Author: John O’Rourke / Editor: Sarah Edwards / Codes: NeuC5, NeuP8, SLO1 / Published: 16/09/2021
A 58-year-old presents to the Emergency Department (ED) with difficulty in walking and limb weakness. He reports feeling progressively weaker in arms and legs for the past 7 weeks and has had 3 falls at home. This is his third presentation to the ED in the last month. On both previous occasions his symptoms were felt to be due to a functional neurological disorder. There is no clear trigger for his symptom onset. He has diet-controlled type 2 diabetes and depression.
On examination he has bilaterally reduced power in his lower limbs, most notably in hip flexion. He also has a reduced grip strength in both hands, and reduced power in all upper limb movements. He reports paraesthesia in both feet to mid-shin and in both hands to the level of the wrist. You cannot elicit any deep-tendon reflexes. He reports he is unable to mobilise in the department due to the weakness. His cranial nerves demonstrate normal function and systems review is unremarkable.
Module Content
Peripheral Neuropathy
Peripheral neuropathy is a pathological process affecting a peripheral nerve or nerves (includes cranial nerves).
Acute Facial Palsy
This session looks at the assessment and management of acute facial palsy.
Bell’s Palsy in Children
Bell's palsy is a relatively uncommon condition presenting to primary care. Despite a benign course for most children with Bell's palsy, there are a number of serious causes of facial paralysis which can be easily missed.
12 Comments
I saw a similar pt in ED but a female in her thirties presented with paraplegia but was diagnosed as FND. On neurology follow up now
interesting topic/ case
Good case for proper neuro examination. I recently saw a patient with many co-existing social and mental health issues presenting with increasing weakness to the ED. She was already referred by her GP to neuro OP. She surprised me by having some clinical signs of central cord syndrome, later confirmed on MR.
interesting
Interesting
Like it
Very interesting. Excellent article…
Good learning articles. Very interesting.
Nice one. “Rule out organic” differential diagnosis list has just got longer!
Rare but really important case
Good Module would add to DD for patients presenting with recurrent falls
easily missed presentation