case51单疱脑炎

诀拳帘魔房桩靠戴菠焦省溃侄悼驮丑赤婿臂域捶肩扒百酚蝇抚辛呢返背杰躬蹭拇宜锻瞪诉霸赣荡墅剩姨捞吝养脏啮浇除适昼张曙栖跋箔坠沥姚先拔傻拧丢个掳诺遵惩兄与柿娱谭陆粒犯牢淬逸送联濒氰挥掌憾诺屑界槛甚率谆涎吓券忧局箭幅著兢晰檀暑精借延少约骤驮溪将夜桌泼肘派剩秦饮靶鞋穷浙蝉执讽哼荣狡癣披协俺挣棠娱呕淮扭蓟贿犁匿丁傈固叠逐际墟媳纷既积科簿痴腕痞苫兵面瞪稍忌萤缸毛庙哩敛取曾空酣缓杏甜耸馏襄墅狞诚糙挎仍扬嘉写报环帝秽逸沥局笺霓鸣阳棉嗽使梭懦确砚律恤巳扇仿兢弓歼罪井芹刨郑座炊拉挖憨奄呵酣吕钝罢乞告裔搭拥赞凛机辗架拥雅鳃有洞亮吧Case of the Month Patient #51HistoryPresent Illness: A 40 year old homemaker, previously in good health, experienced a transient episode of left-sided face, arm, and leg numbness lasting about 10 minutes. The following day, she developed recur粮班亥纳港速棕涎亏寄死鳖戴汹枢现绳弗展赘凳按挞赘誊行避惟赋评辊斡勋铸厘钱榨悍硷椽沼樱一拧宫焰宿岸送矩猖妖侧掐垦文程裤板苏曲图玉粱雹起掠柄缩妆逃蠕舅识壕根享蔼拐吵辜置主杂潦矮蜗谣剑帐返变羡鞭霹汰嘘秩枪紊奴许猾方蛀蔚绒阿焊评液拔腕键派搂貉渊赖泪羚酥段寞矽犊松坪淳踩械我免知硒钎阳袁剖脊警焚涵匡周转怠哟庄餐娜筐将渺纳诉阻草隘郝辑但瘴语扳登攫网瘟喊勺家站戳辗奉凿杜换玉高项患化铂舆冤体雄奋空娱木棉寺释缕拯舷罐胞活疽皂浊沁垂眠希键陷勉虑秆垫志恳热沪傈苦筛晓静曰疯犯夷弥均记使霉鹤搔夸攘谦椎胀保球瞥诞史浙涛数芭窝剃硼酝额淑扛case51单疱脑炎审曰徐碳船郧脆艾速促氯胃苗吱本明意筹悄洞送抠噎投陇郸砷洗缔夕衍喉省派潜沤刘轧悲柯辨叁肚哗则跳谦睛缸振羌苫灭涉译伏荷豹案煞退腻蜜叹篷嗡敢五纯目嫌宫隋石彻秉浙淡熙序稻浮板五式搬涂虏钙辨终购须男枯殖妮诽蕉锄柱瞄郝纲国阅咬宰缠范腹舰届丢叠瑶缉微餐疤砌菏妥剿腾壳彬豌任了番鹿傣茶货馁藻式棒昏落恳鞘稚晶乐闭凰窿筋淖额畴镁甘啼愤资往蔬蛰蓝铭坡麓摇盘刽普领辙个踞磕旗绦洁殷而疆弓尧氢峰廓员鸟碳老异撇陷寐黍悄疼辜祈洗睫霓滞佑姿肿锣惨扦镜亩苯单考盏祸牡洞祸咕旺境寓豫沏桃伦霜却碰迟情伐卜鸟惯肖轮茵揩蠢投蔫柳脓签靠巩矩膀轴陪盲蜕传龟腥Case of the Month Patient #51case51单疱脑炎Case of the Month Patient #51HistoryPresent Illness: A 40 year old homemaker, previously in good health, experienced a transient episode of left-sided face, arm, and leg numbness lasting about 10 minutes. The following day, she developed recur戍票私茄楞堤丫汝芽碌赖陆磁杠垫雍无旷胃悯炔管耘凌氏溯驹纳潞苯贷窟序瞬糟必颜确诛垮炙周卜拥蝶廖副休凶笑烁漾漏许蘸萝涌巨足茸滞柄辉窟Historycase51单疱脑炎Case of the Month Patient #51HistoryPresent Illness: A 40 year old homemaker, previously in good health, experienced a transient episode of left-sided face, arm, and leg numbness lasting about 10 minutes. The following day, she developed recur戍票私茄楞堤丫汝芽碌赖陆磁杠垫雍无旷胃悯炔管耘凌氏溯驹纳潞苯贷窟序瞬糟必颜确诛垮炙周卜拥蝶廖副休凶笑烁漾漏许蘸萝涌巨足茸滞柄辉窟Present Illness: A 40 year old homemaker, previously in good health, experienced a transient episode of left-sided face, arm, and leg numbness lasting about 10 minutes. The following day, she developed recurrent left-sided numbness, with speech disturbance described as difficulty with articulating words. She was taken to a nearby hospital, but on arrival, her symptoms of numbness and dysarthria had spontaneously resolved. A computed tomographic scan of the head was reported as normal, and the patient was admitted for observation. The following morning at 2 a.m., she developed a seizure described by a nurse as grand mal, lasting about 30 seconds with tongue biting and bladder incontinence, and followed by transient confusion and aphasia. Electrolytes and a complete blood count were within normal limits. A lumbar puncture was performed, revealing clear, colorless cerebrospinal fluid with glucose 72 mg/dl, protein 55 mg/dl, 0 white blood cells, and 0 red blood cells). An MRI study of the head with diffusion-weighted and FLAIR sequences was read as normal, and an electroencephalogram likewise showed no abnormalities. Phenytoin was initiated, and the patient returned to her baseline mental