Case 23 - Weakness and abnormal eye movements
Case
A 76 year old woman was brought to hospital with weakness and slurred speech.
She had been well that morning and driven to work. During a meeting she then slumped to one side and could not move her left arm or leg. She had drooping of the left corner of the mouth and was heavily slurring her words. Her colleagues called an ambulance and she was rushed to hospital.
Her past medical history included asthma and hypertension, but no neurological conditions.
On arrival 40 minutes after onset she was conscious and able to speak and obey commands. A brief history was taken during a rapid assessment in the emergency department. She reported no headache and had been well in the recent days, with no head trauma.
On examination she had:
Within 3 minutes of arrival the patient suddenly became unconscious. Her pulses remained palpable, and she was still breathing.
On repeat examination she had:
She was intubated for airway protection.
Where is the lesion?