Sandbox Myopathy: Difference between revisions

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! colspan="19" |Medications
! colspan="19" |Medications
|-
|-
|[[Corticosteroids]]
|[[Corticosteroids]]<ref name="pmid24083177">{{cite journal |vauthors=Gupta A, Gupta Y |title=Glucocorticoid-induced myopathy: Pathophysiology, diagnosis, and treatment |journal=Indian J Endocrinol Metab |volume=17 |issue=5 |pages=913–6 |date=September 2013 |pmid=24083177 |pmc=3784879 |doi=10.4103/2230-8210.117215 |url=}}</ref>
|
|
* Variable
* Variable
Line 86: Line 86:
* Normal
* Normal
|-
|-
|[[Statins]]
|[[Statins]]<ref name="pmid22001973">{{cite journal |vauthors=Tomaszewski M, Stępień KM, Tomaszewska J, Czuczwar SJ |title=Statin-induced myopathies |journal=Pharmacol Rep |volume=63 |issue=4 |pages=859–66 |date=2011 |pmid=22001973 |doi= |url=}}</ref>
|
|
* 60+
* 60+
Line 117: Line 117:
* Normal
* Normal
|-
|-
|[[Alcohol]]
|[[Alcohol]]<ref name="pmid11784353">{{cite journal |vauthors=Preedy VR, Adachi J, Ueno Y, Ahmed S, Mantle D, Mullatti N, Rajendram R, Peters TJ |title=Alcoholic skeletal muscle myopathy: definitions, features, contribution of neuropathy, impact and diagnosis |journal=Eur. J. Neurol. |volume=8 |issue=6 |pages=677–87 |date=November 2001 |pmid=11784353 |doi= |url=}}</ref>
|
|
* Variable
* Variable
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! colspan="19" |Endocrine  
! colspan="19" |Endocrine  
|-
|-
|[[Cushing's disease]]
|[[Cushing's disease]]<ref name="pmid25221399">{{cite journal |vauthors=Sharma V, Borah P, Basumatary LJ, Das M, Goswami M, Kayal AK |title=Myopathies of endocrine disorders: A prospective clinical and biochemical study |journal=Ann Indian Acad Neurol |volume=17 |issue=3 |pages=298–302 |date=July 2014 |pmid=25221399 |pmc=4162016 |doi=10.4103/0972-2327.138505 |url=}}</ref>
|
|
* 25 -45
* 25 -45
Line 195: Line 195:
|Normal
|Normal
|-
|-
|[[Adrenal insufficiency]]
|[[Adrenal insufficiency]]<ref name="pmid30656022">{{cite journal |vauthors=Ruff RL, Weissmann J |title=Endocrine myopathies |journal=Neurol Clin |volume=6 |issue=3 |pages=575–92 |date=August 1988 |pmid=3065602 |doi= |url=}}</ref>
|
|
* 30-50 years
* 30-50 years
Line 234: Line 234:
* Normal
* Normal
|-
|-
|[[Hyperaldosteronism]] with myopathy 
|[[Hyperaldosteronism]] with myopathy<ref name="pmid5037033">{{cite journal |vauthors=Sambrook MA, Heron JR, Aber GM |title=Myopathy in association with primary hyperaldosteronism |journal=J. Neurol. Neurosurg. Psychiatry |volume=35 |issue=2 |pages=202–7 |date=April 1972 |pmid=5037033 |pmc=494037 |doi= |url=}}</ref>
|
|
* 50
* 50
Line 267: Line 267:
* Normal  
* Normal  
|-
|-
|[[Hyperthyroidism]]
