Weight-Lifter With Arm and Leg Weakness

A 37-year-old man was brought to the emergency department (ED) after he had 2 near-syncopal events. The first occurred in the morning and rapidly resolved; the second occurred later in the day at work. The night before he had a headache and neck pain.

In the ED, he reported left arm and leg weakness and was noted to have left facial droop. His medical history was unremarkable. He denied alcohol, cigarette, and illicit drug use. He lifted weights and played racquetball regularly.

The patient had expressive aphasia. Blood pressure was 133/65 mm Hg; heart rate, 56 beats per minute; respiration rate, 18 breaths per minute; temperature, 37°C (98.6°F); and oxygen saturation, 100% on room air. There were no murmurs, rubs, or gallops and no carotid bruit. The left-sided weakness was accompanied by decreased sensation. Results of laboratory studies and a urinary drug screen were normal.

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