Clinical Reasoning: A 68-year-old man with a history of lung cancer presenting with right-sided weakness and aphasia

A 68-year-old man with paroxysmal atrial fibrillation on warfarin, left subclavian thrombosis treated with carotid-subclavian bypass, and lung adenocarcinoma treated with pneumonectomy, chemotherapy, and prophylactic cranial irradiation and in remission since 1987 was admitted to our neurocritical care unit with acute onset of right-sided weakness, expressive aphasia, and lethargy. On admission his temperature was 101.7°F, and initial blood pressure was 140/60 mm Hg. There was no nuchal rigidity. He was alert and mute with impaired comprehension. He had left gaze preference. Vision was impaired in the right field. There was weakness of the right lower face. Strength was full on the left side, the right arm was weak with only antigravity movement, and he withdrew the right leg to painful stimuli. Babinski sign was present on the right.

Source: Neurology - October 5, 2015 Category: Neurology Authors: Gupta, A., Etherton, M. R., McKee, K., Baker, J. M., Izzy, S., Feske, S. K. Tags: All Cerebrovascular disease/Stroke, Radiation therapy-tumor, All Epilepsy/Seizures RESIDENT AND FELLOW SECTION Source Type: research