Case 3 Neurology

Weakness

Work it one clue at a time. The diagnosis stays hidden until you reveal it.

Clue 1

A middle-aged man walks into your clinic complaining of weakness. You take a moment to observe his gait. What do you notice?

Clue 2

This should generate a hypothesis.

You reference your framework for weakness and try to determine the location of the lesion to narrow your differential diagnosis. The patient’s gait has already provided a clue (spasticity).

Clue 3

Clue 4

So you check his reflexes next.

Clue 5

The hyperreflexia suggests an upper motor neuron lesion. Next, you check for Hoffmann’s sign, which if present, would suggest a cervical lesion.

Clue 6

You have just diagnosed cervical myelopathy. Using only your eyes and a reflex hammer.

End of case.