What a Stiff!
A 21-year-old man had chills,
fever, headache, nausea, and diarrhea for two days, after which he felt better.
Two days later, however, his headache returned along with back pain and neck
stiffness. The following morning, he awoke with pain and weakness in both his
arms, the right more than the left. During the rest of that day, the weakness
worsened, and he began to have trouble speaking clearly.
On examination that evening,
he was dysarthric
with shallow respirations. He yawned repeatedly and complained of shortness
of breath. His neck was stiff. His gag reflex was absent, and his soft palate
did not elevate on phonation. The other cranial nerves functioned normally.
His muscles were tender to palpation. The right arm was completely paralyzed
except for slight movement of the fingers, and the left shoulder girdle muscles
were weak. Strength in the legs was normal.
Deep tendon reflexes were absent in the arms but normal in the legs. The
were flexor. Sensory examination was entirely normal.
His breathing worsened progressively, and he was intubated and placed on a mechanical ventilator the following morning.
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