This weeks case highlights the challenges of interpreting an abnormal neurology exam. We discussed the inconsistencies in her exam that are not correlated with a specific neurologic pathway, however absent reflexes are never normal. We went over a wide differential and the importance of baseline NIFS.

MRI completed which showed non-specific white matter lesion in the left frontal lobe, not concerning for MS. Spine MRI normal. Given these findings and slow improvement in her symptoms, LP deferred. Psych and PM&R consulted, thought to be all related to functional neurological disorder. Patient had improvement throughout their hospital stay and discharged home. 

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