What's your diagnosis? – Case 9: confusing neurological signs

Mrs P (49), a primary school teacher, hadn't been feeling well for a couple of days, complaining of excessive tiredness.

Mr P became worried when his wife started feeling dizzy and nauseous and encouraged her to lie down for a while. Some time later, while lying down, Mrs P began slurring her words. She also told her husband that it seemed as if objects in the bedroom were moving up and down. When she noticed difficulty moving her arms, her husband rushed her to the emergency unit at their local hospital.

When Mr P noticed his wife's speech starting to slur, he became very worried. His mother died of a stroke and he was very worried that the same thing was happening to his wife.

Mrs P has no medical or surgical history and does not take any medication. She is generally healthy, but noticed some weight loss over the past four months. She has never smoked and doesn’t drink alcohol. Her mother passed away from cancer of the reproductive system (she is unsure exactly what type of cancer her mother had) and her father died from a heart attack. 

On arrival at the emergency centre, Mrs P had difficulty using proper sentences, but didn’t seem confused in any way. She also didn’t feel weak, but was very off balance when entering the hospital. 

The doctor examining her was very concerned about the sudden onset of her symptoms. The following is a summary of his physical examination findings:

1.       Rapid involuntary movements of both of her eyes (nystagmus)

2.       Inability to stand without support

3.       A slight tremor in both her forearms and hands

4.       A temperature of 38.0 degrees celcius

The doctor excluded a stroke by doing a CT scan. When he did not find any obvious signs of a stroke, he decided to refer Mrs P to a neurologist for further investigation.

What’s your diagnosis?

Clue: No doctor can make a diagnosis if he does not take the patient’s full history into account.

What’s your diagnosisJoin the guesswork on our Facebook page, or comment below. 

NOTE: Health24's on-site GP Dr Owen Wiese will reveal new cases on Thursdays. We'll post the answer with the story on Mondays, or you can get it via the Daily Tip – sign up here.

Previously on What's Your Diagnosis

What's your diagnosis? -  Case 1: vomiting and weight loss
What's your diagnosis? -  Case 2: eye pain
What's your diagnosis? -  Case 3: strange behaviour and a bullet in the back
What's your diagnosis? -  Case 4: seeing odd things
What's your diagnosis? - Case 5: mysterious lungs
What's your diagnosis? - Case 6: runner with seizures
What's your diagnosis? - Case 7: swollen knee
What's your diagnosis? - Case 8: bloody semen

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