Marcus reed 68341 1 26 year old gentleman known to doctor knight from our neurology department struggles with mental health as well as chronic bilateral nonfatigable ptosis with some memory and cognitive problems which began in his early teens and which now often manifest as episodic amnesia investigations in the urology outpatients including eeg emg brain mri whole spine serum ck lactate musk and achr antibodies have been normal or negative background of depression convergence insufficiency migraine palpitations but didn't demonstrate anything significant investigation subclinical hypothyroidism high permetropia believes he may have had ptsd as a result of number of traumatic experiences bilateral ptosis since childhood memory difficulties began after hospital attendance when he has an acute left sided weakness which left him worried he'd experienced a stroke during his visit in the hospital forgot his own name age and where he was which improved at the following 24 hours intermittent body weakness and traumatic daily episodes of forgetting where he is what his birthday is and what his phone number is overall feels his memory difficulties becoming more frequent and severe and also include loss of remote memories tigs atodepant and famotidine his past medical history also includes recent tooth extractions january 13 past instant testicular pain in 2023 gastritis in 2023 previously diagnosed with irritable bowel syndrome mixed anxiety and depressive disorder migraine medications list nefepam from the december 1 for a month tramadol also in the acute prescriptions as well as naproxen and mephyrin current repeat prescriptions amoxin 20 omeprazole 20 mg want to be taken each day he's been referred from in november to the community mental health team for ongoing ptsd symptoms intrusive flashbacks persistent laymane and suicidal thoughts that exceed the available support through primary care and talk works investigations are taken in the emergency department lfts normal full blood count normal eosinase normal crp 1 urea normal ast normal full blood counts and he said looks like he's attended the emergency department on the february 6 also where he underwent normal blood tests at that time and underwent an mri of his pelvis on the february 3 for bilateral groin and central lower abdominal pain normal appearances on the mri pelvis happened on the february 6 on the february 6 he attended the emergency department with 3 weeks of consistent headaches feeling full body weakness refer to neurology and waiting to hear from them last week confused and dizzy palpitations over the last 3 weeks seen by doctor berry and was advised to come back in on the ninth the second and to go home with safety netting and now returned but straight to the medical list without ed review despite them asking them to come back with the neuropsychologist on the 20 fifth of the second psychology practitioner marcus richards bring the door back and move this chair out of way and we'll put enough brackets and what kind of stuff what's been happening tell me all about it had a read about how you going on tell me used to have a gemini to help me write it down because I couldn't okay alright so 7 weeks ago you stopped your nefepam I saw that that you were taking nefepam before and what were you taking nefepam for the doctor gave me back pain because codeine does work it just doesn't do anything at all mhmm and and it was effective yeah yeah very effective good all bad great and then 4 and a half weeks so you hit your head yeah I I I probably was at work or home but I sort of bend down to the I was all over the curb and didn't realize I did headaches too we saw then or before that and feeling weak a couple of days after that 4 weeks ago yeah yeah so so during during that 4 weeks I had the weakness and I called the doctor compared to that mhmm sorry got to hospital he said obviously urology can so the full body weakness was 4 weeks ago and then what's happened in the last week to be honest we go to the leg is just gone so is the arms and just done here today yeah I did have to stop put on so we went good that's is that a fair way for you how far is that it's not too far it's just off the road okay it's past live in a hill so it's not too far fine okay do you mind if I call this person because it's just a gp trying to speak to me is that alright it's alright yeah I'll remember you a second sorry go on you were safe I don't know where we were at we were talking about these it's rob did you play sure sorry I just gonna we were talking about the 4 weeks ago weren't we that you had the all body weakness yeah so it gradually got worse and sort of in the past it's obviously past all week maybe week and a half it starts to sort of show itself on the left side holding something the strength is gone but I don't think this when you say the strength is gone what do you struggle with everything if I try to stand on it it quivers when it gives up what happens it just goes mhmm it it literally just dies in and then do you hit the floor or do you are you able to stand on your right leg I can sometimes stand on the right leg the right leg's obviously doing a lot of work recently so it's even that starts if I grab 1 then I will but it has been a few since I've fallen mhmm I'll see yeah fine horrible the other thing is there's a few the vision's obviously a little bit off balance as well and some weirdos so yeah I saw some recent me okay it sounded very loud louder than you think well no no you just started the direction was off it was in front of me but it sounded like it's next right that's it there is some incontinence as well that's new with urine or urine and sometimes a bit of poop as well that's I need that 1 that is not when did that start a week that yeah so that was actually tuesday sort of last week mhmm yeah sometimes the hand just tends to jerk and thing in the leg it sort of just does its own thing and electric shock runs through the body on it when it hits certain points so it goes down which is quite a strong pain it's not a very light thing I mean to be honest even though I don't really feel because I I've fallen before and no one's been around and mhmm because even when it started for a little bit of week because if it's just fatigue you'll probably get over it but reach the earth stronger that sounds awful and I think the main thing I'm concerned about is the fact that there is no strength there's just there isn't really anything there I trust the toilet it's so it's just banging around the toilet trying to sort of sit down like this mhmm