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.