Brain disorders

Brain tumors

Headaches, personality changes, confusion, difficulty concentrating, drowsiness, loss of balance and coordination, and paralysis or numbness

Sometimes seizures

MRI or CT of the brain

Multiple sclerosis (affects the brain, spinal cord or both)

Usually other symptoms of nervous system malfunction (such as loss of sensation, loss of coordination, and vision problems)

Weakness that

• Tends to come and go

• Sometimes affects different parts of the body

• Is worse in hot weather

MRI of the brain and sometimes of the spinal cord

Sometimes a spinal tap (lumbar puncture)

Sometimes evoked responses

Stroke

Symptoms that occur suddenly:

• Weakness or paralysis, usually on one side of the body

• Abnormalities in or loss of sensation on one side of the body

• Difficulty speaking, sometimes with slurred speech

• Confusion

• Dimness, blurring, or loss of vision, particularly in one eye

• Dizziness or loss of balance and coordination

CT or MRI of the brain

Spinal cord disorders‡

Acute transverse myelitis (sudden spinal cord inflammation), often due to

• Multiple sclerosis

• Inflammation of blood vessels

• Certain infections such as Lyme disease or syphilis

Tingling, numbness, and muscle weakness that

• Occur rapidly (over hours to a few days)

• Start in the feet and move upward

Usually a bandlike tightness around the chest or abdomen

Often difficulty passing urine

When an injury is severe, loss of bowel and bladder control and/or reduced sexual response, including erectile dysfunction in men

MRI of the spinal cord, CT myelography§, or both

Evoked responses

A spinal tap to help identify the cause

Blood tests to help identify the cause

Cauda equina syndrome, caused by pressure on several spinal nerve roots, as may result from

• A ruptured or herniated disk

• Spread of cancer to the spine

Weakness in both legs

Loss of feeling in the upper inner part of the thighs, the buttocks, bladder, genitals, and the area between them (saddle area)

Usually pain in the lower back

Loss of bowel and bladder control and/or reduced sexual response, including erectile dysfunction in men

MRI of the spinal cord or CT myelography§

Compression of the spinal cord that develops suddenly (acute), as may result from

• Abscesses (pockets of pus)

• Hematomas (pockets of blood)

• Injuries of the neck or back

• Some cancers

Symptoms that develop in hours or days

Weakness or paralysis of the legs and sometimes arms and loss of sensation

With abscesses or tumors, tenderness to the touch over the compressed area

MRI of the spinal cord or CT myelography§

Compression of the spinal cord that develops slowly (chronic), as may result from

• Cervical spondylosis (degeneration of the vertebral disks due to arthritis)

• Spinal stenosis (narrowing of the passageway for the spinal cord) due to arthritis

• Some tumors

Symptoms that are present for weeks to months

When an injury is severe, loss of bowel and bladder control and/or reduced sexual response, including erectile dysfunction in men

MRI of the spinal cord or CT myelography§

Compression of a spinal nerve root by a ruptured disk

Weakness, numbness, or both in one leg or arm

Usually back or neck pain that shoots down the leg or arm

Usually MRI or CT of the spinal cord

Usually electromyography (stimulating muscles and recording their electrical activity)

Sometimes nerve conduction studies (measuring how fast nerves transmit signals)

Multiple sclerosis (affects the brain, spinal cord, or both)

Usually other symptoms of nervous system malfunction (such as loss of sensation, loss of coordination, and vision problems)

Weakness that

• Tends to come and go

• Sometimes affects different parts of the body

• Is worse in hot weather

MRI of the brain and spinal cord

Sometimes a spinal tap

Disorders that affect the peripheral nerves and the brain or spinal cord║

Amyotrophic lateral sclerosis (ALS)

Progressive muscle weakness that

• Often starts in the hands

• Sometimes affects one side more than the other

Clumsiness, involuntary muscle contractions, and muscle cramps

Drooling and difficulty speaking and swallowing

As the disorder progresses, difficulty breathing and eventually death

Electromyography and sometimes nerve conduction studies

MRI or CT myelography§ of the brain and spinal cord or both to rule out disorders that can cause similar symptoms

Postpolio syndrome

Muscles that tire easily and progressive muscle weakness

Sometimes muscle twitching and loss of muscle tissue

In people who have had polio

Electromyography and sometimes nerve conduction studies

MRI or CT myelography§ of the brain and spinal cord or both to rule out disorders that can cause similar symptoms

Disorders that simultaneously affect many nerves (polyneuropathies)

Guillain-Barré syndrome

Weakness and often loss of sensation that

• Usually begin in both legs

• Then progress upward to the arms

When severe, difficulty swallowing and breathing

Electromyography and nerve conduction studies

A spinal tap

Hereditary neuropathies (such as Charcot-Marie-Tooth disease)

