Integrated Problems Radiology: Progressive Weakness

29 year old female presents to the emergency room in the winter with four days of progressive left upper and lower extremity weakness.

For each case, consider the following:

1. What imaging study (if any) would you order? Her symptoms seem serious enough to warrent some type of imaging. Often a head CT is a good place to start, as it is readily available and quick to perform. However in the case of subacute symptoms such as hers, an MR might be more revealing.

2. What clinical information would you give to the radiologist who will be doing the study? It is important to include the details of the duration and type of neurologic deficits the patient has, as well as any predisposing history that might be helpful.

3. Do you need to discuss anything with the radiologist before ordering the exam? If you are ordering an MR, you will want to consider whether there are any patient contraindications to the study, such as inplanted electrical devices or issues related to anxiety or claustrophobia, and if you are not certain about these potential problems, you may want to discuss them with the radiologist.