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The initial step in the evaluation of a neonate with limb weakness is to determine the site of the lesion in the nervous system. The most important step to establish the site of neurological damage is to determine the distribution of the weakness. Decreased limb movements limited to one extremity (monoparesis) or to two extremities in the same side (hemiparesis) produce asymmetrical limb movements. Decreased limb movements of both upper (upper extremity diparesis) and lower extremities (paraparesis) produce a discrepancy between upper and lower limb movement. This discrepancy may be difficult to detect because in neonates upper extremity movements are normally more prominent than lower extremity movements as a result of the physiologic rostocaudal maturational pattern of the central nervous system. The physiologic rostocaudal maturational pattern and the quick speed of progression of some disorders during the neonatal period often leads to a changing distribution of weakness during the neonatal period. Neonates with apparent upper extremity monoparesis may later be detected to have hemiparesis. Neonates with bilateral upper extremities weakness often develop quadriparesis as infants.

 

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