Case 20-1995

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Abstract
Presentation of CaseA 66-year-old right-handed man was admitted to the hospital because of a right hemiparesis with sensory involvement, aphasia, and agitation with intermittent somnolence.There was a four-year history of questionable rheumatoid arthritis managed with hydroxychloroquine and prednisone in a dose that rose to 40 mg daily during bouts of increased stiffness and swelling. He also used an albuterol inhaler because of dyspnea that was ascribed to chronic obstructive pulmonary disease or rheumatoid lung disease. The patient was otherwise well until approximately 14 weeks before admission, when he experienced vague tingling of the right arm. One week later . . .