History A 49-year-old woman suddenly developed right arm and leg weakness and has been brought to the emergency department. She described a one-week history of feeling tired and weak, with some confusion. Her medical history includes hypertension, hypercholesterolemia, and hypothyroidism. She was taking ramipril, simvastatin, and levothyroxine. Examination This woman had petechiae over her legs.
Cardiovascular, respiratory, and abdominal exams were normal. Neurological examination showed a mild weakness of the arm and leg but no sensation disturbance or visual disturbance. No higher cortical dysfunction was found. Head CT scan: Normal (No signs of bleeding) Observations Temperature: 37.8°C Heart rate: 76/min Blood pressure: 154/89 mmHg Respiratory rate: 16/min S aO2: 96% on air Investigations Results Normal Range White cells 9.0 4–11 x 10 9 /L Hemoglobin 7.1 13–18 g/dL …