Muscle wasting (atrophy)

Sometimes loss of reflexes

Loss of sensation, including the ability to sense position of the limbs, vibration, pain, and temperature

Electromyography and nerve conduction studies

Sometimes genetic testing

Nerve damage caused by

• Excessive use of alcohol

• Diabetes

• Infections (such as diphtheria, hepatitis C, HIV (human immunodeficiency virus) infection, Lyme disease, or syphilis)

• Sarcoidosis

• Severe illness (especially that requires treatment in an intensive care unit)

• Toxic substances (such as lead or mercury)

• Vitamin deficiency (such as thiamin, vitamin B6, or vitamin B12 deficiency)

Muscle weakness that

• Often begins in both feet

• Then affects the hands

• Then progresses up the legs and arms

Loss of sensation, typically before muscles become weak

Loss of reflexes

Electromyography and nerve conduction studies

Other tests depending on the disorder suspected, such as

• Blood and urine tests to check for toxins

• Blood tests to check for certain antibodies or to measure sugar, vitamin, or medication levels

• Sometimes a spinal tap

Disorders that affect the connections between nerves and muscles (neuromuscular junction disorders)

Botulinum toxin when a dose that is too high is used to treat dystonia or other muscle spasms

Weakness of the treated muscles or sometimes of all muscles

A doctor's examination alone

Botulism (due to the bacteria Clostridium botulinum)

At first, often a dry mouth, drooping eyelids, vision problems (such as double vision), difficulty swallowing and speaking, and rapidly progressive muscle weakness, often beginning in the face and moving down the body

When contaminated food is the source, nausea, vomiting, stomach cramps, and diarrhea

No changes in sensation

Blood or stool tests to check for toxins produced by the bacteria

Usually electromyography

Sometimes examination of a stool sample to check for bacteria

Myasthenia gravis

Weak and drooping eyelids, double vision, difficulty speaking and swallowing, and weakness in the arms and legs

Excessive weakness of affected muscles that

• Occurs after muscles are used

• Disappears when they are rested

• Recurs when they are used again

Sometimes the ice pack test to see whether cold improves muscle strength after muscles are used

Blood tests to check for certain antibodies and/or electromyography

Organophosphate or carbamate (insecticide) poisoning

Tearing of the eyes, blurred vision, increased salivation, sweating, coughing, vomiting, frequent bowel movements and urination, and weak muscles that twitch

Often a doctor’s examination alone

Sometimes blood tests to identify the toxin

Disorders that affect muscles (myopathies)^║

Conditions that cause generalized muscle wasting:

• Burns

• Cancer

• Lack of use due to prolonged bed rest or immobilization in a cast

• Sepsis (infection of the bloodstream)

• Starvation

Loss of muscle tissue

In people with obvious evidence of the problem

A doctor’s examination alone

Electrolyte abnormalities due to certain disorders or use of diuretics, such as

• A low level of potassium (hypokalemia)

• A low level of magnesium (hypomagnesemia)

• A low level of calcium (hypocalcemia)

Weakness that

• Affects the whole body

• May come and go

• Is often accompanied by muscle cramping and twitches

Blood tests to measure the level of potassium and other electrolytes

Muscle malfunction due to use of alcohol, corticosteroids, or various other drugs

Weakness that tends to first cause difficulty standing up or lifting the arms overhead

Use of a drug or medication that can cause muscle damage (such as a statin)

When due to use of alcohol or certain other drugs, muscle aches and pains

Stopping any drug that can cause muscle malfunction

Sometimes electromyography

Blood tests to measure levels of muscle enzymes that leak from damaged muscles into the blood

Muscular dystrophies, such as

• Duchenne muscular dystrophy

• Limb-girdle muscular dystrophy

Progressive muscle weakness that

• May start during infancy, childhood, or adulthood

• Depending on the type, may progress rapidly, causing early death

In some types, an abnormally curved spine (scoliosis) and weakness of the spinal muscles, which often develop during childhood

A thorough family history to determine whether any family members have had a similar disorder

Genetic testing

Sometimes muscle biopsy

Viral infections that cause muscle inflammation. such as

• Herpes simplex virus infections

• HIV infection

• Mononucleosis

• Shingles

• Syphilis

Muscle aches and pains that are worsened by movement, especially walking

Sometimes fever, a runny nose, cough, sore throat, and/or fatigue

Sometimes a doctor’s examination alone

Sometimes blood tests to measure levels of muscle enzymes that leak from damaged muscles into the blood

Often tests of blood and/or spinal fluid to identify the infection causing the symptoms

Sometimes muscle biopsy (removal of a piece of muscle tissue for examination under a microscope)