Abstract
HISTORY The patient presented with a three week history of vague signs, including exercise intolerance, hind limb weakness, cough and regurgitation/vomiting. These signs were insidious in onset, intermittent and had become progressively worse. There had been no response to empirical use of ranitidine, metoclopramide or NSAIDs, but the cough had responded to cephalexin. By the time of referral examination, she could not walk more than a few paces without collapsing, she was dyspnoeic and the coughing had recurred. Questioning did not enable the reflux of food to be differentiated as regurgitation or vomiting.
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