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Case Study #1
One month before admission, this 60-year-old, right-handed widow had a 5-minute episode of numbness and tingling in the left arm and hand, accompanied by loss of movement in the left hand. Two days before admission, she fell while taking a shower and lost consciousness. She was found by a neighbor, unable to move her left arm and leg. Her speech, although slurred and slow, made sense.
Neurologic examination showed a blood pressure of 180/100 with a regular heart rate of 84 beats per minute. The patient was slow to respond but roughly oriented to person, place, and time. She ignored stimuli in the left visual field. The pupils responded to light and there was slight, but definite, bilateral papilledema. Other findings included decreased appreciation of pain on the left side of the face, complete paralysis of the left central face, and complete flaccid paralysis of the left arm and less severe weakness of the left leg; the patient seemed to ignore the left side of her body and was not concerned about her hemiparesis. Reflexes were more pronounced on the left than on the right, and there was a left plantar extensor response. Responses to all sensory stimuli were decreased on the left side of the body.
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