Table 19.
System | Symptoms | Abnormalities in diagnostic test results | Suspected pathology |
---|---|---|---|
Nervous system |
Bilateral motor/ sensory/bowel and bladder signs/symptoms-loss of bowel/bladder function Pain in the lower back, neck, arm, or leg Tingling, numbness, or weakness Difficulty walking Abnormal/increased reflexes in extremities Decreased fine motor skills, balance and coordination |
Lumbar puncture for CSF analysis— cytology/flow cytometry of the cerebrospinal fluid (normal/lymphocytosis with elevated proline) Spine/brain MRI (including axial sections through the region of suspected abnormality) |
Myelopathy |
Fatigable/fluctuating muscle weakness (more proximal) Ocular/bulbar involvement (ptosis, extra ocular movement) Double vision Dysphagia Dysarthria Facial muscle weakness neck/respiratory muscle weakness Myositis Myocarditis |
Brain MRI (no leptomeningeal or cranial nerve enhancement, parenchymal alterations) EMG (pathological jitter) |
Myasthenia gravis Myasthenia-like syndrome |
|
Acute polyneuropathy Symmetrical muscle weakness Sensory symptoms Neuropathic pain localized to lower back and thighs Dysregulation of autonomic nerves |
Anti-ganglioside, anti-acetylcholine receptor, and anti-strained muscle antibodies can be present Lumbar puncture (elevated WBC) |
Guillain-Barre syndrome | |
Asymmetric/symmetric sensory, motor, sensory-motor deficit Focal mononeuropathies Numbness Paresthesia Hypo-/areflexia Sensory ataxia |
Nerve biopsy (to distinguish from direct tumor infiltration) MRI (to evaluate cranial neuropathies/nerve root abnormality) EMG |
Peripheral neuropathy | |
Symptoms related to nerves involved (proximal/distal peripheral sensory and motor nerves, autonomic nervous system), e.g., arrhythmias, silent angina due to damage to nerve fibers and disruption of pain transmission, gastroparesis, severe constipation, bladder paralysis Sweating abnormalities Sluggish pupil reaction Orthostatic hypertension |
Abnormal electrophysiological tests | Autonomic neuropathy (sensory-motor) | |
Headache Photophobia Neck stiffness Nausea/vomiting |
Lumbar puncture for CSF analysis—cytology/flow cytometry of the cerebrospinal fluid (WBC <500, normal glucose) | Aseptic meningitis | |
Confusion Fatigue Spastic tremors Fever Vomiting Altered behavior Headache Seizures Short-term memory loss Lowered level of consciousness Focal weakness Speech abnormality Cerebral symptoms (gait disturbance, tremor, altered movements) |
Lumbar puncture for CSF analysis—cytology/flow cytometry of the cerebrospinal fluid (WBC <250, mononuclear pleocytosis, normal glucose, increased protein level) Brain MRI (diffuse dural enhancement without parenchymal abnormalities) EEG (diffuse non-specific slowing) Anti-NMDA receptor antibodies positive in some cases |
Encephalitis | |
Acute/ subacute weakness Bilateral sensory changes Increased deep tendon reflex |
MRI (inflammation of the spinal cord and other potential causes) Lumbar puncture (± abnormally high numbers of white blood cells or immune system proteins that indicate inflammation) Blood tests (± antibodies associated with neuromyelitis optica, a condition in which inflammation occurs both in the spinal cord and in the optic eye) |
Transverse myelitis |