Right guys …
Here is a good case to work your brains around.
This lady has a 6 month history of fatigue, muscle ache, breathlessness on exertion and, more recently, problems with walking, getting up stairs and washing her hair. She has also noticed a rash on her face.
No sensory symptoms. No bladder or bowel problems. Speech and swallowing are fine.
You therefore have a chronic, progressive neurological disorder characterised by myalgia, rash, breathlessness and weakness.
Watch the video and try and figure out if this feels like a disorder of the central or peripheral nervous system. Pay specific attention to the pattern of weakness and the reflexes to help you out.
Also, might I just say that this is a nice video to show how watching a patient get up and walk is crucial to assessment.
(we cut corners in the examination so please don’t use this as an example of a full motor assessment)
Once you have formulated your localisation, have a think about what conditions you might consider. Follow this link to see if you are right. This answer is on the page the link takes you to.
Needless to say I am, as ever, extremely grateful to all the people who have given me permission to share their videos with you all in the name of educating future doctors.