EpistemisGeneralized fluctuating muscle weakness of central origin
Specialty: General.
Why it occurs
- Multiple sclerosis in the flare-remission phase or demyelinating syndrome of the central nervous system (focal demyelination plaques in the motor pyramidal tracts that cause fluctuating weakness of the extremities that worsens with heat or fever, known as Uhthoff phenomenon)
- Intermittent cerebral vascular disorders or repeated transient ischemic attacks (causing transient hemispatial or bilateral weakness due to focal hypoperfusion)
- Chronic metabolic encephalopathies with a fluctuating course (uremia, initial chronic liver failure, which variably depress cortical excitability)
- Paraneoplastic syndromes with central nervous system involvement (paraneoplastic encephalomyelitis due to onconeuronal antibodies that cause variable diffuse weakness)
- Conversion disorder or fluctuating somatoform motor disorder of psychogenic origin.
Initial workup
Brain and spinal cord magnetic resonance imaging (MRI) with gadolinium contrast, lumbar puncture for analysis of oligoclonal bands in cerebrospinal fluid, electromyography and nerve conduction velocity, and onconeuronal antibody panel.
red flags
Weakness of the respiratory muscles that causes oxygen desaturation or rapidly progressive dyspnea, sudden onset dysphagia, flaccid paralysis that generalizes to all four limbs in an ascending manner, or loss of alertness.
Standard management
- Avoid the empirical use of intravenous corticosteroids before having a structural or immunological diagnostic confirmation
- Methylprednisolone — 1 g intravenously per day for 3 to 5 days, indicated only in acute outbreak phases of confirmed multiple sclerosis
- Central modulators under the direction and strict supervision of a specialist neurologist.
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- General
- Listed causes
- 5
- Treatment options
- 3