More Weakness

A 32 year old woman presents with worsening lower back pain, difficulty in walking and weakness of both lower limbs for 6 months.

The pain was severe, exacerbated by activity and poorly responsive to analgesics. The lower limb weakness was pronounced when climbing stairs and getting up from chairs.

She also complains of a dry mouth, constipation and urinary frequency.

Serum electrolyte levels are normal, while her ESR is 10 mm/1h.

Select Relevant Investigations
Electrodiagnostic studies

Performed

The initial compound muscle action potential amplitude in the deep peroneal nerve was low while repetitive stimulation of the nerve showed an initial decremental response followed by an incremental response of >100% after brief exercise.
VGCC & Ach antibodies

Performed

P/Q type VGCC antibodies : positive
Ach receptor antibodies: negative
MRI brain & spine

Performed

No abnormalities are noted.
CT Chest

Performed

The CT scan of the chest appears normal.

Select Relevant Management
3,4-DAP
Steroids
Chemotherapy
Neostigmine