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\author{bee.f (bee.f)}
\pdfinfo{
  /Title (2-patient-who-has-weakness.pdf)
  /Creator (Cheatography)
  /Author (bee.f (bee.f))
  /Subject (2 Patient who has Weakness Cheat Sheet)
}

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\noindent
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    {\parbox{\dimexpr\textwidth-2\fboxsep\relax}{\noindent
        \hspace*{-6pt}\includegraphics[width=5.8cm]{/web/www.cheatography.com/public/images/cheatography_logo.pdf}}
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\begin{tabulary}{11cm}{L}
    \vspace{-2pt}\large{\bf{\textcolor{DarkBackground}{\textrm{2 Patient who has Weakness Cheat Sheet}}}} \\
    \normalsize{by \textcolor{DarkBackground}{bee.f (bee.f)} via \textcolor{DarkBackground}{\uline{cheatography.com/180201/cs/37875/}}}
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\noindent
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  \mymulticolumn{2}{p{5.377cm}}{\bf\textcolor{white}{Cheatographer}}  \\
  \vspace{-2pt}bee.f (bee.f) \\
  \uline{cheatography.com/bee-f} \\
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  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Cheat Sheet}}  \\
   \vspace{-2pt}Not Yet Published.\\
   Updated 12th April, 2023.\\
   Page {\thepage} of \pageref{LastPage}.
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  %\includegraphics[width=48px,height=48px]{dave.jpeg}
  Measure your website readability!\\
  www.readability-score.com
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\begin{document}
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\begin{multicols*}{2}

\begin{tabularx}{8.4cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{8.4cm}}{\bf\textcolor{white}{Weakness overview}}  \tn
% Row 0
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\mymulticolumn{1}{x{8.4cm}}{{\bf{Distribution:}} reflects the site of lesion (e.g. proximal, distal, bilateral, unilateral, etc.)\{\{nl\}\}{\bf{Type:}} reflects the {\emph{element}} of the nervous system that's impaired} \tn 
% Row Count 4 (+ 4)
% Row 1
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\mymulticolumn{1}{x{8.4cm}}{To understand {\bf{nature}} of {\bf{pathology}} \& {\bf{aetiology}} of muscle {\bf{weakness}}, what 4 things need to be considered?\{\{nl\}\}{\bf{1.}} {\bf{Type}} of weakness\{\{nl\}\} {\bf{2.}} {\bf{Distribution}} of weakness\{\{nl\}\}{\bf{3.}} {\bf{Time}} course of onset\{\{nl\}\}{\bf{4.}} {\bf{Mode}} of onset} \tn 
% Row Count 10 (+ 6)
% Row 2
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\mymulticolumn{1}{x{8.4cm}}{{\bf{Weakness vs. fatigue:}}\{\{nl\}\} - {\emph{Weakness:}} is regional\{\{nl\}\} - {\emph{Fatigue:}} is generalised} \tn 
% Row Count 12 (+ 2)
% Row 3
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\mymulticolumn{1}{x{8.4cm}}{{\bf{Pt records:}}\{\{nl\}\}- Sense of clumsiness, tightness, instability\{\{nl\}\}- Uncoordinated movement\{\{nl\}\}- Numbness} \tn 
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\mymulticolumn{1}{x{8.4cm}}{{\bf{Physical manifestations:}}\{\{nl\}\}- Clumsiness\{\{nl\}\}- Uncoordinated movement\{\{nl\}\}- Loss of fine motor skills\{\{nl\}\}- Imbalance} \tn 
% Row Count 18 (+ 3)
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\mymulticolumn{1}{x{8.4cm}}{{\bf{4 considerations of weakness:}}\{\{nl\}\}- Type of weakness\{\{nl\}\}- Distribution of weakness\{\{nl\}\}- Time course of onset\{\{nl\}\}- Mode of onset} \tn 
% Row Count 21 (+ 3)
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\begin{tabularx}{8.4cm}{X}
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\mymulticolumn{1}{x{8.4cm}}{\bf\textcolor{white}{Etiology}}  \tn
