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A 57-year-old man presented to our service with a 4-month history of clumsiness, unsteady gait and progressive bilateral sensorineural hypoacusia. Neurological examination revealed symmetrical weakness in the lower limbs (power 4/5) with brisk deep tendon reflexes and upgoing plantars.
During initial assessment, there was massive haematemesis but a paradoxical physiological response to intravascular depletion with systolic blood pressure not falling below 160 mm Hg and episodes of sinus bradycardia on telemetry with heart rates ranging from 20 to 40 beats/min, lasting up to 10 s. While bradycardic, he became unresponsive (Glasgow Coma …
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