensory Syndromes

Last Updated: September 27, 2018

Table 1: Upper Versus Lower Motor Neuron Weakness
Key signs to differentiate a lower versus upper motor neuron etiology for weakness
Deep Tendon Reflexes
  • UMN – Increased (decreased acutely or with cerebellar signs)
  • LMN – Decreased
Distribution of Weakness
  • UMN – more prominent in UE extensors and LE flexors, unilateral, rarely isolated to a particular muscle group (can be paraparetic / quadriparetic), rarely bilateral CN
  • LMN – Isolated weakness to a particular muscle group (can be paraparetic, quadriparetic, bilateral CN)
Resistance to Passive Motion
  • UMN – Increased (decreased with cerebellar lesions)
  • LMN – Decreased
Pathologic Reflexes
  • UMN – Observed
  • LMN – Not observed
Additional Symptoms
  • UMN – Sensory anomalies, primitive reflexes, cranial nerve signs, ataxia
  • LMN – Sensory anomalies, cranial nerve signs
Table 2: Hemiplegia and Hemiparesis
Differential list for hemiplegia
Neoplastic
  • Primary (progressive onset)
  • Metastatic (progressive onset)
  • Intralesional hemorrhage (acute onset)
Vascular
  • Infarction (ischemic, hemorrhagic)
  • TIA
  • AVM (progressive)
  • Carotid impingement (trauma, cervical abscess, fibromuscular dysplasia, dissection)
  • Moyamoya disease
  • Sickle-cell anemia
  • Hematoma (epidural, subdural, intracerebral)
  • Vasculopathy (Takayasu arteritis, SLE)
Infectious
  • Abscess (acute or progressive)
  • Cerebritis
  • Infection-induced vasculitis or venous thrombosis
Metabolic
  • Diabetes Mellitus (generating hemiplegic migraine)
Inflammatory
  • Demyelinating disease (progressive)
  • Post-traumatic cerebral edema
Table 3: Common Causes of Cerebral Upper Motor Neuron Weakness
Differential list for common causes of upper motor neuron derived weakness in adult patients
Neoplastic
  • Meningioma
  • Astrocytoma (including GBM)
  • Oligodendroglioma
  • Metastasis
Vascular
  • Infarction (thrombotic, embolic)
  • Hemorrhage (SAH, epidural, subdural, parenchymal)
Infectious
  • Abscess (bacterial, fungal)
  • Cerebral vasculitis
  • Neurovascular syphilis
  • Meningitis
  • Encephalitis
Inflammatory
  • Multiple Sclerosis
  • Sarcoidosis
Miscellaneous
  • Traumatic neuropathy
Table 4: Transient Neurologic Deficit
Differential list for transient neurodeficits
Vascular
  • TIA
  • Parenchymal hemorrhage prodrome
  • Chronic subdural hematoma
  • Cerebral amyloid angiopathy
Miscellaneous
  • Hemiplegic migraine
  • Seizures (Todd’s paralysis)
Table 5: Gait & Stance Disorders
Differential for gait and stance abnormalities
Neoplastic
  • CPA neoplasm
Vascular
  • Cerebral or cerebellar infarct
  • Brainstem infarct
  • Basal ganglia infarct
  • Thalamic infarct/hemorrhage
  • Bilateral subdural hematomas
  • Vertebrobasilar insufficiency
  • Intermittent claudication
  • Chronic lower extremity edema
  • Atherosclerotic heart disease
  • Orthostatic hypotension
Infectious
  • PML
  • AIDS encephalopathy
Endocrine
  • Diabetes mellitus
  • Hyperthyroidism/hypothyroidism
Metabolic
  • Hypovitaminosis B12
  • Osteoporosis
Toxic
  • Alcoholism
Inflammatory
  • Multiple sclerosis
  • Post-radiation leukoencephalopathy
  • Rheumatic arthritis
  • Cervical spondylosis
  • Gout
  • Polymyalgia
  • Degenerative intervertebral disk disease
Miscellaneous
  • Idiopathic gait disorder
  • Normal pressure hydrocephalus
  • Immobility
  • Degenerative joint disease
  • Paget’s disease
  • Dementia
  • Parkinson’s disease
  • Cataracts
  • BPPV
  • Presbyopia
  • Meniere’s disease
Table 6: Dizziness
Differential diagnosis for dizziness
Neoplastic
  • Vestibular schwannoma (CPA)
  • Meningioma (CPA)
  • Hemangioma
  • Paraganglioma (Glomus jugulare)
  • Metastasis (cerebellar)
Vascular
  • Ischemia (brainstem)
  • Hemorrhage (within cerebellum)
  • Aneurysm
  • Cerebrovascular hypotension
  • Vertebrobasilar insufficiency
Infectious
  • Labyrinthitis
  • Otitis media
  • Abscess (cerebellar)
  • Meningitis (bacterial)
  • Syphilis
Endocrine
  • Hypothyroidism
Congenital
  • Chiari malformation
  • Basilar invagination
  • Platybasia
Metabolic
  • Hypocapnia
  • Hypoglycemia
  • Hypovitaminosis B1, B3
Toxic
  • Alcohol
  • Aminoglycosides
  • Lead
  • Phenytoin
Inflammatory
  • Multiple sclerosis
  • Vestibular neuronitis
  • Cerebellar degeneration
  • Sarcoidosis
  • Otosclerosis
Miscellaneous
  • Trauma (labyrinthine disruption, petrous temporal bone fracture)
  • Migraine
  • Meniere’s syndrome
  • Epilepsy
  • Paget’s disease
  • Benign postural positional vertigo
  • Cerumen impaction

DOI: https://doi.org/10.18791/nsatlas.v2.02.1.4

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