Cases for finals #4 – History

30 year old woman

  • 3 week history of sensory disturbance in the legs
  • began in feet and crept up over 7 days
  • band around ribcage
  • feels unsteady; left leg a little weak
  • feels exhausted
  • arms fine

Your Tweetable summary is as follows:

“subacute, progressive neurological disorder characterised by ascending sensory symptoms, with a mid-thoracic level and associated, symmetrical leg weakness.”

This has the feel of a central problem, perhaps sneaking around the spinal cord, and affecting the left side of the cord more than the right – the pathology is usually worse on the side of the weaker leg.

There is something definitely missing from this story, and that is bladder and bowel symptoms. If she had urinary frequency, urgency or a sense of incomplete bladder emptying, then that would clinch it for me.

It does sounds a little like GBS, but the band around the thorax is much more like a spinal cord problem – trust me!

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