|[[Hyperthyroidism]]<ref name="pmid28746208">{{cite journal |vauthors=Li Q, Liu Y, Zhang Q, Tian H, Li J, Li S |title=Myopathy in hyperthyroidism as a consequence of rapid reduction of thyroid hormone: A case report |journal=Medicine (Baltimore) |volume=96 |issue=30 |pages=e7591 |date=July 2017 |pmid=28746208 |pmc=5627834 |doi=10.1097/MD.0000000000007591 |url=}}</ref>
|
|
* 40
* 40
Line 297: Line 297:
* Myotonic
* Myotonic
|-
|-
|[[Hypothyroidism]]
|[[Hypothyroidism]]<ref name="pmid6627693">{{cite journal |vauthors=Khaleeli AA, Griffith DG, Edwards RH |title=The clinical presentation of hypothyroid myopathy and its relationship to abnormalities in structure and function of skeletal muscle |journal=Clin. Endocrinol. (Oxf) |volume=19 |issue=3 |pages=365–76 |date=September 1983 |pmid=6627693 |doi= |url=}}</ref>
|
|
* >55
* >55
Line 326: Line 326:
* Normal
* Normal
|-
|-
|Diabetic infraction  
|Diabetic infraction<ref name="pmid25932331">{{cite journal |vauthors=Horton WB, Taylor JS, Ragland TJ, Subauste AR |title=Diabetic muscle infarction: a systematic review |journal=BMJ Open Diabetes Res Care |volume=3 |issue=1 |pages=e000082 |date=2015 |pmid=25932331 |pmc=4410119 |doi=10.1136/bmjdrc-2015-000082 |url=}}</ref>
|
|
* 45 
* 45 
Line 459: Line 459:
* Neurogenic
* Neurogenic
|-
|-
|[[Fibromyalgia]]
|[[Fibromyalgia]]<ref name="pmid27803417">{{cite journal |vauthors=Ohara N, Katada S, Yamada T, Mezaki N, Suzuki H, Suzuki A, Hanyu O, Yoneoka Y, Kawachi I, Shimohata T, Kakita A, Nishizawa M, Sone H |title=Fibromyalgia in a Patient with Cushing's Disease Accompanied by Central Hypothyroidism |journal=Intern. Med. |volume=55 |issue=21 |pages=3185–3190 |date=2016 |pmid=27803417 |pmc=5140872 |doi=10.2169/internalmedicine.55.5926 |url=}}</ref>
|
|
* 40-50s  
* 40-50s  
Line 522: Line 522:
! colspan="19" |Genetic
! colspan="19" |Genetic
|-
|-
|[[Becker's muscular dystrophy|Becker muscular dystrophy]]
|[[Becker's muscular dystrophy|Becker muscular dystrophy]]<ref name="pmid25037084">{{cite journal |vauthors=Flanigan KM |title=Duchenne and Becker muscular dystrophies |journal=Neurol Clin |volume=32 |issue=3 |pages=671–88, viii |date=August 2014 |pmid=25037084 |doi=10.1016/j.ncl.2014.05.002 |url=}}</ref>
|
|
* <13yrs
* <13yrs
Line 552: Line 552:
* Myopathic
* Myopathic
|-
|-
|[[Duchenne muscular dystrophy]]
|[[Duchenne muscular dystrophy]]<ref name="pmid250370842">{{cite journal |vauthors=Flanigan KM |title=Duchenne and Becker muscular dystrophies |journal=Neurol Clin |volume=32 |issue=3 |pages=671–88, viii |date=August 2014 |pmid=25037084 |doi=10.1016/j.ncl.2014.05.002 |url=}}</ref>
|
|
* <13 yrs
* <13 yrs
Line 582: Line 582:
* '''↑↑'''
* '''↑↑'''
|-
|-
|[[Limb-girdle muscular dystrophy|Limb-girdle muscular]] dystrophies
|[[Limb-girdle muscular dystrophy|Limb-girdle muscular]] dystrophies<ref name="pmid18769252">{{cite journal |vauthors=Guglieri M, Straub V, Bushby K, Lochmüller H |title=Limb-girdle muscular dystrophies |journal=Curr. Opin. Neurol. |volume=21 |issue=5 |pages=576–84 |date=October 2008 |pmid=18769252 |doi=10.1097/WCO.0b013e32830efdc2 |url=}}</ref>