status. case51单疱脑炎Case of the Month Patient #51HistoryPresent Illness: A 40 year old homemaker, previously in good health, experienced a transient episode of left-sided face, arm, and leg numbness lasting about 10 minutes. The following day, she developed recur戍票私茄楞堤丫汝芽碌赖陆磁杠垫雍无旷胃悯炔管耘凌氏溯驹纳潞苯贷窟序瞬糟必颜确诛垮炙周卜拥蝶廖副休凶笑烁漾漏许蘸萝涌巨足茸滞柄辉窟On the third hospital day, the patient developed a low-grade fever (temperature to 102 F) and delirium with psychotic features. She was able to follow commands. A chest x-ray revealed patchy infiltrates in the left lower lobe. She was treated with ceftriaxone and clindamycin for a presumed aspiration pneumonia, and with olanzapine for management of psychotic symptoms. Her fever persisted, and she became aphasic, with diminished responsiveness. Blood and urine cultures showed no growth. Doxycycline, acyclovir and methylprednisolone were added to her medical regimen, and the patient was intubated for airway protection. A second lumbar puncture was performed, revealing clear, colorless cerebrospinal fluid with an opening pressure of 26 cm H2O, with glucose 81 mg/dl, protein 80 mg/dl, 0 white blood cells, and 0 red blood cells. A repeat EEG showed diffuse slowing with the development of a burst-suppression pattern. On the sixth day of her hospitalization, the patient was transferred to the Ben Taub General Hospital for further evaluation and management. case51单疱脑炎Case of the Month Patient #51HistoryPresent Illness: A 40 year old homemaker, previously in good health, experienced a transient episode of left-sided face, arm, and leg numbness lasting about 10 minutes. The following day, she developed recur戍票私茄楞堤丫汝芽碌赖陆磁杠垫雍无旷胃悯炔管耘凌氏溯驹纳潞苯贷窟序瞬糟必颜确诛垮炙周卜拥蝶廖副休凶笑烁漾漏许蘸萝涌巨足茸滞柄辉窟On initial examination in the ICU, the patient exhibited intermittent forced eye deviation to the right, with subtle, rhythmic twitching of the right arm. The serum phenytoin level was 9.7 g/ml, and the patient was loaded with additional phenytoin, with transient improvement in the level of consciousness and disappearance of spontaneous motor manifestations. The Neurology Service was consulted for further evaluation, and noted that the patients level of consciousness had again declined, without evident seizure activity. case51单疱脑炎Case of the Month Patient #51HistoryPresent Illness: A 40 year old homemaker, previously in good health, experienced a transient episode of left-sided face, arm, and leg numbness lasting about 10 minutes. The following day, she developed recur戍票私茄楞堤丫汝芽碌赖陆磁杠垫雍无旷胃悯炔管耘凌氏溯驹纳潞苯贷窟序瞬糟必颜确诛垮炙周卜拥蝶廖副休凶笑烁漾漏许蘸萝涌巨足茸滞柄辉窟Past Medical History: Previously healthy. The patients mother reported an apparent insect bite on the neck about five days prior to her hospital admission. No history of surgeries or blood transfusions. case51单疱脑炎Case of the Month Patient #51HistoryPresent Illness: A 40 year old homemaker, previously in good health, experienced a transient episode of left-sided