Differentials
Functional or psychogenic weakness (e.g., unilateral loss of motor function or psychogenic parkinsonism)
SIGNS / SYMPTOMS
Psychological disorders may mimic relevant clinical findings.
Psychological assessment may be useful in diagnosis.
Referral to a specialist may be appropriate when obvious antecedent causes of paralysis are absent.
INVESTIGATIONS
Electrical testing is confirmatory of non-physiological causes of paralysis and sensory loss.
Amyotrophic lateral sclerosis (ALS)
SIGNS / SYMPTOMS
Progression of muscle weakness and atrophy.
Involvement of other body sites.
The progression of muscle weakness or sensory loss can help differentiate ALS from other neurological disorders.
INVESTIGATIONS
Electrical testing (electromyography and/or nerve conduction velocity) can be used to assess for evidence of diffuse, on-going, chronic denervation in ALS.
Brain or spinal cord injury
SIGNS / SYMPTOMS
The history and clinical examination may help to differentiate the conditions according to the site of injury.
INVESTIGATIONS
Magnetic resonance or other imaging. Imaging can reveal injury to the brain or spine.
Pancoast tumour
SIGNS / SYMPTOMS
There may be no differences in signs and symptoms initially.
Horner's syndrome and paraplegia may develop.
INVESTIGATIONS
Magnetic resonance imaging of the apex of the lung and brachial plexus can show the tumour and its relationship to the brachial plexus.
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