|
|
* <15 yrs
* <15 yrs
Line 616: Line 616:
* Myopathic
* Myopathic
|-
|-
|[[Myotonic dystrophy]]
|[[Myotonic dystrophy]]<ref name="pmid22995693">{{cite journal |vauthors=Udd B, Krahe R |title=The myotonic dystrophies: molecular, clinical, and therapeutic challenges |journal=Lancet Neurol |volume=11 |issue=10 |pages=891–905 |date=October 2012 |pmid=22995693 |doi=10.1016/S1474-4422(12)70204-1 |url=}}</ref>
|
|
* <18 years
* <18 years
Line 655: Line 655:
! colspan="19" |Infectious
! colspan="19" |Infectious
|-
|-
|[[Lyme disease]]
|[[Lyme disease]]<ref name="pmid2795056">{{cite journal |vauthors=Schoenen J, Sianard-Gainko J, Carpentier M, Reznik M |title=Myositis during Borrelia burgdorferi infection (Lyme disease) |journal=J. Neurol. Neurosurg. Psychiatry |volume=52 |issue=8 |pages=1002–5 |date=August 1989 |pmid=2795056 |pmc=1031843 |doi= |url=}}</ref>
|
|
* Variable
* Variable
Line 689: Line 689:
* -
* -
|-
|-
|[[Influenza]]
|[[Influenza]]<ref name="pmid6687269">{{cite journal |vauthors=Bove KE, Hilton PK, Partin J, Farrell MK |title=Morphology of acute myopathy associated with influenza B infection |journal=Pediatr Pathol |volume=1 |issue=1 |pages=51–66 |date=1983 |pmid=6687269 |doi= |url=}}</ref>
|
|
* Variable
* Variable
Line 722: Line 722:
* -
* -
|-
|-
|[[Polio]]
|[[Polio]]<ref name="pmid15933355">{{cite journal |vauthors=Howard RS |title=Poliomyelitis and the postpolio syndrome |journal=BMJ |volume=330 |issue=7503 |pages=1314–8 |date=June 2005 |pmid=15933355 |pmc=558211 |doi=10.1136/bmj.330.7503.1314 |url=}}</ref>
|
|
* <5 yrs
* <5 yrs
Line 757: Line 757:
* Neurological pattern
* Neurological pattern
|-
|-
|[[Syphilis]]
|[[Syphilis]]<ref name="pmid17235095">{{cite journal |vauthors=French P |title=Syphilis |journal=BMJ |volume=334 |issue=7585 |pages=143–7 |date=January 2007 |pmid=17235095 |pmc=1779891 |doi=10.1136/bmj.39085.518148.BE |url=}}</ref>
|
|
* Variable
* Variable
Line 794: Line 794:
* -
* -
|-
|-
|[[Pyomyositis]]
|[[Pyomyositis]]<ref name="pmid15380499">{{cite journal |vauthors=Crum NF |title=Bacterial pyomyositis in the United States |journal=Am. J. Med. |volume=117 |issue=6 |pages=420–8 |date=September 2004 |pmid=15380499 |doi=10.1016/j.amjmed.2004.03.031 |url=}}</ref>
|
|
* Variable
* Variable
Line 829: Line 829:
! colspan="19" |Neurologic
! colspan="19" |Neurologic
|-
|-
|[[Amyotrophic lateral sclerosis|ALS]]
|[[Amyotrophic lateral sclerosis|ALS]]<ref name="pmid26629397">{{cite journal |vauthors=Zarei S, Carr K, Reiley L, Diaz K, Guerra O, Altamirano PF, Pagani W, Lodin D, Orozco G, Chinea A |title=A comprehensive review of amyotrophic lateral sclerosis |journal=Surg Neurol Int |volume=6 |issue= |pages=171 |date=2015 |pmid=26629397 |pmc=4653353 |doi=10.4103/2152-7806.169561 |url=}}</ref>
