Author: Jess Mitchell / Editor: Jason M Kendall / Reviewer: Tadgh Moriarty, Jia Luen Goh, Amanda King / Codes: NeuC7, NeuP2, NeuP7, NeuP8, OptC5, SLO1 / Published: 23/10/2020 / Reviewed: 10/01/2025
A 30-year-old lady presents to the Emergency Department (ED) feeling “numb from the waist down”. She complains of a 6 month history of headaches (worse than her usual migraines), associated with blurred vision.
Her GP initially organised two CT heads and a CT orbit, both of which were normal. She was commenced on propranolol and advised to visit the opticians for change of spectacles. 8 weeks later she reported bilateral leg weakness, loss of proprioception and “legs wobbling”. She attended a physiotherapist who suggested a possible prolapsed disc and her GP organised an MRI (28 week wait). She attended her GP again with worsening symptoms but was advised to await her MRI, and given the “all clear” to go on holiday. She returned from her family holiday unable to walk due to leg weakness, and complaining of genital numbness and bowel and bladder incontinence. She attends the ED.
On examination cranial nerves are intact. A visual field examination reveals a right-sided homonymous hemianopia and right sided inattention. Upper limbs have reduced sensation in a T1 dermatomal distribution bilaterally, but normal power, tone and reflexes.
Right lower limb power is 0/5 with absent reflexes and global parasthesia.
Left lower limb power is 3/5 with reduced reflexes and reduced sensation. She has a sensory level at T10.
Rectal examination reveals reduced anal tone.
A CT head is performed and reveals an area of subtle focal hypodensity in the left parietal deep white matter. There is no evidence of localised mass effect.