CASE 70: LEG WEAKNESS
History
A 24-year-old woman is attending her regular Sunday church service. During the singing
of a hymn she suddenly fell to the ground without any loss of consciousness and told the
other members of the congregation who rushed to her aid that she had a complete par-
alysis of her left leg. She was unable to stand and was taken by ambulance to the emer-
gency department. She has no other neurological symptoms and is otherwise healthy. She
has no relevant past or family history, is on no medication and has never smoked or drunk
alcohol. She works as a sales assistant in a bookshop and until recently lived in a flat with
a partner of 3 years’ standing until they split up 4 weeks previously. She has moved back
in with her parents.
Examination
She looks well, and is in no distress; making light of her condition with the staff. The only
abnormalities are in the nervous system. She is completely orientated and the Mini-mental
State score is normal. The cranial nerves and the neurology of the upper limbs and right
leg are normal. The left leg is completely still during the examination, and the patient is
unable to move it on request. Tone is normal; co-ordination could not be tested because
of the paralysis. Superficial sensation was completely absent below the margin of the left
buttock and the left groin, with a clear transition to normal above this circumference at
the top of the left leg. Vibration and joint position sense were completely absent in the left
leg. There was normal withdrawal of the leg to nociceptive stimuli such as firm stroking
of the sole and increasing compression of Achilles’ tendon. The superficial reflexes and
tendon reflexes were normal and the plantar response was flexor.
Questions
- What is the diagnosis?
- How would you manage this case?