|
|
* >35
* >35
Line 861: Line 861:
* Neuropathic  
* Neuropathic  
|-
|-
|[[Stroke]]
|[[Stroke]]<ref name="pmid20412000">{{cite journal |vauthors=Baldwin K, Orr S, Briand M, Piazza C, Veydt A, McCoy S |title=Acute ischemic stroke update |journal=Pharmacotherapy |volume=30 |issue=5 |pages=493–514 |date=May 2010 |pmid=20412000 |doi=10.1592/phco.30.5.493 |url=}}</ref>
|
|
* >65
* >65
Line 891: Line 891:
* Neuropathic
* Neuropathic
|-
|-
|[[GBS]]
|[[GBS]]<ref name="pmid23628447">{{cite journal |vauthors=van Doorn PA |title=Diagnosis, treatment and prognosis of Guillain-Barré syndrome (GBS) |journal=Presse Med |volume=42 |issue=6 Pt 2 |pages=e193–201 |date=June 2013 |pmid=23628447 |doi=10.1016/j.lpm.2013.02.328 |url=}}</ref>
|
|
* 18  -350
* 18  -350
Line 919: Line 919:
* Neuropathic
* Neuropathic
|-
|-
|[[Multiple sclerosis|Multiple Sclerosis]]
|[[Multiple sclerosis|Multiple Sclerosis]]<ref name="pmid22605909">{{cite journal |vauthors=Goldenberg MM |title=Multiple sclerosis review |journal=P T |volume=37 |issue=3 |pages=175–84 |date=March 2012 |pmid=22605909 |pmc=3351877 |doi= |url=}}</ref>
|
|
* 30's
* 30's
Line 955: Line 955:
! colspan="19" |Neuro-muscular  
! colspan="19" |Neuro-muscular  
|-
|-
|[[Botulinum]]
|[[Botulinum]]<ref name="pmid15257512">{{cite journal |vauthors=Cherington M |title=Botulism: update and review |journal=Semin Neurol |volume=24 |issue=2 |pages=155–63 |date=June 2004 |pmid=15257512 |doi=10.1055/s-2004-830901 |url=}}</ref>
|
|
* Variable
* Variable
Line 988: Line 988:
* Myopathic
* Myopathic
|-
|-
|[[Lambert-Eaton syndrome]]
|[[Lambert-Eaton syndrome]]<ref name="pmid22094130">{{cite journal |vauthors=Titulaer MJ, Lang B, Verschuuren JJ |title=Lambert-Eaton myasthenic syndrome: from clinical characteristics to therapeutic strategies |journal=Lancet Neurol |volume=10 |issue=12 |pages=1098–107 |date=December 2011 |pmid=22094130 |doi=10.1016/S1474-4422(11)70245-9 |url=}}</ref>
|
|
* Variable
* Variable
Line 1,010: Line 1,010:
* Antibodies against voltage-gated calcium channels 
* Antibodies against voltage-gated calcium channels 
|-
|-
|[[Myasthenia gravis]]
|[[Myasthenia gravis]]<ref name="pmid23193443">{{cite journal |vauthors=Jayam Trouth A, Dabi A, Solieman N, Kurukumbi M, Kalyanam J |title=Myasthenia gravis: a review |journal=Autoimmune Dis |volume=2012 |issue= |pages=874680 |date=2012 |pmid=23193443 |pmc=3501798 |doi=10.1155/2012/874680 |url=}}</ref>
|
|
* Variable
* Variable
Line 1,038: Line 1,038:
! colspan="19" |'''Hereditary'''
! colspan="19" |'''Hereditary'''
|-
|-
|[[Glycogen storage disease]]
|[[Glycogen storage disease]]<ref name="pmid11957192">{{cite journal |vauthors=Kannourakis G |title=Glycogen storage disease |journal=Semin. Hematol. |volume=39 |issue=2 |pages=103–6 |date=April 2002 |pmid=11957192 |doi= |url=}}</ref>
|
|
* Variable
* Variable

