Practical approach to the patient with acute neuromuscular weakness

Table 1 Differential diagnosis of acute neuromuscular paralysis

Anterior horn cell disorders

Poliomyelitis

West Nile virus

Peripheral neuropathy/polyradiculopathy

GBS

Porphyria

Diptheria

CMV polyradiculopathy

Lyme neuroborreliosis

Toxins (heavy metals, e.g., arsenic, mercury, hexacarbon, drug intoxication, organophosphate, Buckthorn)

Critical illness polyneuropathy

Tick paralysis

Vasculitic neuropathy

Neuromuscular junction disorder

MG

Lambert-Eaton syndrome

Neuroparalytic envenomation (e.g., tick and snake bites)

Botulism

Organophosphate and carbamate

Hypermagnesemia

Prolonged neuromuscular blockade

Overdose of anticholinesterases

Muscle disease

Periodic paralysis (hypokalemic: Hereditary and secondary, hyperkalemic)

Hypophosphatemia

Critical illness myopathy

Polymyositis, dermatomyositis, infectious myositis (e.g., dengue myositis)

Acute rhabdomyolysis

Adapted from Maramattom et al[2]. GBS: Guillain-Barré syndrome; CMV: Cytomegalovirus; MG: Myasthenia gravis.