The Shaking Runner: A Medical Tent Rarity

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The Shaking Runner: A Medical Tent Rarity - Page #1

Author: Corilyn Pang, MD Co Author #1: Aaron Lee, DO Patient Presentation: During a winter half marathon in the Midwest, a bystander presented to the finish line medical tent seeking help for a race participant having seizures in the adjacent warming tent. History: Upon arrival, we found a 57-year-old male experienced runner, with a history of intermittent shaking episodes after races of various distances, standing and holding onto the tent supports. He requested assistance with standing, but denied seizure activity. He reported that he had ingested two sports gels and a small amount of water while on the course. He completed the race in 1 hour 32 minutes. Ambient temperature at the end of the race was -5 degrees Celsius (22 degrees Fahrenheit), with an average temperature of -6 degrees Celsius (20,.5 degrees Fahrenheit). Trace precipitation fell throughout the race, and the snow depth was 12.7 centimeters (5 inches). Physical Exam: He developed high frequency, low amplitude, repetitive bilateral leg and truncal dystonic jerks lasting approximately 30 seconds that were more pronounced in his lower extremities. He remained alert and oriented throughout the episode and maintained postural balance. He had no incontinence of urine or stool. His vital signs were temperature 35 degrees Celsius (95.1 degrees Fahrenheit), pulse 90 bpm, respirations 16 bpm, and blood pressure 120/60 mmHg. Cardiovascular exam was regular without ectopy or murmurs. His lungs were clear. There were no focal neurologic deficits. The patient had two more episodes under our observation, followed by an asymptomatic period of five minutes, which typically marked the end of these episodes, according to the patient. Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.		Back
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