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Posterior Neck Weakness

Differential Diagnosis Early & selective in disease: May be presenting feature Myasthenia Gravis Anti-AchR antibody postitive Anti-MuSK antibody positive Polymyositis: Brachio-cervical inflammatory myopathy Motor neuron disorders: ALS ALS, Sporadic ALS6: FUS FOSMN Focal Posterior Cervical Myopathies 1 Bent spine syndrome Hypokalemia: Licorice intoxication MEK inhibitors 4 Prominent later in disease: Above diagnoses + FSH dystrophy SMA 5q Proximal lower motor neuron syndrome BVVL Rare causes of posterior neck weakness 2 Myopathy: Hereditary Acid maltase deficiency: Adult onset Carnitine deficiency Desmin myopathy ETFDH Hypokalemic paralysis: Acute MSP IBMPFD1: VCP MSP6: ANXA11 Nemaline rod myopathy Oculopharyngeal MD: Recessive Proximal myotonic dystrophy CMD: Lamin A/C Endocrine Hyperparathyroidism Hypothyroidism Myopathy: Other Inclusion body myositis Canine centronuclear myopathy Selumetinib toxicity Chronic Inflammatory Demyelinating Polyneuropathy (CIDP)   Other Trauma: Cervical hyperflexion injury Radiation exposure involving neck muscles Onset: Years after radiation Also see: Paraspinous weakness Associated Disorders Aberrant internal carotid artery: Ischemic stroke 3

Gowers: Head ptosis in ALS Focal myopathy

POSTERIOR NECK WEAKNESS: MRI Scans
Atrophy & fatty change of neck extensors (Arrow), Semispinalis capitis & Splenius capitis	Gadolinium uptake in superficial paraspinous muscle (Arrow)