An Adopted 42-Year-Old With Slurred Speech and Memory Loss

Catherine Divingian, MD, PhD; Beena Stanley, MD; Jeffrey Jordan, MD


September 15, 2021

Physical Examination and Workup

Upon examination, the patient appears uncomfortable and fatigued. She is using accessory muscles to breathe. Her heart rate is 72 beats/min, her blood pressure is 135/76 mm Hg, her respiration rate is 15 breaths/min, and her oral temperature is 98.8 °F (37.1 °C). She has a body mass index of 35 kg/m2. Her oxygen saturation is 83% on room air. The saturation increases to 95% on 10 L/min of oxygen delivered via face mask.

The neurologic examination reveals weakness in the bulbar muscles and ptosis. Motor strength elsewhere is 4/5. Sensation is intact in the dermatomes tested. Reflexes are brisk and normal. The results of cerebellar testing are normal.

CT of the head and MRI of the brain reveal no abnormalities. Examples of similar CT (Figure 1) and MRI (Figure 2) findings in other patients are shown.

Figure 1.

Figure 2.

The results of a comprehensive metabolic panel, complete blood cell count, and urinalysis are unremarkable. Arterial blood gas values are as follows:

  • Arterial blood pH: 7.34 (reference range, 7.35-7.45)

  • pCO2: 48 mm Hg (reference range, 35-45 mm Hg)

  • pO2: 55 mm Hg (reference range, 75-100 mm Hg)

  • Bicarbonate level: 25 mEq/L (reference range, 22-26 mEq/L)

Similar ECG findings in a different patient are shown in Figure 3.

Figure 3.

Neurology and pulmonary/critical care consultations are obtained.


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