Author: Jamie Nuwer, MD
Co Author #1: Michael Henehan DO
Patient Presentation:
27 year-old female runner collapsed at mile 11 of a half marathon
History:
Collapsed because of right leg weakness. Limping on right leg. Reports numbness and weakness of right lower extremity starting and getting worse throughout the race. She had a similar, milder episode while training 3 days prior to the race. She had recovered from that episode with a brief period of rest.
ROS: no recent travel, no recent illness, no fever, no HA
Meds: none
NKDA
PMHx: multiple sclerosis (MS) recently diagnosed
PSHx: none
SocHx: occasional alcohol, no tobacco nor drugs
Physical Exam:
Vital signs, heart, lung: normal
MSK: normal except strength as below
Skin: warm, diaphoretic
Neuro: mental status and CN normal. Sensation decreased to light touch on the right lower extremity (R LE). Strength 4+/5 R LE otherwise normal. Reflexes 2+ patellar/achilles R LE, otherwise 1+.
Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.