An Accountant Who Loves Aerobics With Hiccups and Incoordination

Ajith Goonetilleke, MB BS, FRCP


July 02, 2021

Editor's Note:
The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.


A 34-year-old woman presents to the emergency department (ED) with a 3-day history of pain around the right ear extending to the temple. She was sitting at work today when she suddenly experienced dizziness, a feeling of discomfort in the throat, and a burning sensation in the left arm and leg. When she tried to stand and walk, her right arm and leg did not move in a normal, coordinated manner.

The patient was previously healthy and does not take any regular medications. She does not smoke or drink. She does vigorous aerobic exercises on an almost daily basis. Her mother and numerous relatives on her mother's side have hypertension.


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