LESIONS

A Guide to Localisation in Neurology

Case 9. Weakness and tingling

Case

A 51 year old right-handed woman woke up one morning with tingling in the right arm and leg.

She had been well the night before - then woke up with the symptoms. When she got out of bed the right leg felt mildly weak, although she could still walk on it. She wondered if she’d slept funnily, but the problem persisted into the late morning.

She otherwise felt well, with no headache, visual or facial symptoms, and had no issues with speech or swallowing. The right side felt numb, and the right arm was a little clumsy when she tried to use it.

Her past history included significant hypertension - she had tried various agents which she’d struggled to tolerate due to side-effects, and she currently was taking a single agent at a low dose. She did not smoke, drink alcohol, or use drugs.

On examination she had:

• Pronator drift in the right arm
• Mild weakness in the right arm and leg (all regions), with normal tone and reflexes
• Reduced (but present) sensation in the right arm and leg on testing touch and pinprick sensation
• Minor inaccuracy of finger-nose testing in the right arm, likely due to weakness rather than true ataxia
• Slow walking with a tendency to drag the right leg

Cranial nerves were normal. Blood pressure was 200/120mmHg. Her pulse was regular.

She was admitted, and in the following 48 hours her symptoms did not evolve.