A Young Man With Difficulty Walking and Double Vision

Sadaf Khattak, MBBS; Sumaira Nabi, MBBS; Irfan Khattak, MBBS; Mazhar Badshah, MD, MBBS

Disclosures

February 09, 2017

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 accurately recognize. 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 30-year-old Pakistani man presents to the emergency department with a 6-month history of intermittent headache (more on neck flexion) and difficulty in walking, with a tendency to fall on the left side. He also complains of double vision for the last 2 months without associated ocular pain, swelling, or decreased vision. No history of vomiting, fever, photophobia, phonophobia, dysarthria, dysphagia, seizures, cognitive decline, hearing impairment, joint pains, weight loss, or weakness of any limb is reported.

His history is significant for a motor vehicle accident approximately 3 months prior and also for repeated fractures (total, four) following trivial trauma. He is not using any medications and has no known allergies. His family history is unremarkable. He is a nonsmoker and denies use of illicit drugs. He is unmarried, a teacher by profession, and lives in a joint family system with a poor socioeconomic background.

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