Ophthalmoplegia and Slurred Speech in an Intravenous Drug User 英文参考文献.docVIP

Learning Forum Ophthalmoplegia and Slurred Speech in an Intravenous Drug User Jaime Vera, Anke Hensiek, Charles Woodrow, Francesca Crawley, Sanjeev Krishna * D E S C R I P T I O N o f C A S E cholinergic synapses, blocking neuromuscular junctions as well as parasympathetic and sympathetic pathways. Cranial nerves are affected before descending weakness of voluntary muscles develops. Typical early symptoms are therefore dry mouth, blurred vision, diplopia, dysphagia, dysphonia, and dysarthria. Pupillary dilatation is common. Limb weakness and respiratory compromise may follow rapidly, and the latter may occur without the former. Re?exes are present unless ?accid paralysis becomes severe enough to suppress them. The toxin does not cross the blood–brain barrier. Sensory disturbance is not a feature of botulism. A diagnosis of wound botulism is also suggested by the history of intramuscular drug injection. The incidence of wound botulism following heroin injection into skin or muscle has risen dramatically in the United Kingdom since 2000 [1]. The site of infection may appear benign (as in this case) [2], and fever is absent unless wounds are co-infected. Gastrointestinal symptoms are not seen in wound botulism. Although unlikely, other differential diagnoses to consider include diphtheria, tick paralysis, carbon monoxide, or organophosphate poisoning. A diplopia and a one-day history of slurred speech. 35-year-old unemployed man presented to Accident and Emergency with a three-day history of progressive There was no history of fever, paraesthesiae, dysphagia, or respiratory dif?culty. He admitted drug abuse including “muscling” (intramuscular injection of heroin). On examination, the patient was well, ambulant, alert, and orientated. Vital signs were normal and oxygen saturation was 97% (room air). There were injection sites in both arms but no infected wounds. There were no cardiac murmurs. The rest of the general examination was normal. Visual ?elds were full and