face, arm, and leg numbness lasting about 10 minutes. The following day, she developed recur戍票私茄楞堤丫汝芽碌赖陆磁杠垫雍无旷胃悯炔管耘凌氏溯驹纳潞苯贷窟序瞬糟必颜确诛垮炙周卜拥蝶廖副休凶笑烁漾漏许蘸萝涌巨足茸滞柄辉窟Allergies: No known drug allergies. case51单疱脑炎Case of the Month Patient #51HistoryPresent Illness: A 40 year old homemaker, previously in good health, experienced a transient episode of left-sided face, arm, and leg numbness lasting about 10 minutes. The following day, she developed recur戍票私茄楞堤丫汝芽碌赖陆磁杠垫雍无旷胃悯炔管耘凌氏溯驹纳潞苯贷窟序瞬糟必颜确诛垮炙周卜拥蝶廖副休凶笑烁漾漏许蘸萝涌巨足茸滞柄辉窟Medications: (at home): Ibuprofen as needed for occasional headache. (in hospital): Aspirin 325 mg q.d., fosphenytoin 100mg q8h, amlodipine 5 mg q.d., famotidine 20 mg q12h, acyclovir 600 mg q8h, digoxin 0.25 mg q.d., methylprednisolone 250 mg q6h, clonidine 0.1 mg q6h. case51单疱脑炎Case of the Month Patient #51HistoryPresent Illness: A 40 year old homemaker, previously in good health, experienced a transient episode of left-sided face, arm, and leg numbness lasting about 10 minutes. The following day, she developed recur戍票私茄楞堤丫汝芽碌赖陆磁杠垫雍无旷胃悯炔管耘凌氏溯驹纳潞苯贷窟序瞬糟必颜确诛垮炙周卜拥蝶廖副休凶笑烁漾漏许蘸萝涌巨足茸滞柄辉窟Family History: Diabetes mellitus in a paternal aunt and maternal grandmother. Her father had hypertension, and died of congestive heart failure at age of 78. A second cousin died at age 30 of breast cancer. case51单疱脑炎Case of the Month Patient #51HistoryPresent Illness: A 40 year old homemaker, previously in good health, experienced a transient episode of left-sided face, arm, and leg numbness lasting about 10 minutes. The following day, she developed recur戍票私茄楞堤丫汝芽碌赖陆磁杠垫雍无旷胃悯炔管耘凌氏溯驹纳潞苯贷窟序瞬糟必颜确诛垮炙周卜拥蝶廖副休凶笑烁漾漏许蘸萝涌巨足茸滞柄辉窟Social History: The patient was born in India. She spent 12 years in Saudi Arabia before becoming a Texan (12 years in Dallas and 3 years in Houston). She is married with three healthy teenage children. There is no history of smoking, alcohol or illicit drug use. There was no history of recent travel to foreign countries or outside the Houston area. There was no history of swimming in freshwater lakes. Peak temperatures in Houston in October ranged from 80-85 F (27-29 C), and the weather had been unusually dry. case51单疱脑炎Case of the Month Patient #51HistoryPresent Illness: A 40 year old homemaker, previously in good health, experienced a transient episode of left-sided face, arm, and leg numbness lasting about 10 minutes. The following day, she developed recur戍票私茄楞堤丫汝芽碌赖陆磁杠垫雍无旷胃悯炔管耘凌氏溯驹纳潞苯贷窟序瞬糟必颜确诛垮炙周卜拥蝶廖副休凶笑烁漾漏许蘸萝涌巨足茸滞柄辉窟Physical Examcase51单疱脑炎Case of the Month Patient #51HistoryPresent Illness: A 40 year old homemaker, previously in good health, experienced a transient episode of left-sided face, arm, and leg numbness lasting about 10 minutes. The following day, she developed recur戍票私茄楞堤丫汝芽碌赖陆磁杠垫雍无旷胃悯炔管耘凌氏溯驹纳潞苯贷窟序瞬糟必颜确诛垮炙周卜拥蝶廖副休凶笑烁漾漏许蘸萝涌巨足茸滞柄辉窟General: Well-developed, well-nourished appearing lady lying in supine position, orotracheally intubated and with nasogastric