23rd August 2024

A 19-year-old female presents to A&E due to a 2-week history of increasing difficulty walking

A 19-year-old female presents to A&E due to a 2-week history of increasing difficulty walking. She reports it started as tingling in her feet but then they became numb. On examination she has reduced power at the ankle joints bilaterally with increased tone and absent plantar and ankle jerks. On sensory examination, there is marked loss of vibration and proprioception distally bilaterally, but pain and temperature sensation are intact. Romberg’s sign is positive. The patient has no past medical history and does not take any regular medications. She is not aware of any conditions that run in the family. On further questioning the patient reports frequent nitric oxide use. What is the most likely cause of her symptoms?

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