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Evaluation of the adult with acute weakness in the emergency department

Andrew W Asimos, MD
Section Editor
Robert S Hockberger, MD, FACEP
Deputy Editor
Jonathan Grayzel, MD, FAAEM


Weakness is a common, nonspecific emergency department (ED) complaint that encompasses a broad differential diagnosis. Causes include neurologic ailments and a range of non-neurologic conditions. The diagnosis of potentially life-threatening neurologic and neuromuscular processes requires a systematic, anatomic approach based upon a careful history, physical examination, and in some cases, imaging studies.

Particularly in the elderly, infection, cardiovascular disease, and dehydration must be considered as possible causes of weakness. However, such conditions cause generalized malaise rather than true neuromuscular weakness and will not be discussed here, except to mention them as important considerations in the differential diagnosis.

The approach to the diagnosis and initial management of patients presenting to the ED with acute, nontraumatic neurologic and neuromuscular weakness will be reviewed here. Medical conditions characterized by general malaise or chronic weakness is discussed separately.


Although this topic reviews the approach to the patient with acute weakness from nontraumatic neurologic or neuromuscular disease, a broad differential diagnosis, including causes of generalized weakness (or malaise), is presented here to assist clinicians looking for additional information about these conditions.

Life-threatening central causes of unilateral weakness

Ischemic stroke – Sudden loss of focal brain function is the core feature of the onset of ischemic stroke. This may manifest as acute, focal, unilateral weakness or paralysis in the face, upper extremity, or lower extremity, or as difficulty with coordination and gait. Other medical illness can mimic stroke (table 1), and symptoms of stroke can vary widely based upon the cause and the artery involved (table 2 and table 3). (See "Overview of the evaluation of stroke" and "Initial assessment and management of acute stroke".)

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Literature review current through: Nov 2017. | This topic last updated: Apr 26, 2017.
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