A 34-Year-Old Woman With Vomiting and Bulbar Weakness

Sumaira Nabi, MBBS; Muhammad Irshad, MBBS, FCPS Neurology; Haris Rajput, MBBS, FCPS Neurology

Disclosures

December 11, 2018

Editor's Note:
The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to recognize accurately. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.

Background

A 34-year-old woman presents to the emergency department with a 10-day history of weakness of the bilateral lower extremities, as well as urinary retention and constipation. She also complains of vomiting and dysphagia with liquids, along with drooling and nasal regurgitation for 3 weeks.

She has no history of fever, headache, altered sensorium, or seizures. She has no medical history, in particular no history of visual impediment, limb weakness, ataxia, or sensory symptoms.

The patient has 3 children, all of whom were born through normal vaginal delivery; the last child was born about 2 months before presentation. The woman is a nonsmoker and is not taking any medications on a regular basis. Her family history is unremarkable as well.

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