I know stand up on it I think that's the main thing that I'm yeah because I had the vaccine yeah I don't think we know by the sounds of by reading your letters it doesn't sound like doctor mike has come up with anything just yet you've had lots of tests haven't you to look for what might be going on well this is actually this is obviously have doctor knight this was this will happen was I did have a neuropsych no he's a neuropsych test that he had it was tough and that was kind of when the weakness started to really show its signs mhmm so I don't know if it was maybe like an activated bit tell me about the neuropsych test what did they have you do just generally sort of was that here or in derritin no no that was in mhmm but I haven't really there's often been really there's no cause I haven't maybe there's a head bang because when I did bang my head I was really dizzy a little bit dizzy and tell me about your function now in terms of being on your feet and things like that have you walked since you got to here I went to the bathroom but I was about here but again it's very unstable and how did it go a shake and give away really let's do do you mind if we see you on your feet is that okay yeah I'm gonna move the plate back forward yeah the leg doesn't move instinctively sometimes I have to think about how to move it yeah it's really good I can't I've got no sensation at all it feels really good to stand on okay I'm gonna get my cash return see if it'll work mhmm okay that's great and who do you live at home with my parents and my brother and your brother you work what's that I do I work at a hotel what do you do in the hotel sort of general work as a mhmm specific as such and is this how you walked in pretty much yeah well it's sort of all though most of it's all just you know more sort of I'm also dragged the leg here mhmm it's just how I've been sort of getting around most of you had similar symptoms you came in a couple of days ago is that right when you see it yeah so it's much better then I can actually walk on it mhmm but I'm much well not much issue but it wasn't like it was now like there's no near what it is now mhmm okay and how about your arm can you can you pick this up yeah it's quite heavy yeah I don't know but yeah I can I can sort of catch it I can't really keep it you can take it down if you like wherever you need yeah that's fine can I examine you do you mind you're in good spot for me to examine you actually I'll stop by just gonna put your hands and I can't listen to your face very cool you stop by having a look at your hands what kind of food are you making what sorry you said you went to a hotel you you said you're a chef no no I just thought that general work now but not my general kitchen work no well yeah sometimes yeah the other thing is the throat stopped working as well there you the throat still stopped working I couldn't swallow anything I'm full of different symptoms yeah it's difficult isn't it good thing how many bowels and bladder doing alright I said I've had a few accidents it's a minor 1 it slips out but I can sort of get some toilet rush to the toilet is that what it is or is it just that it's just that it comes out without noticing it comes out without noticing yeah sometimes it just doesn't really fit it sort of slips out on its own arms up like this like a chicken like this lovely get better doesn't it actually and push down on me arms out like this with the fingers played apart don't let me push them together and test your reflexes back just test the feeling feel me touching you here feel me touching you everywhere well yeah it does it's only touching you or is it I feel feel pins and needles in the whole hand mhmm okay it's something but I don't know exactly do you feel this vibrating not the coldness but the vibration close your eyes for me tell me when it stops little tingly feeling clap when you're falling like this and turn your hand over between each 1 and on the other hand turning your other hand over so keeping this hand the same but lifting the hand up turning it over and pulling it down up over down up over down yeah very good and now the other side can you turn this hand over like yeah that's perfect now clock yeah lovely so bear with me not too much fine alright I'll just take this call let me give you your legs yeah hello hello sorry don't know if this is a dodgy phone I can now yeah yeah of course hi it's rob medical arch I'm nadia of course so are you are you able to swing your legs up was that yeah and have you heard back about the whole genome sequencing yet no no so don't you mind giving me any idea about how you said it could take a few months would you lift this leg up for me that's lovely go lovely strength and push down against it push down against it yep very good and push down on the other side people say lift bend your knees for me yeah make sure you're on the other side take it like you're kicking a football go on bum down now flex lovely now push down little belly cushion on the car pedal actually the power's not too bad is it you've got reduced range of movement but the power is pretty good this is a normal view of me touching you here yeah any any sensation touching that side I can't really feel it can't really feel it no I can't it doesn't feel that's normal a little bit of pins and needles inside but have no idea mhmm tell me when it stops k so not really got the vibration itself like this 1 okay and in terms of coordination can you lift your heel up to your knee alright and swipe it down lift it up kick my hand yeah and back to your knee again okay try on the other side then feel like a discoordination of movement as opposed to lack of power you've got plenty of strength in it but just feeling a bit discoordinated the strength just it comes and goes when it feels like it it won't be coming and how about the eye symptoms that you're getting any change there they haven't got any better sometimes 1 eye will just go blurry I I didn't yeah of course so I see you've got an upcoming neuropsychiatric appointment on the 20 fifth because you because I'm not going to be a couple days but I didn't think I was gonna make it anyway well it was meant to be in a couple of days but you made it back yeah it's more more assessments is it or is it to go through the results or is it just results that'd be good to admit to get find out what's going on how's your mood been lately this really really I've just I've just been seeing I I have complex ptsd so it's not yeah it is defeating go down the stairs I'm a little bit nervous I had a fall