Neurological Case 56

Qingyierjing 神经科学临床和基础 2017-07-19

Leanne, a 25- year -old bartender, comes to the hospital with difficulty walking. She is normally fi t and well, but a fortnight ago was off work with a stomach upset. Over the past week, she has been experiencing pins and needles in her hands and feet, and over the past few days has been losing the strength in her arms and legs. Yesterday she was unable to reach up to the highest shelves to bring down the pint glasses, and today she is having diffi culty walking even a few steps.

Her symptoms came on over the 7 days prior to admission. Initially she noticed numbness on the soles of both feet, which gradually spread up to her knees, and over the course of a few days reached her hands. At that time she also had difficulty getting up from the chair, and now her arms are weak as well. She has not had any double vision, but on one or two occasions, when she was swallowing liquids, she complained that they would go up her nose and she would
choke. She was not breathless. Bowel and bladder functions 
were normal, but, 2 weeks prior to the symptoms, she had had a 3-day bout of profuse diarrhoea.

On examination, the pulse and blood pressure were normal. Eye movements were full and there was no diplopia. She had slight diffi culty swallowing water, but the voice was normal, the cough was good and there was no facial weakness. The cranial nerves were otherwise normal. The limbs were normal on inspection, with no wasting or fasciculations. Tone was reduced, power was reduced symmetrically to 3/5 in all muscle groups in the legs and 4/5 throughout the arms. Sensation was altered in all modalities in the legs to knee level and in the arms to mid- forearm level, in a glove and stocking pattern. There was no sensory level. All of the refl exes were absent and the plantars were mute. 

Her vital capacity was measured at 3.0L, which was in the normal range for her size. The ECG showed a heart rate of 80 beats per minute, blood pressure was 130/70mmHg without postural drop, and routine blood tests were normal. Lumbar puncture showed an acellular CSF with an elevated protein level of 1.5g/L (0.1– 0.45g/L) but normal glucose ratio. Nerve conduction studies showed widespread slowing of conduction in sensory and motor nerves.


What is the likely diagnosis?


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