Case Challenge #12

History of Present Illness

A 27 yo black female with no significant PMH reports two week history of descending numbness, paresthesias and weakness. She was doing well until about one month ago, when she had a viral illness; reports cough, stuffy nose, myalgias, general malaise which resolved w/o intervention in one week.

About two days later noted numbness in her bilateral hands, which proceeded to become a tingling sensation going over her L arm. She then began to note numbness in her bilateral feet and weakness in her legs and L arm. She also notes some blurring of her vision. Over the last few days her weakness progressed to where she could no longer walk w/o assistance and now has limited strength in hands.

Past History

No sig PMH/PSH. Father with DM, HTN.

Vitals

AF, P 104, BP 128/63, RR18, 96%.

Neurologic Exam
  • Facial sensation decreased on L with flat L nasolabial fold
  • Mild afferent pupillary defect on right
  • RUE 5/5, except 2/5 wrist; LUE 5/5
  • RLE 3/5; LLE 4/5
  • Reflexes 3+ in UE and bilateral clonus LE
  • Sensation decreased to pinprick T8-L1 distribution
  • L toe upgoing, R toe equivocal
Labs
  • CBC and CMP unremarkable
  • Lumbar Puncture: Glucose 86, Protein 65, Nuc cells 24, RBC 254, Poly 2%, Lymphs 90%, Monos 7%, Eos 1%
Imaging

Untitled

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