67 year old lady
- 3 month history of problems with speech, swallowing and vision
- speech slurred, especially when tired
- vision okay first thing; as the day wears on, eyelids droop and gets double vision
- jaw aches on chewing and liquids going up the nose in last 2 weeks
- coughing lots
Thoughts?
Right, so your punchy summary might be…
“Chronic, progressive neurological disorder, characterised by slurred speech, dysphagia, ptosis and diplopia.”
Nasal regurgitation of liquids suggests a flaccid weakness of the palate and coughing suggests aspiration.
The diurnal variation might be a useful clue