Mystery Case

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.

Good luck.

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