Cases for finals #1 – History

76 year old man

  • 9 month history of problems with walking
  • difficulty getting out of bed, up stairs
  • stamina reduced; can’t get down to the local shops
  • feeling breathless on exertion
  • weight loss of 1 stone
  • feels his legs are weak
  • difficulty gripping things, opening jars
  • thinks his thighs and calf muscles have thinned
  • speech is a little slurred at times

Thoughts?

You need to find a pithy, tweetable summary of this story. I might say there was a;

“chronic, progressive disorder characterised by weakness in the upper and lower limbs, coupled with weight loss, slurred speech and reduced exercise tolerance”.

There are no sensory symptoms and bladder and bowel are spared, so I wouldn’t put spinal cord lesions high on the list. Also, the slurred speech is above the level of the spinal cord.

Weight loss is a worry. In general medicine, it usually reflects systemic disease or cancer. In neurology cases it smacks of peripheral, rather than central, pathologies – think muscle, motor nerves, that kind of thing.

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