24 year old man
- recent “man flu”
- felt unsteady on his feet 3 days ago
- feet tingling yesterday in feet
- struggled to get out of bed this morning; legs collapsed when walking
- arms feel heavy; grip poor today; hard to do buttons on shirt
“Subacute, progressive neurological disorder characterised by ascending weakness affecting all four limbs. Severe enough to impact walking (can’t beat gravity) with some minor sensory symptoms”
You may feel you can jump right in with a diagnosis here but try to contain yourself and look at this critically.
Where could this be?
- Central is possible but not cortex (not confused, convulsing etc.) and not brainstem (not weird enough).
- Cervical spinal cord is possible (arms, legs; motor and sensory) and white matter would also do (but bilateral, symmetrical, simultaneous symptoms odd).
- Could well be peripheral and sensory symptoms pull you away from NMJ or muscle. MND seems very unlikely as it is too quick so you are left with ?peripheral nerve.
Now you have to use the examination findings to prove/disprove your hypotheses…