An interesting recent case highlights the importance of looking past initial presentations and preconceptions.
I met GW a 78 year old gentleman who was struggling with leg weakness. He had always been extremely active and independent, but, some months earlier, in the hot weather had experienced a funny turn that left him with some temporary weakness on the left side of his body. He had felt unwell and weak and had been unable to get out of his car for a number of hours. He was assessed in hospital and was diagnosed as having had a transient ischaemic attack (often referred to as a mini-stroke or a TIA).
As expected after a TIA, his symptoms of weakness resolved. Soon after this episode, however, he started to notice pain in his left foot and leg. This progressed and soon weakness developed, making walking difficult. This was devastating for someone who had previously been so active. He was told that he had developed sciatica and, likely irreversible, weakness in his foot known as foot drop. He had also been told by other medical practitioners that his initial ‘funny’ episode could have been a stroke rather than a TIA, which had resulted in permanent leg and foot weakness.
He came to see me for my opinion. I took a full medical history and neurological examination. This revealed a weakness in his left great toe. This can be a sign of irritation of the L5 nerve root. This is one of the spinal nerves that start from the spinal cord exiting through a hole (foramina) in the fifth lumbar vertebra. It seemed from the history that the irritation occurred at the same time as the TIA. It was likely that the prolonged seated position had caused the effect on the nerve.
Mr. GW was agreeable to a course of spinal manipulation therapy. The aim of this was to relieve the pressure on the nerve root. Within a few sessions, he had started to notice increased strength in his toe that led to an increase in mobility. Within a few weeks he had a full return to function and is now once again fully active and enjoying his hobby of bee keeping.
This case neatly highlights the importance of performing a full neurological examination, even when a neurological diagnosis has been made. Had this not happened, GW would still be experiencing an impaired quality of life, from a condition that is eminently treatable.
