2 CASE HISTORY/EXAMINATION
A 68-year-old female patient, functional class I, with no known comorbidities. presented to the emergency department with left arm pain and progressive weakness, along with left leg pain for one and a half months. No preceding respiratory or gastrointestinal symptoms were reported. Her family history was unremarkable, and she denied using tobacco, alcohol, or other drugs. In addition, there was no history of gastrointestinal disorders, weight loss, diabetes, ischemic heart disease, or thyroid disorders. On examination, the patient was pale with no associated jaundice or lymphadenopathy. She was in sinus tachycardia with a B.P of 183/109 and was afebrile.
On neurologic examination, left upper limb power was 2/5 with claw hand and associated tremors. The lower limb power on the left was 4/5 with normal tone. Power and tone on the right side were normal. Higher neurological functions were normal and bilateral Babinski sign was negative. Rest of the systemic examination was unremarkable.