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Neurological picture
Small spiral, big mass
  1. Nirosen Vijiaratnam1,
  2. Andrew John Lees2,
  3. Huw R Morris1,2,3
  1. 1 Department of Neurology, Royal Free Hospital, London, UK
  2. 2 Department of Molecular Neuroscience, Institute of Neurology, University College London, London, UK
  3. 3 Department of Clinical Neurosciences, Royal Free Campus Institute of Neurology, University College London, London, UK
  1. Correspondence to Dr Nirosen Vijiaratnam, Department of Neurology, Royal Free Hospital NHS Trust, London NW3 2QG, UK; nirosenv{at}gmail.com

http://dx.doi.org/10.1136/jnnp-2018-319019

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    A right-handed 44-year-old woman presented with a 4-month history of sudden-onset right leg weakness and a 4-week history of small handwriting. On examination, facial expression, blink rate and spontaneous and associative movements were normal. Power in her right leg was mildly reduced proximally with a collapsing, variable nature and she was unable to perform ankle dorsiflexion. Hoover’s sign was positive. She had slight impairment of dexterity in the right arm, but there was no bradykinesia. The stretch reflexes were normal and symmetrical and the plantar responses down going. On pen-and-paper tasks, she had right-sided small script but there was no size decrement, and the Archimedes spiral was small in size with consistent spiral turn spacing (figure 1A, B). MRI brain showed a large left parafalcine meningioma with areas of acute/subacute blood …

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    Footnotes

    • Contributors NV: study concept and design, acquisition and interpretation of data, drafting and revision of manuscript. AJL: interpretation of data, drafting and revision of manuscript. HRM: interpretation of data, drafting and revision of manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.