Generalized (general) weakness

Complaints of general weakness can conceal such different syndromes as an asthenic condition for various reasons, pathological muscle fatigue and even true paretic syndromes. What is important is a detailed clinical analysis of the entire clinical picture and the weakness itself, its syndromic environment, including somatic, neurological and mental status, which is the key to recognizing the nature of general weakness.

Features of the occurrence of general weakness and its subsequent course can be one of the possible approaches to the diagnostic search algorithm.

[1], [2], [3], [4]

The main causes of generalized (general) weakness

I. Generalized weakness with a gradual onset and slow progression:

1. General somatic diseases without direct damage to the neuromuscular apparatus.
2. General somatic diseases with a direct effect on the neuromuscular apparatus.
   1. Endocrinopathy.
   2. Metabolic disorders.
   3. Intoxication (including medicinal).
   4. Malignant neoplasms.
   5. Diseases of the connective tissue.
   6. Sarcoidosis.
3. Myopathies.
4. Psychogenic weakness.

Ii. Acute and rapidly progressive generalized weakness:

1. Somatic diseases.
2. Myopathy.
3. Topical lesions of the nervous system (polio, polyneuropathy)
4. Psychogenic weakness.

Iii. Intermittent or recurrent general weakness.

1. Neuromuscular diseases (myasthenia gravis, MacArdla disease, recurrent paralysis).
2. Diseases of the central nervous system. (Intermittent compression of the spinal cord with the dental process of the second cervical vertebra).

Generalized weakness with gradual onset and slow progression

Patients complain of increasing general weakness and fatigue, they may feel psychological fatigue, decreased performance and lack of cravings.

The reasons are:

General somatic diseases without direct damage to the neuromuscular apparatus, such as chronic infections, tuberculosis, sepsis, Addison's disease, or malignant diseases, are among the most frequent causes of progressively growing weakness. Weakness is usually combined with the specific symptoms of the underlying disease; general clinical and physical examination in these cases is most important for diagnosis.

Common diseases with a known direct effect on the neuromuscular apparatus. Weakness in these diseases is often predominantly proximal, especially pronounced in the region of the belts of the upper or lower extremities. This category includes:

• Endocrinopathy, such as hypothyroidism (characterized by cold, pale, dry skin; lack of inclinations; constipation; thickening of the tongue; hoarse voice; bradycardia; swelling of muscles, slowing down of Achilles reflexes; etc.; often accompanied by other neurological symptoms, such as paresthesia, ataxia, carpal tunnel syndrome, crump); hyperthyroidism (characterized by proximal muscle weakness with difficulty getting up from squatting position; signe dutabouret, sweating; tachycardia; tremor; hot skin, heat intolerance, diarrhea; etc.; neurological symptoms such as pyramidal and other signs are rarely observed); hypoparathyroidism (marked muscle weakness and crumpy, tetany, headaches, fatigue, ataxia, convulsive seizures, rarely hallucinations and choreoathetoid symptoms); hyperparathyroidism (distinguished by true myopathy with muscle atrophy; depression; emotional lability, irritability, confusion; constipation); Cushing's disease, etc.
• Some metabolic disorders, such as glycogenosis (characterized by damage to the heart and liver) or diabetes.
• Some types of intoxication and exposure to pharmacological drugs that can lead to slowly increasing general weakness. Chronic forms of alcoholic myopathy develop for weeks or months and are accompanied by atrophy of the proximal muscles. While taking chloroquine (delagil), vacuolar myopathy is observed; taking cortisone, especially fluorophosphate, and prolonged use of colchicine can cause reversible myopathy.
• Malignant neoplasms may be accompanied by polymyositis, or simply generalized weakness.
• Connective tissue diseases, especially systemic lupus erythematosus and scleroderma, in which muscular symptoms are combined with polymyositis, are serious causes of slowly progressive general weakness.
• Sarcoidosis. Patients usually complain of general weakness, malaise, poor appetite, weight loss. In addition, sarcoid granulomas in skeletal muscles and tendons are described, which is manifested by even greater muscle weakness, less often by myalgias.

Many true myopathies, such as hereditary muscular dystrophies, as the disease progresses, can lead to generalized weakness.

Psychogenic weakness is usually observed in the picture of polysyndromic psychogenic disorders (functional neurological stigmas, pseudo-fit, speech disorders, dysbasia, paroxysmal disorders of various types, etc.), which facilitate clinical diagnosis.

Accidental observation described spastic tetraplegia (tetraparesis) as the first (initial) manifestation of Alzheimer's disease, proven by pathological study post mortem.

[5], [6], [7], [8], [9], [10]

Acute and rapidly progressive generalized weakness

In these cases, mainly proximal muscles are also involved. Possible reasons:

Somatic diseases, such as hypocalcemia of various etiologies, can lead to widespread severe weakness within a few hours.

Myopathies, especially acute paroxysmal myoglobinuria (rhabdomyolysis) (characterized by muscle pain and red urine); myasthenia with its rare generalized form and symptomatic form due to penicillamine therapy (Myasthenia is characterized by an increase in weakness during muscular work, and the patient gets tired easily, but the condition improves after rest and in the morning); polymyositis (often accompanied by red-purple spots on the skin, muscle soreness and mostly proximal weakness).

Existing (actual) lesions of the nervous system. More or less generalized weakness can be the result of an infectious lesion of the cells of the anterior horns (neuronopathy), such as polio (weakness without loss of sensitivity, fever, areflexia, changes in cerebrospinal fluid), tick-borne encephalitis, other viral infections, intoxication, OVDP (polyradiculopathy Gia Barre) are usually accompanied by distal paresthesia and some sensitive changes. Rare acute polineiropatii, such as porphyria (abdominal symptoms, constipation, epileptic seizures, tachycardia, urine photosensitivity) also lead to weakness with minimal sensory changes.

Psychogenic weakness is sometimes manifested as an acute loss of muscle tone (fall attacks).

[11], [12]

Intermittent or recurrent general weakness

The following diseases should be included in this category:

Neuromuscular diseases, especially myasthenia gravis (see above) and insufficiency of muscle phosphorylase (Mac-Ardle's disease), which is characterized by hypokalemic paralysis that appears with pain and weakness during prolonged muscle tension. Paroxysmal myoplegia (recurrent family hypokalemic paralysis) is characterized by the development of generalized weakness and flaccid paralysis within a few hours (in the arms or legs, more often - tetraparesis, less often - hemi or monoparesis) with tendon reflexes. Consciousness is not disturbed. Provocative factors: sleep at night, abundant food intake, excessive exercise, hypothermia, drugs (glucose with insulin, etc.). The duration of attacks - a few hours; frequency - from single during life to daily. Myoplegic syndromes are described in thyrotoxicosis, primary hyperaldosteronism and other conditions accompanied by hypokalemia (gastrointestinal diseases, urethrosigostomy, various kidney diseases). There are also hyperkalemic and normokalemichesky variants of periodic paralysis.

Diseases of the central nervous system: intermittent compression of the spinal cord with the denticular process of the second cervical vertebra, leading to intermittent tetraparesis; vertebrobasilar insufficiency with drop attacks.

[13], [14], [15], [16]

What do you want to examine?

• Muscle tissue
• Muscles

What analyses are necessary?

• Lactic acid (lactate) in blood
• Creatinine in serum