The importance of the history and examination cannot be over-emphasised for this case scenario. Investigations are mainly required to support your clinical impression or rule out important differential diagnoses.
Charlotte is an 11-year-old girl who loves sport and had recently started competing at state level in athletics and swimming. Charlotte’s mother brought her in to the surgery and reported that over the previous four to six weeks strange things had been happening to Charlotte. She had seemed to have lost the flow in her running style and her swimming coach was concerned that she had recently been moving her arms in an awkward manner. Charlotte’s mother said that on one occasion she had seen Charlotte drop her water bottle five times as she walked from the pool to the car. There had also been a few hours one morning when Charlotte’s speech had sounded distorted, but it had then returned to normal. Charlotte appeared happy and unconcerned, and her neurological examination revealed no abnormality.