Revision as of 09:02, 8 April 2018


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Flow chart

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Objective Muscle weakness
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yes
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
No
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Malignancy
Arthralgia
Anemia
Firbomyalgia
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Generalized
 
 
 
 
 
 
 
 
 
 
 
 
 
Localized
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Myasthenia gravis
Periodic paralysis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Asymmetric
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Symmetric
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Cerebrovascular accidents
Demyleinating disorders
Atrophy
Mononeuropathy
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Specific pattern
 
 
 
 
 
 
 
Specific pattern
 
 
 
 
 
 
 
Proximal
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Hereditary neuropathy
Muscular dystrophy
 
 
 
 
 
 
 
Myoapthy
Duchenne muscular dystrophy
 
 
 
 
 
 
 
Motor neuron disease
Peripheral neuropathy
 
 
 

Differentiating Various Muscle Weakness

Disease Symptoms History Physical

Examination

Diagnosis
Age of onset Muscle weakness Fever Myalgia Contractures Gait abnormality Neuropathy Atrophy Stiffness Myoglobinuria Other features Laboratory Findings Creatine Kinase Muscle Biopsy Electromyogram
Medications
Corticosteroids[1]
  • Variable
  • Proximal
 - + - - - + - -
  • + History of medications
  • Facial and sphincter muscles usually are spared
  • Normal
  • Normal
  • Normal
Statins[2]
  • 60+
  • Proximal
 - + - - - - - -/+(rhabdomyolysis)
  • N/A
  • Positive medication history
  • Tenderness
  • Muscle aches
  • ↑↑ Liver enzymes
  • ↑↑
  • Necrosis
  • Degeneration, and regeneration of fibers
  • Phagocytic infiltration
  • Normal
Alcohol[3]
  • Variable
  • Proximal
 - - - + +/- - - -
  • Change in mental status
  • Telangiectasia
  • Peripheral neuropathy
  •  nonspecific and are normal in many patients
  • Normal or ↑↑
  • Normal
  • Normal
Endocrine
Cushing's disease[4]
  • 25 -45
  • Proximal
 - - - - - + - -
  • N/A
  • Normal
  • Atrophy of type 2 muscle fibers, especially type 2B
 Normal
Adrenal insufficiency[5]
  • 30-50 years
  • Proximal
 - + - - - - + -
  • Auricular-cartilage calcification 
  • Electrolyte abnormalities
  • Normal
  • Normal
  • Normal
Hyperaldosteronism with myopathy[6]
  • 50
  • Proximal
  • Distal
 - - - - - - - +

