What's Your Diagnosis? Sharpen Your Diagnostic Skills Young Mam With Left-Sided Paralysis and Numbness

摘要

HISTORY A 28-year-old man presents to the emergency department (ED) with left upper extremity paralysis and left lower extremity numbness, which he first noted on awakening that morning. Five days earlier he had received a diagnosis of tension headache at another ED. He denies any weight loss, fevers, photophobia, visual changes, recent trauma to the head or neck, neck stiffness, chest pain, cough, vomiting, or leg swelling. His past medical history is significant for cerebral palsy and self-diagnosed migraine headaches. Over the past 18 months, he has sought medical attention at various EDs for dental pain, sore throat, and back pain. He smokes but denies alcohol and illicit drug use. The patient reports that he is homosexual and that he has tested negative for HIV within the past year. His family history is significant for systemic lupus erythematosus and diabetes mellitus.