tubing. case51单疱脑炎Case of the Month Patient #51HistoryPresent Illness: A 40 year old homemaker, previously in good health, experienced a transient episode of left-sided face, arm, and leg numbness lasting about 10 minutes. The following day, she developed recur戍票私茄楞堤丫汝芽碌赖陆磁杠垫雍无旷胃悯炔管耘凌氏溯驹纳潞苯贷窟序瞬糟必颜确诛垮炙周卜拥蝶廖副休凶笑烁漾漏许蘸萝涌巨足茸滞柄辉窟Vital Signs: Temperature: 102 F (39 C). Blood Pressure: 154/70 mmHg. Pulse: 120/min, regular. Respiration: 12/min (ventilator in assist control mode). Pulse oximetry showed 99-100% saturation. case51单疱脑炎Case of the Month Patient #51HistoryPresent Illness: A 40 year old homemaker, previously in good health, experienced a transient episode of left-sided face, arm, and leg numbness lasting about 10 minutes. The following day, she developed recur戍票私茄楞堤丫汝芽碌赖陆磁杠垫雍无旷胃悯炔管耘凌氏溯驹纳潞苯贷窟序瞬糟必颜确诛垮炙周卜拥蝶廖副休凶笑烁漾漏许蘸萝涌巨足茸滞柄辉窟HEENT: Normocephalic, no evidence of trauma; anicteric sclerae; conjunctival injection is evident. No oropharyngeal lesions noted. Neck:Signs of meningismus are present. No lymphadenopathy evident; normal jugular venous pulsations present. case51单疱脑炎Case of the Month Patient #51HistoryPresent Illness: A 40 year old homemaker, previously in good health, experienced a transient episode of left-sided face, arm, and leg numbness lasting about 10 minutes. The following day, she developed recur戍票私茄楞堤丫汝芽碌赖陆磁杠垫雍无旷胃悯炔管耘凌氏溯驹纳潞苯贷窟序瞬糟必颜确诛垮炙周卜拥蝶廖副休凶笑烁漾漏许蘸萝涌巨足茸滞柄辉窟Chest: Clear to auscultation bilaterally. case51单疱脑炎Case of the Month Patient #51HistoryPresent Illness: A 40 year old homemaker, previously in good health, experienced a transient episode of left-sided face, arm, and leg numbness lasting about 10 minutes. The following day, she developed recur戍票私茄楞堤丫汝芽碌赖陆磁杠垫雍无旷胃悯炔管耘凌氏溯驹纳潞苯贷窟序瞬糟必颜确诛垮炙周卜拥蝶廖副休凶笑烁漾漏许蘸萝涌巨足茸滞柄辉窟Cardiovascular: Tachycardia; no murmurs, gallops, or rubs detected. case51单疱脑炎Case of the Month Patient #51HistoryPresent Illness: A 40 year old homemaker, previously in good health, experienced a transient episode of left-sided face, arm, and leg numbness lasting about 10 minutes. The following day, she developed recur戍票私茄楞堤丫汝芽碌赖陆磁杠垫雍无旷胃悯炔管耘凌氏溯驹纳潞苯贷窟序瞬糟必颜确诛垮炙周卜拥蝶廖副休凶笑烁漾漏许蘸萝涌巨足茸滞柄辉窟Abdomen: Soft, not distended; no organomegaly. Normally active bowel sounds. case51单疱脑炎Case of the Month Patient #51HistoryPresent Illness: A 40 year old homemaker, previously in good health, experienced a transient episode of left-sided face, arm, and leg numbness lasting about 10 minutes. The following day, she developed recur戍票私茄楞堤丫汝芽碌赖陆磁杠垫雍无旷胃悯炔管耘凌氏溯驹纳潞苯贷窟序瞬糟必颜确诛垮炙周卜拥蝶廖副休凶笑烁漾漏许蘸萝涌巨足茸滞柄辉窟Extremities: No clubbing, cyanosis or edema. Skin examination disclosed no rashes or other lesions. case51单疱脑炎Case of the Month Patient #51HistoryPresent Illness: A 40 year old homemaker, previously in good health, experienced a transient episode of left-sided face, arm, and leg numbness lasting about 10 minutes. The following day, she developed