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Endgames Case Report

Acute global limb weakness

BMJ 2011; 342 doi: (Published 18 April 2011) Cite this as: BMJ 2011;342:d1516
  1. Jackie Gilbert, consultant physician1,
  2. Saad Yousif Saheecha, specialist trainee, general medicine1,
  3. Victor Oguntolu, consultant physician2
  1. 1King’s College Hospital NHS Foundation Trust, London SE9 5RS, UK
  2. 2University Hospital Lewisham, London, UK
  1. Correspondence to: J Gilbert jackiegilbert{at}
  • Competing interests: All authors have completed the Unified Competing Interest form at (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

A 31 year old man presented with a two day history of sudden onset, bilateral upper and lower limb weakness. Bulbar, sensory, and bladder function were unimpaired. A transient episode of bilateral hand and leg weakness had occurred one week earlier.

Medical history included alcohol dependence (abstinent for one year) and acute kidney injury secondary to use of non-steroidal anti-inflammatory drugs. He had no family history of muscle disorders. He denied using diuretics, laxatives, or recreational drugs.

On examination his body mass index was 24, he was afebrile and tachycardic (135 beats/min), and he had a blood pressure of 135/63 mm Hg. Respiratory and abdominal examinations were normal. He showed grade 4 symmetrical global limb weakness with normal tone, reflexes, sensation, and cranial nerve function. He had no muscle tenderness, wasting, or …

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