a 20-year-old woman with slurred speech and weakness

yesterday we briefly examined a very pleasant university student who has been unwell since earlier this year

she was alert - we did not test her higher order cognitive function

she had obvious slurring of her speech, which had been present for a month or so

we concentrated on examining her arms

we talked (again) about the importance of INSPECTION

fasciculations can be quite hard to see, especially if the light is poor and the muscles involved are small, so really have a good look - make sure you turn the lights on & adequately expose the patient (which can be done comfortably and with dignity)
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as an aside, i wanted to mention motor neurone disease - i know very little about this condition; it results in upper and lower motor neurone signs; it must be one of the worst diseases and there are no treatments, riluzole, the only drug available increases life expectancy by a few months at best (miller et al, 2007);

here is link to a video of the historian tony judt talking about the disease

he died in august
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we went on to test tone and then power

this is often done quite badly

my most useful tip (after practise a lot) would be to slow down & think about what you are doing

use the MRC grading scale

if a patient uses their muscles to move their arm (or leg) into the correct position against gravity, then they have already scored 3/5
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here is a link to another website showing you how to do a neuro exam

i particularly like the muscle action & innervation chart in the motor section

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we talked about the decreased utility of testing for inco-ordination in the context of muscle weakness
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this lady has a diagnosis of multiple sclerosis

she has had several clinical events and has had a full diagnostic work up including MRIs, LP, VEP

the visual evoked potential involves being shown a visual stimulus, eg a pattern, and then measuring electrical responses primarily from the occipital lobe using EEG

[why the occipital lobe?]

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she was actually admitted for episodes of loss of consciousness, the cause of which is not entirely clear

interestingly she is due to have a tilt table test - i mentioned my ignorance of the effects of MS on the autonomic nervous system

she is in the midst of a relapse affecting her speech, face, right arm & leg, and is due to start steroids this week

Salaam