Yellow and Weak Young Man

Abstract

19-year-old man was admitted to hospital with left arm weakness and altered sensation as the main complaint lasting for 24 hours and a 5 day history of altered sensation in both feet and weakness in his legs. The day before admission he realised that he could not lift his left arm above his head. He also had pins and needles in his fingertips bilaterally. He denied any head injury or other trauma. He had no recent illness including diarrhoea and vomiting. He had felt fatigued and exhausted for last 4 weeks. On examination there was bilateral ankle weakness (4+/5) with foot drop, more prominent on the right (4/5). He was not able to lift his left arm over his head (2/5 proximally). He also had some difficulties lifting his right arm over his head (especially against resistance – 3/5). There was some ataxia and dysmetria (during finger/nose testing) but likely due to weakness. Reflexes were absent in all four extremities. Cranial nerves were normal. He was not breathless during physical activity. Bulbar functions were normal. There was rather distal light touch hypoasthesia but rest of the sensory functions were normal (vibration sense, pain). His complexion was slightly pale and yellowish. He had a temperature of 37.6 °C.