Weakness

A Systematic Approach To Acute, Non-traumatic, Neurologic And Neuromuscular Causes

Asimos, Andrew W. MD
Birnbaumer, Diane M. MD, FACEP
Karas, Stephen Jr. MD, FACEP
Shah, Sid M. MD, FACEP

Author Andrew W. Asimos, MD Associate Medical Director, Stroke Program, Carolinas Medical Center, Charlotte, NC; Clinical Assistant Professor, Department of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill, NC.
Peer Reviewers
Diane M. Birnbaumer, MD, FACEP Professor of Medicine, UCLA; Associate Program Director, Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA.
Stephen Karas, Jr., MD, FACEP Clinical Professor, UCSD Department of Medicine, San Diego, CA.
Sid M. Shah, MD, FACEP Assistant Clinical Professor, Michigan State University; Sparrow/MSU Emergency Medicine Residency Program; Ingham Regional Medical Center, Lansing, MI.

Emergency Medicine Practice 4(12):p 1-26, December 2002.

The chief complaint box on the chart says it all: “Weak and tingling, desires second opinion.” To compound your dilemma, an emergency medicine physician across town who saw the patient earlier in the day told her that she was just “anxious.” The patient says she is anxious because her legs are “buckling.” You hope that your neurologic examination will provide some obvious findings, since neuro never was your forte. Pinprick sensation is normal. Maybe she is “a little weak,” but she doesn't seem to be making much of an effort. You have trouble “getting reflexes,” but you have trouble interpreting the reflex exam on lots of your patients. By the time you finish examining the patient, your stomach feels as weak as the patient's knees. She probably is just anxious, and you are certain that no diagnostic test or fancy neurologic examination will prove otherwise…. But maybe an MRI of the brain or spinal cord or a scan of something would help.