A middle aged man w/ epilepsy and DM presents with subacute weakness and recurrent falls found to have hypoglycemia, AKI, transaminitis, and c/f myoglobinuria.
Approach to weakness:
1) Distinguish Generalized fatigue versus Localized neuromusclar weakness
2) If Generalized fatigue –> metabolic, infectious workup
3) If localized weakness:
a. UMN signs –> CNS (cerebral cortex, brainstem, spinal cord)
b. LMN signs –> anterior horn cells and beyond, including peripheral nerve, NMJ, muscle