Making
a diagnosis
A careful history needs to be taken which includes family history,
problems during pregnancy or at birth. If the problem is of recent onset,
contact, ingestion or inhalation of heavy metals, pesticides and other toxins
should be covered. On examination a careful check needs to be made of the
spine for signs of spina bifida. All modalities of sensation need to be
carefully checked. Muscle power should be graded according to the Medical
Research Council (MRC) Scale and a careful check made for signs of wasting,
fasciculation and hyper-reflexia.
Investigations
Electrolytes should be checked routinely as imbalances in both calcium
and magnesium can cause neurological problems. Electromyelographs (EMGs) and
even muscle biopsies may be needed to determine the diagnosis. Imaging of the
spinal cord and of the brain may also be required.