23 year old comes in wiith uncontrollable movements. Hasn't taken his neuroleptic drugs for 2 months. Ex heroin abuser,
controlled on methadone. Hep C and HIV positive; on no treatment. Admits to smoking crack recently. No foreign
travel, no GI symptoms.
On examination is apyrexial. No rash. Mildly tachycardic, pupils not dilated. Grimacing with lip-smacking and
head-turning. Conscious and able to speak. Crossing and uncrossing legs, flailing arms from shoulders. The peripheries
seem less severely affected than centrally. Signs settle for a few hours with diazepam 5mg but then return. Thoughts?
Rowley Cottingham.
Consultant in Emergency Medicine.
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