A 64-Year-Old Man Unable to Lift His Arm or Walk

Winston Tan, MD; Nicole Ganon, PA; Ashton Ritter, MMS

Disclosures

May 21, 2019

Physical Examination and Workup

His vital signs on admission include temperature of 98.3°F (36.8°C), blood pressure of 140/60 mm Hg, heart rate of 92 beats/min, respiratory rate of 18 breaths/min, and SpO2 of 97% on room air.

Upon physical examination, he is alert and oriented to person, place, time, and situation. He is in no acute distress. He has normal speech and no facial weakness, and his cranial nerves are intact. He has 5/5 strength in right-side upper and lower extremities and grade 3/5 weakness of the left arm and left leg. He has difficulty with the coordination of movement. He is unable to walk unassisted. He has decreased sensations on the lower right foot to the knee, as well as fingers to mid-forearm on the right side. Cardiac examination findings are negative. Decreased breath sounds are noted in the right upper lobe. He has normal abdominal examination findings.

His complete blood cell count and basic metabolic panel are within normal limits. His international normalized ratio is 1.2. Imaging study findings are shown below.

Figure 1.

Figure 2.

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