MRCP2-3556
A 30-year-old woman presents to the Emergency department with sudden onset left-sided arm and leg weakness. She had a generalised headache prior to the onset of weakness, along with an area of anaesthesia over the right cheek. She also experienced blurring of vision, but denied any diplopia, visual aura or restriction of visual fields.
Her medical history includes menorrhagia and a laparoscopy for intermittent abdominal cramps. She is a smoker and admits to a cocaine habit. She drinks 16 units of alcohol per week, lives with her 4-year-old daughter and does occasional temporary work.
On examination, she appears well and cooperative. Her blood pressure is 135/67 mmHg, pulse is 78/min and regular, and heart sounds are normal. There are no carotid bruits. On cranial nerve examination, she complains of an area of anaesthesia over the right cheek. Fundoscopy, visual fields, pupillary reflexes, and facial musculature are all normal.
Upper limb examination reveals normal tone bilaterally with brisk symmetrical reflexes. Power is normal in the right arm, but she is unable to move the left arm. Sensation appears normal. Lower limb examination reveals left-sided rigidity with suppressed knee and ankle reflexes, mute plantar response, and a power of 0/5.
A contrast-enhanced CT scan of the brain is normal. A lumbar puncture is performed and yields the following data:
– Opening pressure 13 cmH2O (5 – 18)
– CSF protein 0.34 g/L (0.15 – 0.45)
– CSF white cell count 4 cells per ml (<5)
– CSF red cell count 3 cells per ml (<5)
– CSF oligoclonal bands Positive –
– Serum oligoclonal bands Positive –
What is the most likely diagnosis for this patient?