A 20-year-old woman presents with weakness in her arms and legs. The symptoms began about 4 days earlier with tingling in her hands and feet and have progressed to the point of her stumbling frequently and dropping weighty objects. She is also having trouble with writing. She denies bowel or bladder symptoms, dizziness, dyspnea, or other difficulties in breathing.HISTORY:She is an otherwise healthy young woman who lives in an apartment with friends while attending college. Her only medication is an oral contraceptive. She does state that she had a severe diarrheal illness 2 weeks earlier along with several of her roommates.PHYSICAL EXAMINATION:Vital signs are normal; no postural changes to her pulse or blood pressure are noted. There is no nystagmus. Heart and lungs are normal. Rectal examination shows good sphincter tone. On neurological examination, cranial nerves are intact. The patient has symmetrical weakness of the arms and hands as well as the muscles of the legs. Reflexes are diffusely hypore-flexic to areflexic.
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