Weakness is the one of the most common consults we get in neurology and often the most challenging. In this week’s episode, I interview Dr. Robert Bucelli, a neurologist at Washington University specializing in neuromuscular disorders, and ask him for tips for evaluating weakness. We discuss how to tailor your history and exam to a chief complaint of weakness. We talk about all the relevant questions to ask and how these questions allow you to narrow down your differential and guide further testing. We use a case of statin induced myopathy as the basis for our discussion. Dr. Bucelli got his MD and Phd from the University of Buffalo. He then completed a neurology residency at Washington University followed by a fellowship in Neuromuscular disorders and has been a faculty member here at Washington University ever since. He is the five-time recipient of the Eliasson Award for Teaching Excellence, an award given annually by neurology residents to attending physicians that demonstrate excellence in teaching.

Time stamps:

• 03:50: Dr. Bucelli’s background

• 15:20: Advice for developing as a neurology resident

• 23:20 Clinical case of statin induce myopathy

• 30:09: Proximal vs distal weakness

• 35:15: Asymmetric vs symmetric weakness

• 36:20: Neurological examination for weakness

• 45:23: Upper vs lower motor neuron signs

• 48:30: Assessing muscle tone on exam

• 50:50: Patient exam

• 53:00: Diagnostic workup of proximal weakness

• 55:30: Three types of statin induced myopathy

• 1:01:50: Diagnostic workup to differentiate between different causes of stain induced myopathy

• 1:03:20: Summary and key takeaways

Disclosures:

Dr. Bucelli is a consultant for the company NeuroQuestions LLC. Brain Boy Neurology reports no relevant financial disclosures.