Weak in the Knees

A 61-year-old woman presented to her primary care physician with a 4-week history of progressive leg weakness, bilateral leg pain, and difficulty walking. The weakness was symmetric and did not fluctuate during the course of the day. Foreword In this Journal feature, information about a real patient...

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Bibliographic Details
Published inThe New England journal of medicine Vol. 369; no. 5; pp. 459 - 464
Main Authors Conwell, Walter D, Josephson, S. Andrew, Li, Howard, Saint, Sanjay, Janssen, William J
Format Journal Article
LanguageEnglish
Published Boston Massachusetts Medical Society 01.08.2013
Subjects
Antigens
Breast cancer
Cancer therapies
Case reports
Family medical history
Head & neck cancer
Headaches
Knee
Leg
Lung cancer
Medical imaging
Nervous system
NMR
Nuclear magnetic resonance
Pain
Patients
Primary care
Scleroderma
Spinal cord
Walking
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Summary:A 61-year-old woman presented to her primary care physician with a 4-week history of progressive leg weakness, bilateral leg pain, and difficulty walking. The weakness was symmetric and did not fluctuate during the course of the day. Foreword In this Journal feature, information about a real patient is presented in stages (boldface type) to an expert clinician, who responds to the information, sharing his or her reasoning with the reader (regular type). The authors' commentary follows. Stage A 61-year-old woman presented to her primary care physician with a 4-week history of progressive bilateral leg weakness, bilateral leg pain, and difficulty walking. The weakness was symmetric, without exacerbating or ameliorating factors, and did not fluctuate during the course of the day. The patient also reported depression, anxiety, memory problems, and intermittent headaches that had begun several months earlier. She had a dry mouth but no difficulty swallowing. Previously very active, she had become homebound over a period of several months because of the leg weakness. Response Weakness is a common symptom and can result from dysfunction of either the central nervous system (brain or spinal cord) or the peripheral nervous system (anterior horn cell, nerve, neuromuscular junction, or muscle). Bilateral symmetric weakness of the legs can also result from problems with either the central . . .
ISSN:0028-4793
1533-4406
DOI:10.1056/NEJMcps1210293