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 you would like to suggest for a future Case Challenge, please contact us.
A 60-year-old, right-handed woman is brought to the emergency department (ED) for left-sided weakness after an unwitnessed fall. She fell to the floor on her left side while attempting to get out of bed. She realized that her entire left side was weak, and she did not have the strength to stand up on her own.
Her family states that she has been sleeping much more than normal and had had a severe occipital headache for the past 3 days, accompanied by 6-7 episodes of vomiting per day. The vomiting is not relieved by antacids and proton pump inhibitors, and it is not associated with nausea. She also complained to her family of feeling feverish for the past few days and had appeared intermittently agitated. She denies any history of head trauma, photophobia, diplopia, convulsions, dizziness, difficulty speaking, or difficulty swallowing.
No prior history of stroke, transient ischemic attacks, hypertension, coronary artery disease, rheumatic heart disease, or atrial fibrillation is noted. The patient reports no allergies. On review of her family history, she reports that her husband was diagnosed with pulmonary tuberculosis (TB) 10 months ago. She states that he was treated with antituberculosis medications for 6 months but admits that he had not been compliant with the entire course of treatment. She did not have a tuberculin skin test (TST), interferon gamma-release assay, or chest radiograph when he was diagnosed.
The patient does not smoke tobacco, drink alcohol, or use illicit drugs. She has never used oral contraceptive agents. She lives in Mumbai, India, and has never traveled abroad.
Medscape © 2015
Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.
Cite this: Shradha B. Ahuja, Rajiv S. Hira, Vijay Panikar. Left-Sided Weakness in a 60-Year-Old Woman - Medscape - Dec 10, 2015.