26th August 2024

A 54-year-old woman presents because she’s concerned about episodes of double vision

A 54-year-old woman presents because she’s concerned about episodes of double vision which she notices particularly in the mornings. She has also felt generally tired recently. She is usually a keen gym goer but has found it more and more difficult to get into her workouts recently, however, once she warms into things she often improves a lot. She has also had problems recently with constipation, which she has been trying to manage with prune juice. She has also noticed her mouth being quite dry. She has been extensively worked up by her GP with no cause found on blood tests, so she has been referred to your clinic.

On examination, you note mild ptosis, but cranial nerve examination is otherwise normal. She has some weakness in her hip flexors and extenders and in her knees. You are not able to elicit reflexes. There are no sensory signs.

What test is most likely to identify the most likely diagnosis?

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