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• W2069066098 abstract "Individual reprints of this article are not available. Address correspondence to Brian G. Weinshenker, MD, Department of Neurology, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (e-mail: weinb @mayo.edu). A 25-year-old right-handed man was brought to our emergency department because of confusion and right arm and right leg weakness. Two days earlier, during an evening meal, he developed a severe left-sided headache that lasted several hours and forced him to bed; he was afebrile and had no other neurologic symptoms. He had “migraines” in the past that occurred only once a year. He also had frequent, less severe headaches that were controlled with aspirin. He suspected that the current headache was a migraine. On the evening of onset of the headache, he was examined at his local emergency department; he was afebrile and had no focal neurologic findings. Findings on a computed tomographic (CT) scan without contrast were normal. He was treated with ketorolac methamine, hydroxyzine, and sumatriptan and discharged. The next morning, the patient’s headache had not resolved. His temperature was 38.6°C, and his physician prescribed ceftriaxone. Throughout the rest of the day, his headache did not improve. Family members noted that the patient appeared “confused.” The next morning, 2 days after onset of the headache, the patient’s family brought him to our emergency department because of worsening confusion, disorientation, and unsteadiness when walking. A general examination revealed an athletic man in no acute distress. He was afebrile, and vital signs were normal. He was drowsy and inattentive; neglect of his right hemispace was apparent. He had nonfluent aphasia with poor naming and repetition and followed only simple 1step commands. The patient was able to move all 4 extremities spontaneously, although he moved his right arm and leg less than his left arm and leg. A pronation drift of the outstretched right upper extremity was evident. Reflexes were symmetrical, and the plantar responses were flexor. No nuchal rigidity was noted. A complete blood cell count was unremarkable, and no leukocytosis was present. 1. Which one of the following diagnoses is most likely in this patient? a. Encephalitis b. Subarachnoid hemorrhage (SAH) c. Meningitis d. Migraine with prolonged aura e. Seizure" @default.
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• W2069066098 date "2001-01-01" @default.
• W2069066098 modified "2023-09-25" @default.
• W2069066098 title "25-Year-Old Man With Recurring Headache and Confusion" @default.
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• W2069066098 doi "https://doi.org/10.4065/76.1.75" @default.
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