Etiology and evaluation of the child with weakness
- Author
- Russell Migita, MD
Russell Migita, MD
- Clinical Associate Professor of Pediatrics
- University of Washington Medical School
- Section Editor
- George A Woodward, MD
George A Woodward, MD
- Section Editor — Pediatric Signs and Symptoms
- Professor of Pediatrics
- University of Washington School of Medicine
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — UpToDate
- Deputy Editor — Adult and Pediatric Emergency Medicine
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Clinical Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
INTRODUCTION
The approach to the child with weakness will be reviewed here. The approach to an infant or newborn with hypotonia or weakness is discussed separately. (See "Approach to the infant with hypotonia and weakness" and "Overview of peripheral nerve and muscle disorders causing hypotonia in the newborn".)
DEFINITIONS
Weakness is a decreased ability to voluntarily and actively move muscles against resistance. Weakness may arise from any portion of the motor unit and is typically divided into upper motor neuron and lower motor neuron weakness as follows:
●Upper motor neuron weakness – Upper motor neuron weakness arises from lesions in the cerebral cortex and corticospinal tracts down to, but not including, the anterior horn cell in the dorsal spinal cord.
●Lower motor neuron weakness – Lower motor neuron weakness results from lesions located in the anterior horn cell, peripheral nerve, neuromuscular junction, or muscle.
Weakness can be confused with hypotonia or ataxia. Hypotonia is a decreased resistance to passive range of motion. Ataxia refers to decreased muscular coordination. (See "Approach to the infant with hypotonia and weakness" and "Approach to the child with acute ataxia".)
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To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:Literature review current through: Jun 2017. | This topic last updated: Nov 18, 2015.The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.References- Sweney MT, Silver K, Gerard-Blanluet M, et al. Alternating hemiplegia of childhood: early characteristics and evolution of a neurodevelopmental syndrome. Pediatrics 2009; 123:e534.
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Top- INTRODUCTION
- DEFINITIONS
- CAUSES OF ACUTE WEAKNESS
- Upper motor neuron lesion
- - Cerebral cortex
- Intracranial hemorrhage
- Stroke
- Brain tumor
- Seizure
- Hemiplegic migraine
- Alternating hemiplegia of childhood
- - Spinal cord
- Spinal cord trauma
- Spinal cord tumor
- Paraspinal infection or inflammation
- Transverse myelitis
- Lower motor neuron lesion
- - Anterior horn cell disease
- Poliomyelitis and other enteroviruses
- - Peripheral nerve
- Guillain-Barré syndrome
- Peripheral nerve toxins
- Acute intermittent porphyria
- Other
- - Neuromuscular junction disorders
- Botulism
- Myasthenia gravis
- Organophosphate or carbamate poisoning
- Neurotoxic snake envenomation
- Tick paralysis
- - Muscle
- Rhabdomyolysis
- Myositis
- Familial periodic paralysis
- Trichinellosis
- - Other
- Electrolyte disturbance
- Drug-related
- Conversion disorder
- CAUSES OF CHRONIC WEAKNESS
- EVALUATION
- Initial stabilization
- History
- Physical examination
- - Muscle examination
- - Neurologic examination
- - Other findings
- Ancillary studies
- DIAGNOSTIC APPROACH
- Sudden onset, severe weakness
- Acute onset weakness
- Subacute or chronic weakness
- SUMMARY
- REFERENCES