Physical Examination and Work-up
The patient appears pale and icteric. She displays stupor alternating with irritability. Her heart rate is 136 beats/min, blood pressure is 103/62 mm Hg, temperature is 98.06°F (36.7°C), and respiratory rate is 16 breaths/min.
Upon heart examination, regular heart sounds are noted (S1, S2). A grade 2/6 systolic murmur is heard all over the precordium.
The abdomen is soft and nontender, and bowel sounds are positive. The spleen is palpated 3 cm below the costal margin.
The patient's cranial nerves are intact. She has normal power and sensation over the right side (upper and lower limbs). She has left-sided hemiparesis and hemianesthesia (upper and lower limbs).
Laboratory findings are as follows:
Hemoglobin level: 6.5 g/dL
White blood cell count: 24,000 cells/mcL
Platelet count: 500,000 cells/mcL
Prothrombin time/partial thromboplastin time: Normal
Routine chemistry: Normal
Results of blood smear examination, high-performance liquid chromatography, and brain CT scan are shown in Figures 1-3.
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