Mystery Case


Your case for this week is an absolute corker. See if you can do better than the numerous clinicians who missed the more subtle symptoms for over 12 months before this patient came in to A&E in a really precarious situation.

Watch the video, listen to the quality of the speech and file away the basic features from the clinical signs demonstrated. Keep your eyes peeled for axial muscle strength – it is rarely taught and rarely done, but can be extremely helpful.

Hope you feel as happy as I did when you see the outcome after treatment – this is one of the greatest feelings you can have as a medic.

Follow the link for more information on the disorder.


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  1. Hi Neil that’s super ! I wonder what alternative diagnoses he got before the right one ? Also interested that he didn’t look especially more weak oN left arm after exercise, is it often that subtle ? Lovely case and happy for him !

    • Hi Lucy. Think it was a bit more subtle and lots of “normal” ENT tests and a bit of ophthalmology input too. He got quite ill before he ended up in front of a neurologist in A&E. You’re right he didn’t fatigue that much in his limbs – well spotted. His speech really did fatigue though so the clues were there

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