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.
A 27-year-old man reports recent balance problems and several episodes of bladder incontinence. He is a factory assembly worker and has no difficulty using his hands for repetitive tasks at work; however, he feels off balance when he walks. He says that he is not dizzy. He explains that his legs feel stiff, and it seems as if he is going to fall. He has had at least three episodes of bladder incontinence on different occasions. All the episodes occurred during the day, when he already knew that he needed to urinate but had not had a break to use the toilet.
He says that he has been healthy and athletic and did well in school. He went to a vocational program during his last year of school and has done well in his job, with no complaints or interpersonal issues. He lives with his parents and his younger brother. His parents are healthy, and he has a maternal uncle who uses a wheelchair as the result of a work injury.
He drinks a few beers each week and does not smoke. He played on a community baseball team a year ago, but he does not think he would be able to play at the local community level with his current balance problems and leg stiffness.
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Cite this: Heidi Moawad. A 27-Year-Old Factory Worker With Incontinence and Imbalance - Medscape - Jan 09, 2023.