A 50-year -old woman with chronic renal failure has been on hemodialysis for five years. She had multiple gadolinium enhanced MRIs for chronic low back pain (LBP). She developed inability to raise arms and legs that evolved over six months. She had no dysphagia. She was found to have hard skin and breasts and her CK level and EMG were normal.

´┐╝Find the answer and diagnosis in the next edition of Practical Neurology or online, posted along with the patient video at PracticalNeurology.com.

Case selected from Dr. Shaibani's Video Atlas of Neuromuscular Diseases in press, by Oxford University Press. Aziz Shaibani, MD, FACP, FAAN is Director of Nerve & Muscle Center of Texas and Clinical Associate Professor of Medicine at Baylor College of Medicine in Houston, TX. He is also Adjunct Professor of Neurology at Kansas University Medical Center in Kansas City, Kansas.