Case study: ascending motor weakness

Ms SE a 26-year old single woman presents with an acute ascending motor weakness. On examination she has a lower motor neurone pattern of weakness and areflexia. She had recent diarrhoeal illness 2 weeks ago. At present she is unable to walk due to lower limb weakness and has mild distal weakness in her hands that is limiting her ability to perform fine motor tasks. Her vital capacity is normal, she has full control of her bladder and bowel and there is no evidence of autonomic dysfunction. General examination is unremarkable with no evidence of systemic disease.

Teaching points:

Level one

Areflexia: What is a reflex? What does areflexia mean?
What is a lower motor neurone weakness?
Differential diagnosis of acute ascending weakness?
How do you differentiate a motor neuropathy from acute spinal cord pathology?

Level two

What do you expect the nerve conduction study results to show?
How do you monitor respiratory function in patients with neurological disease? At what level do you admit a patient to ITU for monitoring?

Level three

What findings on the nerve conduction studies support a diagnosis of demyelination?
Apart from nerve conduction studies what other investigations would you do an why?
The consultant recommending treating this patient with IVIG. How do you use IVIG? What are the complications of using IVIG?

Answers