MUSCULAR ATROPHY
MUSCULAR ATROPHY: Excerpt from Algorithmic Diagnosis of Symptoms and Signs
Ask the Following Questions:
- Is it focal or diffuse? Focal muscular atrophy would suggest poliomyelitis, early spinal muscular atrophy, peripheral vascular disease, and sympathetic dystrophy. However, occasionally it is an indication of an early spinal cord tumor, herniated disk, or peroneal muscular atrophy. It can also be a sign of an entrapment syndrome of one of the peripheral nerves. Focal muscular atrophy with hyperactive reflexes suggests amyotrophic lateral sclerosis, multiple sclerosis, spinal cord tumors, or syringomyelia.
- Are the reflexes hypoactive or hyperactive? Muscular atrophy with hypoactive reflexes suggests peripheral neuropathy, poliomyelitis, spinal muscular atrophy, myasthenia gravis, peripheral vascular disease, sympathetic dystrophy, herniated disk, early spinal cord tumor, and peroneal muscular atrophy. Muscular atrophy with hyperactive reflexes suggests multiple sclerosis, spinal cord tumors, syringomyelia, and amyotrophic lateral sclerosis.
- Are there associated sensory changes? The finding of muscular atrophy with sensory changes suggests a peripheral neuropathy, Guillain-Barré syndrome, Friedreich's ataxia, multiple sclerosis, transverse myelitis, a herniated disk, spinal cord tumor, and peroneal muscular atrophy. It may also suggest syringomyelia.
- Are the reflexes normal? The presence of normal reflexes suggests anorexia nervosa, tuberculosis, metastatic malignancy, and hyperthyroidism.
DIAGNOSTIC WORKUP
The basic workup includes a CBC, sedimentation rate, urinalysis, chemistry panel, ANA titer, serum protein electrophoresis, and VDRL test. Additional muscle enzymes may be ordered such as serum aldolase and CPK. A 24-hr urine collection for creatinine and creatine may be done.
At this point, it is best to consult a neurologist. He will probably order nerve conduction velocity studies and EMGs of the involved extremities. He also will be best qualified to determine the need for CT scans or MRIs of the brain or spine, as well as the particular study to order in each individual case. At times, spinal fluid analysis and muscle biopsies may be necessary to solve the problem. Also, a Tensilon test or acetylcholine receptor antibody titer may be ordered in suspected myasthenia gravis.
Book Source Details
- Book Title: Algorithmic Diagnosis of Symptoms and Signs
- Author(s): R. Douglas Collins
- Year of Publication: 2003
- Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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