Compare and contrast the clinical and diagnostic features of ascending polyneuritis (Guillain Barre Syndrome), myasthenia gravis and motor neurone disease.
This could be answered using a table format. Suggestions include the following:
ascending, |
myasthenia |
motor neurone |
|
weakness |
yes |
yes |
yes |
reflexes |
absent |
present |
May be increased (eg. amyotrophic lateral sclerosis) |
characteristic distribution |
ascending |
Eyes & cranial |
asymmetrical` |
progression |
acute and |
relapsing |
progressive |
fatigue |
no |
characteristic |
no |
fasiculation |
no |
no |
characteristic |
increased CSF protein |
yes |
no |
no |
UMN signs present |
no |
no |
May be present(eg. amyotrophic lateral sclerosis) |
sensory features |
often dysthesia |
no |
no |
pain |
May be |
no |
no |
delayed nerve conduction |
yes |
no |
no |
fade + post tetanic facilitation |
no |
yes |
no |
‘jitter’ on EMG |
no |
no |
yes |
response to anticholinesterases |
no |
yes |
no |
response to plasmapheresis |
May occur |
yes |
no |
Approach to the ICU patient with generalised weakness is discussed elsewhere.
This table is a detailed version. The features listed by the college here have been incorporated into the greater table in the abovelinked summary ("Causes of Weakness in Intensive Care Patients ")
In short:
Chapter 51 (pp. 568) Acute cerebrovascular complications by Bernard Riley and Thearina de Beer
Chapter 57 (pp. 617) Neuromuscular diseases in intensive care by George Skowronski and Manoj K Saxena
Reeves and Swenson have an excellent online textbook chapter (12) entitled "Evaluation of the Patient with Weakness"