Case Reports

Rapidly deteriorating mobility in a young man: Case description and possible differential diagnoses

V Srirangam

A 32 year old gentleman, presenting initially with a ‘dragging’ foot, rapidly progressed to become paraplegic within a year. Here, a case summary is presented initially, followed by the differential diagnosis for the clinical presentation. Investigations primarily showed combined central and peripheral demyelination which could have been secondary to the anti-CRMP5 antibodies found in his serum. Such antibodies are highly associated with malignancy and, as a consequence, our patient was extensively investigated for an occult neoplasm (which was not found). While the central and peripheral demyelination may have been secondary to an antibody-mediated paraneoplastic syndrome, other differentials such as autoimmune combined demyelination must also be considered.

Management of severe shock in a young adult following lower GI bleeding within a rural context

Mark Boydell, Richard Moore

A 37 year old female with no previous medical history
presented to the emergency department (ED) in a rural
Australian hospital with a new onset of per rectum (PR)
bleeding which had been ongoing for the last 6 hours. Her
history was one of intermittent occasional PR bleeding and some changes in her bowel habit over the last 2 years.

Tongue-tied: Management in Pierre Robin Sequence

Nikita Rajaraman Rajaraman, Elvino Barreto

An 18-month-old male with Pierre Robin Sequence (PRS) presented to A&E with airway obstruction and hypoxia due to retroglossoptosis. The patient was resuscitated immediately and intubated. Gold standard treatment was surgical management by mandibular distraction osteogenesis. However, as the patient was unable to afford the surgery, a simpler and cheaper surgical technique had to be employed. The procedure involved pulling the base of the tongue anteriorly and tying to the hyoid bone. This maintained airway patency and patient was extubated. Mother was given feeding and positioning advice for the child. It is expected that the mandibular growth will eventually catch up with the tongue growth.


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