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An elderly man with muscle cramps
  1. N Younis,
  2. I F Casson
  1. Royal Liverpool and Broadgreen University Hospital, Prescot Street, Liverpool L7 8XP, UK
  1. Dr Younis (naveedy{at}

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Answers on p 731.

A 60 year old man presented to the emergency department with slurring of speech and generalised weakness associated with cramps affecting his hands. He had no medical illnesses apart from a left sided cataract removed a year ago. A 12 lead electrocardiogram was performed.


What is the abnormality on the 12 lead electrocardiogram (fig 1)?
What are the possible causes of the abnormality of the electrocardiogram?
What is the likely diagnosis?

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