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\mymulticolumn{1}{x{8.4cm}}{{\bf{Introduction:}} Causes of weakness are categorised by lesion location. Some disorders have characteristic of lesions in more than one location. E.g. {\emph{Amyotrophic lateral sclerosis (ALS)}} may have findings of both UMN \& LMN dysfunction. Disorders of the SC may affect tracts from UMN, LMN (anterior horn cells), or both} \tn 
% Row Count 7 (+ 7)
% Row 1
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\mymulticolumn{1}{x{8.4cm}}{{\bf{Common causes of {\emph{focal}} weakness}}\{\{nl\}\}- Stroke: unilateral weakness\{\{nl\}\}- Neuropathies: including trauma or entrapment caused (e.g. carpal tunnel syndrome) \& that are immune-mediated (e.g. Bell palsy)} \tn 
% Row Count 12 (+ 5)
% Row 2
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\mymulticolumn{1}{x{8.4cm}}{{\bf{{\emph{Temporary focal}} weakness:}}\{\{nl\}\}- TIA (transient ischemic attack)\{\{nl\}\}- Hypoglycaemia: with treatment hypoglycaemia \& resulting weakness resolve} \tn 
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\mymulticolumn{1}{x{8.4cm}}{{\bf{{\emph{Generalised}} weakness:}}\{\{nl\}\}- Disuse atrophy: resulting from illness or frailty (specifically in older pts)\{\{nl\}\}- Generalised muscle wasting: due to prolonged immobilisation in an intensive care unit (ICU) - aka {\emph{ICU myopathy}}\{\{nl\}\}- Critical illness polyneuropathy - aka {\emph{ICU neuropathy}}\{\{nl\}\}- Common myopathies: e.g. alcoholic myopathy, hypokalaemia, corticosteroid myopathy\{\{nl\}\}- Use of paralytic drugs in critical care pts} \tn 
% Row Count 24 (+ 9)
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\begin{tabularx}{8.4cm}{X}
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\mymulticolumn{1}{x{8.4cm}}{\bf\textcolor{white}{Fatigue}}  \tn
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\mymulticolumn{1}{x{8.4cm}}{{\bf{Introduction:}} Many pts report weakness when they have fatigue. This can prevent maximal effort \& muscle performance during strength testing} \tn 
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\mymulticolumn{1}{x{8.4cm}}{{\bf{Common causes:}}\{\{nl\}\}- Acute severe illness of almost any cause, {\bf{cancers}}, {\bf{chronic infections}} (e.g.HIV, hepatitis, endocarditis, mononucleosis), {\bf{endocrine disorders}}, {\bf{renal failure}}, {\bf{hepatic failure}}, {\bf{heart failure}}, \& {\bf{anaemia}}\{\{nl\}\}- Multiple sclerosis can cause {\emph{daily fatigue}} that increases with exposure to {\bf{heat \& humidity}}\{\{nl\}\}- Pts with fibromyalgia, depression or chronic fatigue syndrome may report weakness or fatigue but have {\emph{no defined objective abnormalities}}} \tn 
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\mymulticolumn{1}{x{8.4cm}}{\bf\textcolor{white}{Pathophysiology}}  \tn
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\mymulticolumn{1}{x{8.4cm}}{{\bf{Introduction:}} Voluntary movement initiated in cerebral cortex in the posterior aspect of the frontal lobe. Neurons involved - UMN or corticospinal tract nuerons - synapse with LMN in the spinal cord. LMN transmit impulses to the neuromuscular junction to initiate muscle contraction} \tn 
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\mymulticolumn{1}{x{8.4cm}}{{\bf{Common mechanism of weakness include dysfunction of:}}\{\{nl\}\}- {\bf{UMN:}} corticospinal \& corticobulbar tract lesions\{\{nl\}\}- {\bf{LMN:}} due to peripheral poly neuropathies or anterior horn cell lesions\{\{nl\}\}- {\bf{Neuromuscular junction}}\{\{nl\}\}- {\bf{Muscle:}} due to myopathies} \tn 
