A 74-year-old woman developed right face, arm, and leg weakness. A. The patient was residing in a rehabilitation facility while recovering from and infection. She was doing well until one morning, when she suddenly developed slurred speech and right-sided weakness. An emergency neurology consultation was called. Medical history was notable for hypertension, coronary artery disease, and recent onset of a-feb.
B. Decreased right nasolabial fold. Weak movements of the right face, but with only mild forehead involvement. Gag reflex present, but with decreased palate movement on the right. Speech slurred and dysarthric. Rightward tongue deviation.
C. Tone flaccid on the right side, normal on left. Marked right hemiparesis, with power 2/5 in right deltoid, 0/5 in right triceps, biceps, and hand muscles. Power 2/5 in right iliopsoas and quadricepts and 0/5 in right foot.