Answer to question of the day: Neurological exam
December 6th, 2009
We had some great input and debate from students on this question of the day from a nero exam. Congrats to those of you who correctly guessed it as Guillain Barre Syndrome.
Now check your hypothesis against the clinical signs:
| Tone | Any sign of UMN lesion or hypotonia (cerebellar?) NO
But there is some reduced tone in the left arm: |
| Power | He is weak and its come on over the past few days: this is classical of GBS: an ascending peripheral motor and sensory poylneuropathy. |
| Coordination | Normal: as expected |
| Sensation | Normal: So can it still be GBS??? YES! The sensory signs are often vary vague: there may be only back |
| Reflexes | Clinical tip: no reflexes Auggests a lower motor neurone problem. Could it me MND? Very unlikely: there’s only LMN signs and the onset of the illness is too acute. |
| Other things | GBS: measure the Forced Vital Capacity:
If this is low: the patient may need ventilation. Also remember: cardiac conduction deficits (monitor the patient on Remember FVC monitoring in GBS. |
Right on, have seen a case of GBS in practice, sensation was NORMAL when testing it, but the guy still had symptoms, which is important on two counts, first the fact that its a clue to the diagnosis with the weakness, and secondly its classic for GBS to present like this
Pure motor neuropathies are rare. Good list to learn for students. Just tried to find a link on the web to one but keep on winding up on wrongdiagnosis lol