Diferencia entre revisiones de «Amyotrophic lateral sclerosis»
m (Rossdonaldson1 moved page Amyotrophic Lateral Sclerosis (ALS) to Amyotrophic lateral sclerosis) |
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==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Weakness DDX}} | {{Weakness DDX}} | ||
==Evaluation== | |||
==Management== | ==Management== | ||
*Nebulized medications | |||
*[[Steroids]] | |||
*[[Antibiotics]] for infectious complications | |||
*Assisted ventilation / intubation if in [[respiratory failure]] and aligned with [[goals of care]] | |||
==Disposition== | |||
==See Also== | ==See Also== | ||
*[[Weakness]] | *[[Weakness]] | ||
*[[Intubation]] | *[[Intubation]] | ||
==External Links== | |||
==References== | ==References== | ||
Revisión del 09:59 24 oct 2020
Background
- Progressive muscle atrophy/weakness due to degeneration of upper and lower motor neurons
- Patients will rarely present to the ED undiagnosed
- Likely related to mutated superoxide dismutase (SOD1) gene
- Involvement of the anterior horn cells
Clinical Features
- Acute respiratory failure
- Predicted by forced VC <25 mL/kg or 50% decrease from normal
- Aspiration pneumonia
- Trauma related to extremity weakness
- Asymmetric weakness without sensory findings with mixed upper and lower motor nerve findings
Differential Diagnosis
Weakness
- Neuromuscular weakness
- Upper motor neuron:
- CVA
- Hemorrhagic stroke
- Multiple sclerosis
- Amyotrophic Lateral Sclerosis (ALS) (upper and lower motor neuron)
- Lower motor neuron:
- Spinal and bulbar muscular atrophy (Kennedy's syndrome)
- Spinal cord disease:
- Infection (Epidural abscess)
- Infarction/ischemia
- Trauma (Spinal Cord Syndromes)
- Inflammation (Transverse Myelitis)
- Degenerative (Spinal muscular atrophy)
- Tumor
- Peripheral nerve disease:
- Neuromuscular junction disease:
- Muscle disease:
- Rhabdomyolysis
- Dermatomyositis
- Polymyositis
- Alcoholic myopathy
- Upper motor neuron:
- Non-neuromuscular weakness
- Can't miss diagnoses:
- ACS
- Arrhythmia/Syncope
- Severe infection/Sepsis
- Hypoglycemia
- Periodic paralysis (electrolyte disturbance, K, Mg, Ca)
- Respiratory failure
- Emergent Diagnoses:
- Symptomatic Anemia
- Severe dehydration
- Hypothyroidism
- Polypharmacy
- Malignancy
- Aortic disease - occlusion, stenosis, dissection
- Other causes of weakness and paralysis
- Acute intermittent porphyria (ascending weakness)
- Can't miss diagnoses:
Evaluation
Management
- Nebulized medications
- Steroids
- Antibiotics for infectious complications
- Assisted ventilation / intubation if in respiratory failure and aligned with goals of care
Disposition
See Also
External Links
References
Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 7e (2010), Chapter 167. Chronic Neurologic Disorders