Herpes zoster is often associated with motor dysfunction with or without a rash.
+Acute rabies infection typically begins as a Ramsay-Hunt syndrome before progressing to severe throat spasm and to cardiac and renal failure.
+Weakness or diplopia when fatigued may be the only complaint with multiple sclerosis.
+Treatment for polymyositis is early administration of systemic steroids.
+Serum calcium should be measured in patients with recurrent generalized weakness that follows periods of heavy exertion or that is present upon awakening.
Ramsay-Hunt syndrome refers to herpes zoster involving the tympanic membrane, ear canal, and other areas in the distribution of the sensory branches of the facial nerve. Herpetic zoster may result in motor abnormalities in up to 25% of cases. Weakness or diplopia only on exertion is a common complaint in early cases of multiple sclerosis. Another early presenting sign is retrobulbar neuritis; in fact, 50–75% of cases occur in patients who develop multiple sclerosis. Steroids may transiently exacerbate weakness in patients with polymyositis and should not be started on patients who will be discharged from the ED. Acute periodic paralysis appears to involve abnormalities in cellular function, possibly related to potassium transport. The disease is most common in young men. No specific physical findings may be found and it is often misdiagnosed as hysterical in origin.