Muscle weakness Character Location Qualitative Ask generally Ability to walk Affect on daily life Quantitative Time questions Previous episodes Relieving factors Context and aggravating factors: Ask generally Context of onset Ideas Injuries Lifestyle changes Associated features Aura Fever Nausea Spams Headache Vomiting Back pain Dizziness Chest pain Weight loss Facial droop Night sweats Palpitations Loss of height Neck stiffness Vision changes Auditory changes Sensory changes Speech changes Sensitive to light Sensitive to sound Balance difficulties Spine tenderness Altered bowel habits Coordination difficulty Medications Past medial history Family history Social history Diet Exercise Smoking Recreation drugs Affect on daily life Differentials TIA Migraines Peripheral vascular disease MS Vertebral compression fracture Lumbar disc herniation Guillain barre Cerebral neoplasm Subarachnoid haemorrhage UMN: Interruption of a neural pathway at a level above the anterior horn cell. Increase in tone. Increase in peripheral reflexes. Interruption of this pathway has the greatest effect on antigravity muscles -> pyramidal weakness. Little or no muscle wasting. LMN: Lesion that interrupts the reflex arc between the anterior horn cell and the muscles. Sudden reduction in tone. Sudden reduction in reflexes. Fasciculation Prominent muscle wasting. Muscle diseases: Weakness in a particular muscle of a muscle group. Muscle wasting Decrease in muscle tone. Reduction or absent reflexes. NMJ diseases Generalised muscle weakness Worse with repetition Muscle reflexes and tone are normal. Tremors and Involuntary Movements