Case [Image] courtesy of Dr Aditya Shetty, <a href="https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/27747">rID: 27747</a>
A 24 year old woman presents with R faial numbness and difficulty walking
HPI: A 24-year-old woman presents with right facial numbness and difficulty eating and walking. The symptoms occurred over a period of several hours. On examination the corneal (blink) reflex was present on the left but absent on the right. She was unable to move her jaw to the left. The right masseter and temporalis muscles would not contract. She had decreased sensation in all sensory modalities on the right side of her face. Tests showed she had loss of fine touch, pressure, vibration and two point discrimination in trigeminal dermatomes on the right face. Sensation was entirely normal over the rest of her body, head, and left face. She was incoordinated in the use of her right upper and lower extremities, and had difficulty checking their motion. Her strength was entirely normal, as were her deep tendon reflexes.
PMH: No previous history of hospitalizations or surgeries.
Family Hx: No relevant family history
Social Hx: Usually drinks 5-8 drinks each weekend. 20 pack-year history of smoking. History of IV drug use. Sexually active with multiple female partners.
ROS: Negative except noted above.
Temperature: 38.2°C (100.8°F)
HR: 81 bpm
SpO2: 94% on room air
HEENT: An enlarged, painless, soft left cervical lymph node is noted.
CV: Regular rate and rhythm, S1 and S2 intact, no murmurs, rubs, or gallops
Lungs: Crackles heard in the right lower lung field.
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