19th August 2024

An 85-year-old woman is brought to A&E from her nursing home with weakness of her left arm and leg

An 85-year-old woman is brought to A&E from her nursing home with weakness of her left arm and leg. She has a background of Parkinson’s disease, diabetes, atrial fibrillation and a previous right hip fracture with replacement. She is unsure when the left arm and leg weakness started, saying that it seems to “come and go” but is getting worse. The nursing home staff report that over the last few days she has spent more time sleeping during the day and is more forgetful. On examination, she has reduced power of the left arm and leg and a shuffling gait with an ataxic component. She falls asleep a number of times during the examination. What is the most likely diagnosis?

Select the SINGLE most appropriate option from the list below. Select ONE option only.