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\mymulticolumn{1}{x{8.4cm}}{{\bf{Location correlates with physical findings:}}\{\{nl\}\}- {\bf{UMNL:}} disinhibits LMN → causing ↑ muscle tone ({\bf{spacticity}}) \& ↑ muscle stretch reflexes ({\bf{hyperreflexia}}); Babinski reflex is specific for corticospinal tract dysfunction; UMNL can also ↓ tone \& reflexes if motor paralysis is sudden \& severe (e.g {\emph{spinal cord transections}} → tone 1st ↓, then ↑ gradually over days/weeks) or if lesion damages the motor cortex of the precentral gyrus \& not nearby motor associations\{\{nl\}\}- {\bf{LMNL:}} disrupts reflex arcs → causing hyporefelxia \& ↑ muscle tone ({\bf{flaccidity}}), \& may cause fasciculations; with time, muscle atrophy\{\{nl\}\}- {\bf{Peripheral polyneuropathies:}} most noticeable in the longest nerves (i.e. weakness is prominent in the distal limb than the proximal \& in legs more than arms) \& produce signs of LMNL (e.g. ↓ reflexes \& muscle tone)\{\{nl\}\}- {\bf{Neuromuscular junction - myasthenia gravis:}} (most common disorder) fluctuating weakness that worsens with activity \& lessens with rest\{\{nl\}\}- {\bf{Diffuse muscle dysfunction:}} (myopathies) most noticeable in the largest muscle groups (proximal muscles)} \tn 
% Row Count 35 (+ 23)
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\begin{tabularx}{8.4cm}{X}
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\mymulticolumn{1}{x{8.4cm}}{\bf\textcolor{white}{Evaluation}}  \tn
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\mymulticolumn{1}{x{8.4cm}}{{\bf{Temporal pattern:}}} \tn 
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\mymulticolumn{1}{x{8.4cm}}{{\bf{Anatomic pattern:}}} \tn 
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\mymulticolumn{1}{x{8.4cm}}{{\bf{ Physical examination:}}} \tn 
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\mymulticolumn{1}{x{8.4cm}}{{\bf{Additional findings:}}} \tn 
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\begin{tabularx}{8.4cm}{X}
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\mymulticolumn{1}{x{8.4cm}}{\bf\textcolor{white}{Key points}}  \tn
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\mymulticolumn{1}{x{8.4cm}}{{\bf{Distinguish}} loss of muscle strength from a feeling of fatigue} \tn 
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\mymulticolumn{1}{x{8.4cm}}{⏺ If fatigue has {\bf{no anatomic or temporal pattern}} of weakness in pts with a normal physical examination, suspect {\bf{chronic fatigue syndrome}}, an as-yet undiscovered systemic illness {\bf{(e.g. severe anaemia, hypothyroidism, Addison disease)}}, a psychologic problem {\bf{(e.g. depression)}}, or an adverse drug effect} \tn 
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\mymulticolumn{1}{x{8.4cm}}{⏺ If pts have {\bf{true muscle}} weakness, first focus on determining whether weakness is caused by dysfunction of the {\bf{brain, spinal cord, plexuses, peripheral nerves, neuromuscular junction, or muscles}}} \tn 
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\mymulticolumn{1}{x{8.4cm}}{⏺ If pts have {\bf{hyperreflexia}} \& increased muscle tone {\bf{(spasticity)}}, particularly if {\bf{Babinski reflex}} is present, suspect an {\bf{UMN (corticospinal tract)}} lesion in the {\bf{brain or spinal}}: MRI is usually required} \tn 
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\mymulticolumn{1}{x{8.4cm}}{⏺ If pts have {\bf{hyporeflexia}}, {\bf{↓ tone}}, {\bf{atrophy}}, \& {\bf{fasciculations}}, suspect a {\bf{LMNL}}} \tn 
% Row Count 22 (+ 3)
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\SetRowColor{white}
\mymulticolumn{1}{x{8.4cm}}{⏺ If pts have {\bf{difficulty climbing stairs}}, {\bf{combing hair}}, \& {\bf{standing up}} with predominantly {\bf{proximal muscle weakness}} \& {\bf{intact sensation}}, suspect {\bf{myopathy}}} \tn 
% Row Count 26 (+ 4)
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% That's all folks
\end{multicols*}

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