SLOW CHANGES
At first her daughter resisted. She felt fine, she told her mother. And if the stairs did seem a little tougher lately, it was because she hadn't been working out. But in truth, her friends had also commented about the way she went up stairs, and she had noticed a few worrisome things herself. She had recently gone skiing, for example, and even the easiest moves — maneuvers she mastered as a child — seemed strangely difficult. She couldn't turn; she couldn't even snowplow.
LOSING STRENGTH
On exam, the specialist noted that the patient had some clear weakness in her thigh muscles. Indeed, she couldn't stand from a seated position unless she used her hands to push herself up. Even when she walked on a level surface, her hips swung from side to side — like a subtle parody of some femme–fatale sashay.
When thinking about a patient who has weakness, it's essential to distinguish between symptoms resulting from a problem in the muscle itself and those caused by the nerves that control the muscle. If it's a problem in the nervous system, you have to figure out which part of the system is affected: Is it in the brain? In the spine? In the muscle itself? Each location suggests a different set of diseases.
Which test would be the least helpful in evaluating this patient?
MRI of the brain
MRI of the spinal cord
Dopplers of the legs
An electromylograph (EMG)
An ELISA for Lyme disease