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**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 glioblastoma) 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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