Author: Noordeen Sathakathulla / Editor: Nick Tilbury / Codes: NeuC10, NeuP8, PhC1, PhP3, SLO1 / Published: 14/12/2020
An 18-year-old male is brought to the emergency department (ED) by his mother complaining of a 1-week history of worsening weakness of both lower limbs, a tingling sensation in both hands and an unsteady gait. He denies any bowel or bladder abnormalities or recent trauma.
His past medical history is unremarkable and he denies taking any alcohol or recreational drugs in the last 4 weeks.
His initial observations and GCS are stable.
On examination he has bilateral lower limb power of 4/5, an ataxic gait, decreased deep tendon reflexes, mildly decreased sensation in the lower limbs and a positive Romberg’s test. The rest of the systemic examination is unremarkable.
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Question 1 of 3
1. Question
Which of the following immediate investigations would be appropriate for this patient (select all that apply)?
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Question 2 of 3
2. Question
All the blood and urine results are normal. What is the most appropriate next investigation?
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Question 3 of 3
3. Question
The CT head is normal and a lumbar puncture done on the ward shows a normal leucocyte and protein levels. Further detailed examination reveals loss of vibration and proprioception.
What is the most appropriate next step?CorrectIncorrect
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15 responses
Interesting case. Well written Noordeen.
well written !good case thanks
Good case
I very much enjoyed this. This was well written and the learningnpoints clear, thank you.
Good reminder
Excellent presentation
A good new one to look out for! Thank you for sharing.
Very good presentation
How interesting. Thank you!
Good presentation
Excellent
complicated but very interesting presentation. Great job. Thank you very much.
Very nice review
wonderful implementation of the informations
excellent case