Ataxia, ophthalmoplegia, areflexia | Figure 1

Ataxia, ophthalmoplegia, areflexia

43M with no past medical history presenting with 1 day history of binocular horizontal double vision. MRI Brain and Orbits normal. He initially refused LP but agreed when he started feeling worse, being unable to sit up without support, clear upper and lower limb ataxia. Reflexes absent. CSF WBC count 6, protein 59 mg/dL.

Patient received treatment but continued to worsen, with complete opthalmoplegia, pupils 5 mm and unresponsive to light, urinary retention. His symptoms started to improve around day 10 and patient was transferred to rehab.

Diagnosis?

Similar cases

Female, 21 years old
No significant medical history.
Her symptoms started 8 months ago with occasional headaches, followed by diplopia, increased headache intensity, nausea, and vomiting.
Physical examination reveals left facial paralysis, inability to abduct the left eye, and left-sided dysmetria and dysdiadochokinesia.

A 21-year old, previously healthy, MSM patient was admitted with various symptoms including fever, headache, and vomiting, eventually leading to a diagnosis of viral meningitis, for which he received supportive therapy and acyclovir.

68M African-American retired Navy presenting after second event of confusion and other neurological symptoms. Imaging showed cerebellar atrophy.

A 52-year-old man presented with a 20-minute history of chest pain radiating to the left shoulder and neck, associated with dyspnea and diaphoresis. He had a history of hypertension, long-term smoking, and a sedentary lifestyle. On physical examination, bibasilar crackles were noted on lung auscultation. An electrocardiogram (ECG) was performed in the primary care setting, and the patient was promptly referred to the emergency department.

A 28-year-old woman presented with a 3-day history of intense pruritus over the lower back. She reported no recent travel or exposure to new environments. She cares for a small kennel with approximately eight dogs rescued from the streets. Physical examination revealed multiple small vesicles, some clustered and others scattered, predominantly involving the lumbar region and the left gluteal area.

A 4-month-old male infant presented with skin lesions localized to the chin for the past 3 days. Physical examination revealed multiple small pustules with surrounding inflammatory signs on the chin, along with a few scattered papules on the chest.

\
patient in late teens presenting after a collapse, no chest pain, no previous cardiac history, no history of sudden death in family, are there any features in this ekg that would warrant further work-up or is this just a pediatric ekg?