Answer to question of the day: Neurology exam
October 20th, 2011
Well done to those who answered correctly, and comisserations tho those who got caught out… the correct answer to this question was:
g. Guillain Barre Syndrome
See why it was Guillain Barre Syndrome below. 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 pain as the presenting feature. |
| Reflexes | Clinical tip: no reflexes suggests 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 a cardiac monitor) |
Remember FVC monitoring in GBS.
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