22 yr old Australian flight attendant two days
previously worked a flight
from Johannesburg to Dubai. At home he experienced a burning pressure in
the back and right chest which worsened. It became sufficiently
uncomfortable that he boarded a taxi for the airline medical clinic.
Fifteen minutes later, on arrival at the clinic, he found his legs didn't
work properly getting out of the taxi. His walking was very unsteady.
Approximately an hour later a call was received at my hospital emergency
room that a young man with a "movement disorder" was being sent over. I
subsequently received a call from the Emergency Room physician that there
was an ICU admission for me, a case of possible Guillain-Barre syndrome,
but with a movement disorder.
The patient repeatedly affirmed that the previous day he was 100% normal.
There had been a cold 10 days prior, but no other infection. One year ago
he was evaluated and treated for a dorsal back discomfort. No history of
trauma or other illness of note.
Temperature 36.7, pulse 68, BP 110/ 60, height 185cm.
He was alert but quite agitated on a guerney, with the backrest up and his
legs spilling off the end of the guerney, one or both legs frequently
jumping up with knee and hip flexion, foot and great toe dorsiflexion. The
ankles both had clonus, patellar reflexes were hyperactive, and both
plantar relexes were markedly extensor. He could not move the right leg to
command, and had only minimal voluntary movements on the left. Both legs
moved more involuntarily than on command. There was definitely feeling
present in the legs, but sensation was abnormal, extending up to halfway
between the umbilicus and ribs. The urinary bladder was large to
percussion, and catheterization slowly over hours drained out 2000cc. His
cognitive function was intact, cranial nerves normal, and the arms had
normal strength and sensation, without tremor, and absent to 1+ tendon
reflexes. ENT, chest, abdomen, and skin otherwise normal. After 10mg
diazepan, 25 mg hydroxyzine and 25mg meperidine given IV he became more
Hemoglobin 13.8, WBC 4,800 with normal diff, platelets 256,000; sodium,
potassium, calcium, magnesium, urea, creatinine, chloride, CO2, alkaline
phosphatase, AST, ALT were all normal. Prothrombin time INR was 1.0, PTT
32 sec. Thoracic spine films and chest Xray were normal.
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