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Bilateral LMN palsy with tongue weakness, wasting and fasciculations. → Bulbar motor Neuron disease Note
Bilateral LMN palsy ... differentiates this from an UMN ... fasciculations #LMN ... CN12 #clinical #video
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 Incomplete spinal cord syndromes (ISCS) • Central - Small Lesion - Suspended sensory deficit, classic cape
Disproportionate motor (UMN ... Ipsilateral weakness (UMN ... small band of LMN ... paraparesis (mixed UMN ... and LMN types)
Upper Motor Neuron (UMN) lesions are lesions occurring anywhere in the CNS from the brain up
Motor Neuron (UMN ... However, in UMN ... UMC & LMN lesions ... UMN lesions are ... @DharSaty #UMN
Amyotrophic Lateral Sclerosis (ALS) Summary ALS: combination of the clinical examination finding of amyotrophy with the pathologic
involving both UMN ... combination of UMN ... involvement • UMN ... combination of UMN ... evidence of both UMN
Liver Function Test (LFTs) Elevation AST - Cardiac and skeletal muscle, kidney, brain ALT - More specific for
Liver Function Test ... specific for the liver ... Value = (ALT / ULN ... ALT) / (ALP / ULN ... SinaiBmoreIMRes #Liver
Liver Enzymes (LFTs) - Causes of Hepatocellular and Cholestatic Liver Injury Hepatocellular Liver Injury • AST/ALT elevation
Liver Enzymes (LFTs ... and Cholestatic Liver ... Hepatocellular Liver ... value = (ALT + ULN ... phosphatase + ULN
Elevated Liver Enzymes - Differential Diagnosis Algorithm Severe ALT > 15x ULN • Viral • Drugs/Toxins •
Elevated Liver Enzymes ... Severe ALT > 15x ULN ... Moderate ALT 5-15x ULN ... Mild ALT < 5x ULN
Generalized Weakness - Differential Diagnosis Framework "l feel weak": • Infectious: Influenza, EBV, PNA, Bacteremia, Sepsis •
Infection • Neuro: UMN ... stroke, tumor), LMN
Liver Chemistries - Interpretation of LFTs R-value: Serum (ALT/ULN ALT) / (Alk phos/ULN ALP) • R >
Liver Chemistries ... R-value: Serum (ALT/ULN ... ALT) / (Alk phos/ULN ... Identify Acute Liver ... - Specific to liver
Abnormal Liver Function Tests - Differential Diagnosis Algorithm for Transaminitis Hepatocellular Pattern (ALT or AST > ALP):
Abnormal Liver Function ... Severe - ALT >15X ULN ... Moderate - ALT 5-15X ULN ... Mild - ALT < 5x ULN
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