A 57-Year-Old Man With Hemiparesis After Coughing

Francesco Brigo, MD; Giampaolo Tomelleri, MD

Disclosures

November 27, 2017

Editor's Note:
The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.

Background

A 57-year-old man presents to the emergency department with left-sided facial, arm, and leg weakness along with slurred speech after suffering violent and repetitive bouts of coughing. His wife also suggests that his right eye is smaller than the left. The patient complains of pain over his right eye.

His medical history is notable for hypertension and smoking one pack of cigarettes per day for 10 years. He denies any illicit drug use. He does not consume alcohol. He is employed, does not exercise, and has a sedentary lifestyle. He has no history of previous head or neck injury.

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