recently they did x rays they said there's no damage to the bone yeah so don't mind what we do today obviously you've been here a long time poor thing so I had some blood tests since you came here and they're all completely normal so that doesn't show any signs of infection or anything else that might be exacerbating the things yeah they were the last time and that's quite a bit of a medical marvel and I've had a few incidents in the past where yeah it seems like we've struggled to get to find out what's going on despite a lot of tests and I'm sorry about that I think sometimes we there are things that don't show up on tests and they can often respond to good neuropsychiatric interventions that they can undertake sometimes that can be really helpful so I'm sure those tests are worth pursuing in the results in terms yeah in terms of what we do today I don't mind what we do today I'm completely guided by you as you're the 1 living with this I don't think from my perspective that there'll be anything transformative that we'll be able to do in the hospital so don't think you're weak on that side I think you are coordinated I think we could speak to the neurology team but realistically that's unlike tapaday talk tomorrow and I think that we could bring you into hospital to pursue that that'll be fine we could alternatively pursue that as an outpatient and I could ask them and I think a lot of it how we do this is guided by you and how you're managing at home and where you wanna be you know probably here just in case I have another 4 1 I think that's my biggest concern because I think that's the thing I've struggled with at the minute and I don't know yeah of course and you live with your parents obviously but they might not be there all the time they're not with parents I mean the mom's a nurse where does your mom work she work here been working here yeah what does she do here she's not being at work all the time in the water so I'm getting the feeling that you'd rather be in hospital that's totally fine yeah I'd rather be in hospital and make you a bed but I don't know what what will I get while I'm here or what it will matter to you that's what I said I think I think it's unlikely that we're gonna be able to do anything transformative or answer any big questions here we've been having these so they have got worse at the moment your tests haven't identified anything that we could fix that might make it better sometimes people have infections for example things like that that cause these symptoms to worsen but your blood test unless people are bit dehydrated or they have a kidney problem which causes these kind of symptoms for your blood it's difficult to know exactly what to do dehydration because I probably haven't been drinking enough mean we'll have a look and see when your last ct head scan was and we could consider doing another 1 of those but I think I mean ct head was yeah I heard about that again on that side was very good so yeah that's the thing I said the muscle's working it's just not being already quite right yeah that's the mhmm yeah but yeah we can certainly yeah hopefully make you feel safer by keeping an eye on you in hospital as I say I think it's unlikely we're gonna do anything transport the variety of this stuff is gonna be outpatient still we I mean what will likely happen tomorrow so what's likely to happen is we'll try and get you a bed we've been trying to get you a bed ever since you came into hospital 8 hours ago so we haven't been sitting around doing nothing the moment someone comes into hospital for the medical side we try to find them a bed so we've been looking for a bed for you but we haven't been able to find 1 and we'll keep looking to try and find a bed for you to try and get you be hopefully we'll get you out of a and e tonight that'd be nice and into a bed in the acute medical unit and then you can be seen by the acute medical team tomorrow morning who are not gonna be any more experienced in neurology than I am but they have some ability they can speak to neurology yeah yeah and see what the guy I spoke to on friday said that he said you know he said what's happening mhmm but yeah I appreciate you know I I feel I saw the doctor's day he said the doctor and I he said you know because he yeah yeah yeah so we'll do that then shall we yeah wouldn't mind trying the drip I mean it might not do anything but right it's probably worth trying so yeah sounds good try and move around and walk and things like that because any loosening things up and learning how to use it is important yeah so I'll definitely try and go if I walk where I can I mean but yeah yeah I think that going through all this you're a young man these are important years of your life aren't they and to spend them all in hospital is shit if so yeah no was yeah I had a surgery in june as well so so I'll get I'll do our best to get you a bed as we were before 3 2 2 of course in the ed I'll speak to the ed team and see whether we can get you into ed to wait there I'll see what they're able to facilitate and I'll see whether we can get you over to our end you wait too and I asked them to move you over there earlier but hopefully we're gonna discharge some people and we can get you in there at the very least mhmm that'll be a bit nicer here sorry it's not very nice I know I'm not hungry we we we should be allowed to eat and something else too I'm sorry yeah there should be some sandwiches and things what do you eat chew and things like that I think we might have okay I'll ask you to eat something I'll order it really yeah you need to take shower I would say yeah most of them are just trying to help because they're trying to get new jobs that's pretty good isn't it so I'll come to you so I'll just join this so try to do your knee flexion I'll just check on examination more coordination particularly affecting the left hand side holding the left arm in a fixed position but able to raise his wrist and no wrist drop and able to keep his elbow flexed in a fixed position on provocation in power power was 5 out of 5 on the left however stiff and reduced range of movement he actively however passively able to move throughout hoover's sign positive impression worsening of chronic neurological symptoms being investigated by neurology team with no organic cause found so far no objective evidence of left sided weakness despite symptoms of left sided weakness patient concerned about being at home and falling at home further constellation of neurological symptoms plan admit for observation neurology review name home when able