ABSTRACT
A 19-year-old woman presents to her general practitioner saying that she is unable to open her fists. She says that three days ago she woke up and found it to be like this. She says she also started to see in black and white for a few hours and could see no colours. She explains that she has been otherwise healthy recently. Her records indicate that she has presented regularly to the GP in the past. The last five presentations have been for an ear infection, pains on the soles of both feet, shoulder pain, restless legs at night and neck pain. She has a cousin with cerebral palsy and her grandfather had a stroke one year ago and is now in a wheelchair. Further questioning reveals no other neurological symptoms. She did not do well in GCSEs and required extra help at school in the past for learning. She started work at a supermarket and was recently promoted to the checkout. She says that she does not like this, and prefers being on shelf stacking duties. Her father is known to the practice as someone who has significant problems with alcohol dependence syndrome. Systematic enquiry for depression is unremarkable. She does describe some anxiety about work but has great difficulty articulating it.