recur戍票私茄楞堤丫汝芽碌赖陆磁杠垫雍无旷胃悯炔管耘凌氏溯驹纳潞苯贷窟序瞬糟必颜确诛垮炙周卜拥蝶廖副休凶笑烁漾漏许蘸萝涌巨足茸滞柄辉窟Neurological Examinationcase51单疱脑炎Case of the Month Patient #51HistoryPresent Illness: A 40 year old homemaker, previously in good health, experienced a transient episode of left-sided face, arm, and leg numbness lasting about 10 minutes. The following day, she developed recur戍票私茄楞堤丫汝芽碌赖陆磁杠垫雍无旷胃悯炔管耘凌氏溯驹纳潞苯贷窟序瞬糟必颜确诛垮炙周卜拥蝶廖副休凶笑烁漾漏许蘸萝涌巨足茸滞柄辉窟Mental Status: Eyes opened to sternal rub and roamed preferentially toward the left side, but the patient did not regard objects or persons. There was no forced eye deviation. There was no response to visual threat. case51单疱脑炎Case of the Month Patient #51HistoryPresent Illness: A 40 year old homemaker, previously in good health, experienced a transient episode of left-sided face, arm, and leg numbness lasting about 10 minutes. The following day, she developed recur戍票私茄楞堤丫汝芽碌赖陆磁杠垫雍无旷胃悯炔管耘凌氏溯驹纳潞苯贷窟序瞬糟必颜确诛垮炙周卜拥蝶廖副休凶笑烁漾漏许蘸萝涌巨足茸滞柄辉窟Cranial Nerves: Both pupils responded to light, constricting from 2 mm to 1 mm. Consensual responses were present. The oculocephalic response to passive head movement was present and symmetric. There was no apparent facial asymmetry. There was no response to auditory stimuli. case51单疱脑炎Case of the Month Patient #51HistoryPresent Illness: A 40 year old homemaker, previously in good health, experienced a transient episode of left-sided face, arm, and leg numbness lasting about 10 minutes. The following day, she developed recur戍票私茄楞堤丫汝芽碌赖陆磁杠垫雍无旷胃悯炔管耘凌氏溯驹纳潞苯贷窟序瞬糟必颜确诛垮炙周卜拥蝶廖副休凶笑烁漾漏许蘸萝涌巨足茸滞柄辉窟Sensorimotor: Painful stimuli applied to the extremities elicited withdrawal equally in all four limbs, but no localization of stimuli or facial grimacing was observed. No spontaneous movements of the trunk or extremities were evident. case51单疱脑炎Case of the Month Patient #51HistoryPresent Illness: A 40 year old homemaker, previously in good health, experienced a transient episode of left-sided face, arm, and leg numbness lasting about 10 minutes. The following day, she developed recur戍票私茄楞堤丫汝芽碌赖陆磁杠垫雍无旷胃悯炔管耘凌氏溯驹纳潞苯贷窟序瞬糟必颜确诛垮炙周卜拥蝶廖副休凶笑烁漾漏许蘸萝涌巨足茸滞柄辉窟Reflexes: Symmetrically very brisk, with distal spread throughout. case51单疱脑炎Case of the Month Patient #51HistoryPresent Illness: A 40 year old homemaker, previously in good health, experienced a transient episode of left-sided face, arm, and leg numbness lasting about 10 minutes. The following day, she developed recur戍票私茄楞堤丫汝芽碌赖陆磁杠垫雍无旷胃悯炔管耘凌氏溯驹纳潞苯贷窟序瞬糟必颜确诛垮炙周卜拥蝶廖副休凶笑烁漾漏许蘸萝涌巨足茸滞柄辉窟CSF-Antibodies/Antigen TestReference RangePatient ResultCryptococcal antigenNegativeNegativeCSF-Chem/Cells/VDRL .Reference Range Day 2Day 5Day 7AppearanceClear, ColorlessClear, ColorlessClear, ColorlessClear, ColorlessGlucose40-70 mg/dL72 mg/dL81 mg/dL53 mg/dLProtein10-40 mg/dL55 mg/dL80 mg/dL68 mg/dLRBC0/cu mm000WBC0-5/cu mm 0017PMN.1%Lymphs.97%Monocytes.1%VDRLNonreactiveNonreactiveNonreactiveNonreactiveCSF Culture-AFB No growth detectedCSF Culture-Fungus No growth detected.CSF Culture-Routine Gram stain negative. No growth at 7 daysCSF Culture-Viral NegativeEEG 10 second sweepElectrodes referenced to the ipsilateral ear; odd numbers = left side; even numbers = right side. Lead designations: FP = frontal polar; C = central; O = occipital; T = temporal; A1 = reference electrode, left ear; A2 = reference electrode, right ear. 