Rhabdomyolysis

  • Normal
  • Normal
  • Normal
Hyperthyroidism[7]
  • 40
  • Proximal
 - - - - - + + +
  • Sweating
  • Tremor'
  • Swelling on neck examination
  • ↑↑
  • Non specific
  • Myotonic
Hypothyroidism[8]
  • >55
  • Proximal
 - + + - - + + + Rhabdomyolysis
  • Myoedema 
  • Muscle pseudohypertrophy
  • ↑↑
  • Nonspecific 
  • Normal
Diabetic infraction[9]
  • 45 
  • Proximal
 + + - - + + - -
  • Cramps
  • Sudden onset of pain
  • Anterior thigh muscles are most commonly involved
  • H/O long standing diabetes
  • Swelling
  • Tenderness
  • Elevation of the erythrocyte sedimentation rate
  • Leukocytosis
  • Normal
  • Normal
Inflammatory / Rheumatologic
Dermatomyositis[10]
  • 40s-50s
  • Can affect childreen
  • Proximal
 + + - - - - + -
  • ↑↑
  • Perimysial mononuclear infiltrate
  • Myopathic
Polymyositis[11]
  • > 18 years
  • Proximal
 + + - - - - + -
  • N/A
  • N/A
  • ↑↑
  • Endomysial mononuclear infiltrate
  • Patchy necrosis
Inclusion body myositis[12]
  • 50s
  • Proximal
  • Distal
 - - - - - - - -
  • N/A
  • Antibodies to cytoplasmic 5'-nucleotidase
  • ↑↑
  • Inflammatory cells
  • Invading muscle cells,
  • Vacuolar degeneration
  • Inclusions or plaques
  • Neurogenic
Fibromyalgia[13]
  • 40-50s
  • Generalized
 - - - - + - - -
  • History of depressive disorder
  • Tenderness in the soft tissue anatomical location
  • Normal
  • Normal
  • Normal
  • Normal
Polymyalgia Rheumatica[14]
  • 50s
  • Diffuse
 + + - - - - + -
  • History of joints stiffness which is worse in the morning
  • Restricted shoulder motion
  • Normal
  • Normal
  • Normal
Genetic
Becker muscular dystrophy[15]
  • <13yrs
 Proximal - - + + - + - -
  • Growth delay
  • Age of onset of symptoms is much delayed than duchenne
  • +Grower sign
  • ↑↑
    • Muscle fibril degeneration, regeneration
    • Isolated fiber hypertrophy
    • Muscle replacement with fat and connective tissue
  • Myopathic
Duchenne muscular dystrophy[16]
  • <13 yrs
 Proximal - - + + - + - -
  • Calf psedohypertrophy
  • Early onset
  • +Grower sign
  • ↑↑
Limb-girdle muscular dystrophies[17]
  • <15 yrs
 Proximal - + + + - + - -
  • Calf hypertrophy
  • Autosomal dominant
  • Deterioration of ability to run/walk
  • Muscle weakness is generally symmetric, 
  • LMNA gene
  • CAV3 gene
  • ↑↑
  • -
  • Myopathic
Myotonic dystrophy[18]
  • <18 years
  • Proximal
  • Distal
 - - + + - - + -
  • +Family history
  • Muscles often contract and are unable to relax
  • Mutations in the DMPK gene
  • -
  • -
  • Myopathic
Infectious
Lyme disease[19]
  • Variable
  • Proximal
 + + - +/- + - - -
  • + Tick bite
  • Hiking/Tip
  • Clinical diagnosis
  • +Serology
  • -
  • -
  • -
Influenza[20]
  • Variable
  • Negative
 + + - + - - - +
  • Cold weather
  • H/o Ill contacts
  • Muscle weakness, tenderness, and swelling.
  • ↑↑ Liver enzymes
  • +PCR
  • ↑↑
  • -
  • -
Polio[21]
  • <5 yrs
  • Proximal
 - - - + + + - -
  • History of skipped immunization.
  • Isolation from pharyngealsecretions, CSF
  • +Serology
  • -
  • -
  • Neurological pattern
Syphilis[22]
  • Variable
  • Negative
 - - - + + - - -
  • History of risk factors (MSM, unprotected sex, multiple sex partners)
  • Darkfield examinations
  • VDRL
  • RPR
  • FTA-ABS
  • -
  • -
  • -
Pyomyositis[23]
  • Variable
  • Proximal
  • Distal
 + + - - - - + -
    • Muscles are painful, swollen, tender, and indurated.
    • Depending on the site of involvement, it may mimic appendicitis (psoas muscle), septic arthritis of the hip (iliacus muscle), or epidural abscess (piriformis muscle).
  • Leukocytosis
  • Elevated ESR
  • -
  • -
  • -
Neurologic
ALS[24]
  • >35
  • Proximal
  • Distal
 - - - - + + + -
  • N/A
  • Clinical diagnosis
