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A correction has been published: N Engl J Med 1999;340(10):824.

Case Records of the Massachusetts General Hospital
Weekly Clinicopathological Exercises
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Volume 340:300-307 January 28, 1999 Number 4
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Case 3-1999— A 41-Year-Old Woman with Muscle Weakness, Painful Paresthesias, and Visual Problems
Daniel L. Menkes, Darryl E. Palmer-Toy, and E Tessa Hedley-Whyte

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Presentation of Case

A 41-year-old woman was admitted to the hospital because of muscle weakness, painful paresthesias, and transient visual problems.

The patient had been well until four months earlier, when a rash developed on her thighs, and lumbar pain radiated down the backs of both legs to the heels, followed by the development of tingling and numbness in the feet. About one month before admission, she began to have episodes of transient monocular blindness that involved either eye, but usually the right. The episodes began with sudden "black clouding" of the visual field, with "tunnel vision," and subsided after one to five . . . [Full Text of this Article]

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Dr. Daniel L. Menkes's Diagnoses

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