QuestionSBA
QuestionChoice
Guillan-Barre typically presents with an ascending weakness and paralysis following viral infection, neither of which is described here.
10035596
e
Guillan-Barre syndrome
QuestionChoice
This is correct. The patient is presenting with signs and symptoms of multiple sclerosis with multiple demyelinating lesions in space and time. The story is in keeping with Uthoff's phenomenon where symptoms worsen in the heat, i.e. during exercising.
10035592
a
Multiple sclerosis
QuestionChoice
Syringomyelia tends to present with loss of pain and temperature sensation, weakness and reflex changes due to damage to the spinothalamic tract. Symptoms vary depending on where the syrinx occurs but are more likely to affect the upper extremities. Syringomyelia would cause a progressively worsening clinical history as opposed to distinct events.
10035594
c
Syringomyelia
QuestionChoice
This is not in keeping with the vignette with no mention of fatigability, eye drooping, or muscle weakness. The incidences appear distinct in time correlating with different lesions in the nervous system more in keeping with multiple sclerosis as opposed to continuously present as would be expected in myasthenia gravis.
10035593
b
Myasthenia Gravis
QuestionChoice
This tends to present with bilateral numbness, neck stiffness, and loss of manual dexterity in hands generally in older patients. It would not explain the leg weakness here.
10035595
d
Degenerative cervical myelopathy
QuestionComment
ok but the symptoms post workout made it sound like myasthenia
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Kawasaki Metabolism
Concept
Chapter
2693
3745
Multiple Sclerosis
Topic
141
Neurology
19522
Multiple sclerosis can present with transient neurological symptoms, often exacerbated by heat, as seen in Uthoff's phenomenon.
A 29-year-old woman comes to the GP describing two separate instances over the last few months of pins and needles in her left arm and right leg, respectively.  She says both of these episodes came on shortly after a gym workout and lasted a few days. In addition, she also experienced weakness in her left leg for almost a day, two weeks ago.

What is the most likely diagnosis?
a