  • Normal
  • Nonspecific findings of chronic denervation with reinnervation
  • Neuropathic
Stroke[25]
  • >65
  • Proximal
  • Distal
 - - - + + + - -
  • Weakness of the involved arm
  • Head CT
  • Normal
  • Normal
  • Neuropathic
GBS[26]
  • 18 -350
  • Proximal
 - - - + - - + -
  • Weakness of lower extremities followed by upper extremities
  • Cytologic albumin ratio
  • Normal
  • Normal
  • Neuropathic
Multiple Sclerosis[27]
  • 30's
  • Proximal
  • Distal
 - - - + + - - -
  • Attacks or exacerbation
    • Localized weakness
    • Focal sensory disturbances
    • Hyper reactive reflexes
    • Increased tone or stiffness
  • Head CT ologo-clonal bands
  • Normal
  • N/A
  • Neuropathic
Neuro-muscular
Botulinum[28]
  • Variable
  • Distal
 - - - + - - + -
  • H/O food exposure
  • +Toxin
  • Normal
  • N/A
  • Myopathic
Lambert-Eaton syndrome[29]
  • Variable
  • Distal
 - - + + - - + -
  • Weakness of the bulbar muscles
  • Ocular
  • Limb weakness
  • Weaknessa is often relieved temporarily after exertion or physical exercise.
  • Antibodies against voltage-gated calcium channels 
Myasthenia gravis[30]
  • Variable
  • Proximal
 - - + + - - + -
  • Limb weakness
  • Isolated neck, limbs and respiratory weakness
  • Weakness often worsens with activity
Hereditary
Glycogen storage disease[31]
  • Variable
  • Proximal
 - - - - - + - -
  • Elevated liver enzymes
  • ↑↑
  • Normal
  • Normal
  1. ↑ Gupta A, Gupta Y (September 2013). "Glucocorticoid-induced myopathy: Pathophysiology, diagnosis, and treatment". Indian J Endocrinol Metab. 17 (5): 913–6. doi:10.4103/2230-8210.117215. PMC 3784879. PMID 24083177.
  2. ↑ Tomaszewski M, Stępień KM, Tomaszewska J, Czuczwar SJ (2011). "Statin-induced myopathies". Pharmacol Rep. 63 (4): 859–66. PMID 22001973.
  3. ↑ Preedy VR, Adachi J, Ueno Y, Ahmed S, Mantle D, Mullatti N, Rajendram R, Peters TJ (November 2001). "Alcoholic skeletal muscle myopathy: definitions, features, contribution of neuropathy, impact and diagnosis". Eur. J. Neurol. 8 (6): 677–87. PMID 11784353.
  4. ↑ Sharma V, Borah P, Basumatary LJ, Das M, Goswami M, Kayal AK (July 2014). "Myopathies of endocrine disorders: A prospective clinical and biochemical study". Ann Indian Acad Neurol. 17 (3): 298–302. doi:10.4103/0972-2327.138505. PMC 4162016. PMID 25221399.
  5. ↑ Ruff RL, Weissmann J (August 1988). "Endocrine myopathies". Neurol Clin. 6 (3): 575–92. PMID 3065602.
  6. ↑ Sambrook MA, Heron JR, Aber GM (April 1972). "Myopathy in association with primary hyperaldosteronism". J. Neurol. Neurosurg. Psychiatry. 35 (2): 202–7. PMC 494037. PMID 5037033.
  7. ↑ Li Q, Liu Y, Zhang Q, Tian H, Li J, Li S (July 2017). "Myopathy in hyperthyroidism as a consequence of rapid reduction of thyroid hormone: A case report". Medicine (Baltimore). 96 (30): e7591. doi:10.1097/MD.0000000000007591. PMC 5627834. PMID 28746208.
  8. ↑ Khaleeli AA, Griffith DG, Edwards RH (September 1983). "The clinical presentation of hypothyroid myopathy and its relationship to abnormalities in structure and function of skeletal muscle". Clin. Endocrinol. (Oxf). 19 (3): 365–76. PMID 6627693.
  9. ↑ Horton WB, Taylor JS, Ragland TJ, Subauste AR (2015). "Diabetic muscle infarction: a systematic review". BMJ Open Diabetes Res Care. 3 (1): e000082. doi:10.1136/bmjdrc-2015-000082. PMC 4410119. PMID 25932331.
  10. ↑ Dalakas MC (1991). "Polymyositis, dermatomyositis and inclusion-body myositis". N Engl J Med. 325 (21): 1487–98. doi:10.1056/NEJM199111213252107. PMID 1658649.
  11. ↑ Dalakas MC (1991). "Polymyositis, dermatomyositis and inclusion-body myositis". N Engl J Med. 325 (21): 1487–98. doi:10.1056/NEJM199111213252107. PMID 1658649.
