A case of chronic dysaesthesia in the torso and upper limbs

EANS Case of the Month: November 2015
(by Hamza Soleiman and Andreas K Demetriades, Department of Neurosurgery, Western General Hospital, Edinburgh, UK)


Case report
 
29 year old female, presented with repeated attacks of itchy dysaesthesia for 13 years. The sensation would start in the left hand, spreading up into the neck and trunk, followed by jumping spasms of the left leg. The sensation would last for over 10 minutes; when the sensation lasted over 30 minutes she would then get spasms. At times the symptoms would last for up to 1 day.

There was also a 3 year history of left sided arm and shoulder itching associated with leg spasms, and her gait was starting to get affected. The family noted an occasional limp. There was also a 3 month history of left sided facial numbness but no pain.

Examination showed slowed left fine finger movement; weakness 4/5 in left elbow extension, and fingers extension and abduction; left sided hyperreflexia with left ankle clonus; and dysaesthesia in the left foot but preserved normal sensation.

Imaging:

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* 1. What is the potential diagnosis?

* 2. How would you proceed?

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