A 40-year-old female presents with a history of
difficulty in walking. There was no significant past medical history and she
was not taking any medications. She smoked 20 cigarettes a day and had done so
for 20 years. She consumed 12 units of alcohol a week.
On examination there was no muscle wasting, she was noted
to have increased tone in her lower limbs, power was decreased in both lower
limbs, reflexes were exaggerated and plantars were upgoing.
There was no sensory deficit. Neurological examination of
the cranial nerves, upper limbs and abdomen was normal.
Hb 12. 6 g/dL
WBC 7.5 x 109 /L
ESR 14 mm in 1st hour
Sodium 138 mmol/L
Potassium 4.3 mmol /L
Urea 4.4 mmol/L
Corrected calcium 2.9 mmol/L
Chest X-ray showed bilateral hilar lymphadenopathy
In this patient which one of the following would you
arrange next ?
Mediastinoscopy and lymph node biopsy
Endoscopic ultrasound and lymph node biopsy
MRI brain and spinal cord