ABSTRACT
We describe the finding of unsuspected aortic coarctation, discovered by catheterisation at 4 months, in a neonate first daignosed on the fourth day of life as having tetralogy of Fallot with pulmonary atresia and major aorto-to-pulmonary collateral arteries. This previously unreported combination contravenes the established theory of patterns of flow during fetal life, and presented difficult issues in clinical management.
Subject(s)
Aortic Coarctation/diagnosis , Aortic Coarctation/therapy , Pulmonary Atresia/diagnosis , Pulmonary Atresia/therapy , Tetralogy of Fallot/diagnosis , Tetralogy of Fallot/therapy , Angioplasty, Balloon , Aortic Coarctation/complications , Aortic Coarctation/diagnostic imaging , Echocardiography , Female , Humans , Infant, Newborn , Pulmonary Atresia/complications , Pulmonary Atresia/diagnostic imaging , Radiography , Tetralogy of Fallot/complications , Tetralogy of Fallot/diagnostic imagingABSTRACT
Three patients, aged 7-15 years, with Guillain-Barré syndrome presented with pain as the primary complaint. Two did not complain of weakness and their progressive loss of function was incorrectly ascribed to the pain. One did complain of weakness, in association with flu-like symptoms, but the significance of the complaint was not appreciated. At diagnosis all three had profound, predominantly proximal weakness. We believe the delayed diagnosis relates to doctors' lack of opportunity to examine patients with muscle weakness. We conducted a questionnaire survey of junior hospital doctors asking them about their hands-on experience of testing muscle strength and about their knowledge of the Medical Research Council (MRC) Scale of muscle strength. Doctors who claimed most experience did not have a better knowledge of the MRC scale. We recommend doctors-in-training should be given more opportunity to examine patients with muscle weakness and should be made familiar with a clinical scale of muscle strength.
