26th August 2024

An 18-year-old man is referred urgently to the neurology clinic with concerns about weakness

An 18-year-old man is referred urgently to the neurology clinic with concerns about weakness. He came to this country as a refugee separated from his family aged 9 and has no known medical history. During his school years, he had a lot of difficulty keeping up with other children during PE and did not thrive academically, though this was attributed to his late entry into the education system. He works as an assistant in a haberdashery now but finds it increasingly difficult to reach down rolls of heavy fabric from higher shelves. He also finds he needs to sit down for most of the day and can find it very hard to get back up again from the low chairs at work.

On examination, you note a proximal weakness with relative preservation of distal function. An ECG is performed which shows an AV conduction block, and an echo finds early signs of dilated cardiomyopathy. What is the most common cause for his symptoms?

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