  12. ↑ Dalakas MC (1991). "Polymyositis, dermatomyositis and inclusion-body myositis". N Engl J Med. 325 (21): 1487–98. doi:10.1056/NEJM199111213252107. PMID 1658649.
  13. ↑ Ohara N, Katada S, Yamada T, Mezaki N, Suzuki H, Suzuki A, Hanyu O, Yoneoka Y, Kawachi I, Shimohata T, Kakita A, Nishizawa M, Sone H (2016). "Fibromyalgia in a Patient with Cushing's Disease Accompanied by Central Hypothyroidism". Intern. Med. 55 (21): 3185–3190. doi:10.2169/internalmedicine.55.5926. PMC 5140872. PMID 27803417.
  14. ↑ Myklebust G, Gran JT (1996). "A prospective study of 287 patients with polymyalgia rheumatica and temporal arteritis: clinical and laboratory manifestations at onset of disease and at the time of diagnosis". Br J Rheumatol. 35 (11): 1161–8. PMID 8948307.
  15. ↑ Flanigan KM (August 2014). "Duchenne and Becker muscular dystrophies". Neurol Clin. 32 (3): 671–88, viii. doi:10.1016/j.ncl.2014.05.002. PMID 25037084.
  16. ↑ Flanigan KM (August 2014). "Duchenne and Becker muscular dystrophies". Neurol Clin. 32 (3): 671–88, viii. doi:10.1016/j.ncl.2014.05.002. PMID 25037084.
  17. ↑ Guglieri M, Straub V, Bushby K, Lochmüller H (October 2008). "Limb-girdle muscular dystrophies". Curr. Opin. Neurol. 21 (5): 576–84. doi:10.1097/WCO.0b013e32830efdc2. PMID 18769252.
  18. ↑ Udd B, Krahe R (October 2012). "The myotonic dystrophies: molecular, clinical, and therapeutic challenges". Lancet Neurol. 11 (10): 891–905. doi:10.1016/S1474-4422(12)70204-1. PMID 22995693.
  19. ↑ Schoenen J, Sianard-Gainko J, Carpentier M, Reznik M (August 1989). "Myositis during Borrelia burgdorferi infection (Lyme disease)". J. Neurol. Neurosurg. Psychiatry. 52 (8): 1002–5. PMC 1031843. PMID 2795056.
  20. ↑ Bove KE, Hilton PK, Partin J, Farrell MK (1983). "Morphology of acute myopathy associated with influenza B infection". Pediatr Pathol. 1 (1): 51–66. PMID 6687269.
  21. ↑ Howard RS (June 2005). "Poliomyelitis and the postpolio syndrome". BMJ. 330 (7503): 1314–8. doi:10.1136/bmj.330.7503.1314. PMC 558211. PMID 15933355.
  22. ↑ French P (January 2007). "Syphilis". BMJ. 334 (7585): 143–7. doi:10.1136/bmj.39085.518148.BE. PMC 1779891. PMID 17235095.
  23. ↑ Crum NF (September 2004). "Bacterial pyomyositis in the United States". Am. J. Med. 117 (6): 420–8. doi:10.1016/j.amjmed.2004.03.031. PMID 15380499.
  24. ↑ Zarei S, Carr K, Reiley L, Diaz K, Guerra O, Altamirano PF, Pagani W, Lodin D, Orozco G, Chinea A (2015). "A comprehensive review of amyotrophic lateral sclerosis". Surg Neurol Int. 6: 171. doi:10.4103/2152-7806.169561. PMC 4653353. PMID 26629397.
  25. ↑ Baldwin K, Orr S, Briand M, Piazza C, Veydt A, McCoy S (May 2010). "Acute ischemic stroke update". Pharmacotherapy. 30 (5): 493–514. doi:10.1592/phco.30.5.493. PMID 20412000.
  26. ↑ van Doorn PA (June 2013). "Diagnosis, treatment and prognosis of Guillain-Barré syndrome (GBS)". Presse Med. 42 (6 Pt 2): e193–201. doi:10.1016/j.lpm.2013.02.328. PMID 23628447.
  27. ↑ Goldenberg MM (March 2012). "Multiple sclerosis review". P T. 37 (3): 175–84. PMC 3351877. PMID 22605909.
  28. ↑ Cherington M (June 2004). "Botulism: update and review". Semin Neurol. 24 (2): 155–63. doi:10.1055/s-2004-830901. PMID 15257512.
  29. ↑ Titulaer MJ, Lang B, Verschuuren JJ (December 2011). "Lambert-Eaton myasthenic syndrome: from clinical characteristics to therapeutic strategies". Lancet Neurol. 10 (12): 1098–107. doi:10.1016/S1474-4422(11)70245-9. PMID 22094130.
  30. ↑ Jayam Trouth A, Dabi A, Solieman N, Kurukumbi M, Kalyanam J (2012). "Myasthenia gravis: a review". Autoimmune Dis. 2012: 874680. doi:10.1155/2012/874680. PMC 3501798. PMID 23193443.
  31. ↑ Kannourakis G (April 2002). "Glycogen storage disease". Semin. Hematol. 39 (2): 103–6. PMID 11957192.
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