A 16-year-old African American boy presents to the emergency department with right facial numbness, right upper extremity weakness, and slurred speech for 2 days. The symptoms started suddenly and were preceded by right calf pain 1 day before. Two weeks earlier, he was treated for a gunshot wound in his right thigh with debridement and internal nail fixation for a femur fracture. He was then sent home 3 days later with an acetaminophen and oxycodone combination for pain. He admits to having a brief period of shortness of breath immediately after the symptoms started and denies any other symptoms. He also admits to being very sedentary since his last admission. He does not have sickle cell disease and denies any significant family history and any drug, alcohol, or tobacco use.
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