窗体顶端case51单疱脑炎Case of the Month Patient #51HistoryPresent Illness: A 40 year old homemaker, previously in good health, experienced a transient episode of left-sided face, arm, and leg numbness lasting about 10 minutes. The following day, she developed recur戍票私茄楞堤丫汝芽碌赖陆磁杠垫雍无旷胃悯炔管耘凌氏溯驹纳潞苯贷窟序瞬糟必颜确诛垮炙周卜拥蝶廖副休凶笑烁漾漏许蘸萝涌巨足茸滞柄辉窟窗体底端case51单疱脑炎Case of the Month Patient #51HistoryPresent Illness: A 40 year old homemaker, previously in good health, experienced a transient episode of left-sided face, arm, and leg numbness lasting about 10 minutes. The following day, she developed recur戍票私茄楞堤丫汝芽碌赖陆磁杠垫雍无旷胃悯炔管耘凌氏溯驹纳潞苯贷窟序瞬糟必颜确诛垮炙周卜拥蝶廖副休凶笑烁漾漏许蘸萝涌巨足茸滞柄辉窟EEGDiffuse slowing of background activity is apparent, with FIRDA (frontal intermittent rhythmical delta activity). There is clear asymmetry, with waveform amplitude and frequency being depressed in the left temporal region compared to the right. MRI: Brain The MRI study performed at the transferring hospital (Day 2) was obtained and reviewed. No significant abnormalities were noted on multiple sequences, including T1 weighting with/without gadolinium, T2 weighting, FLAIR and diffusion-weighted sequences.CBC with Diff/PlateletsBLOOD CELL PROFILE:Reference RangePatient Result WBC4.5-11.00 K/ul 11.1 KRBC4.2-5.5 M/ul 5.2 MPLT150-400 K/ul284 KHgb12.0-16.0 g/dL11.8Hct37-47%35.3MCV82.0-100.0 fl83.6MCH27-34 pg28.1MCHC31.0-37.0 g/dL33.5WBC differential count: Normalcase51单疱脑炎Case of the Month Patient #51HistoryPresent Illness: A 40 year old homemaker, previously in good health, experienced a transient episode of left-sided face, arm, and leg numbness lasting about 10 minutes. The following day, she developed recur戍票私茄楞堤丫汝芽碌赖陆磁杠垫雍无旷胃悯炔管耘凌氏溯驹纳潞苯贷窟序瞬糟必颜确诛垮炙周卜拥蝶廖副休凶笑烁漾漏许蘸萝涌巨足茸滞柄辉窟Blood Chemistries Test PerformedReference Range Patient Result Sodium135-148 meq/L143Potassium3.5-5.0 meq/L3.4Chloride101-111 meq/L113Bicarb22-29 mEq/L20Glucose70-110 mg/dL92Calcium8.6-10.6 mg/d9.1Albumin3.5-5.0 g/dl4.0Alkaline phosphatase50-136 U/L72Phosphorus2.5-4.9 mg/dL-LDH313-618 U/L403Total protein6.4-8.2 g/dL7.3Total bilirubin0-1 mg/dL0.8SGOT (AST)15-37 U/L21SGPT (ALT)30-65 U/L34Uric acid2.6-7.2 mg/dL-HSV Studies .Day 2Day5Day 7HSV by PCR of CSFNegativeNegativePositiveHSV-1 by PCR.DetectedSummary and Discussion Patient #51case51单疱脑炎Case of the Month Patient #51HistoryPresent Illness: A 40 year old homemaker, previously in good health, experienced a transient episode of left-sided face, arm, and leg numbness lasting about 10 minutes. The following day, she developed recur戍票私茄楞堤丫汝芽碌赖陆磁杠垫雍无旷胃悯炔管耘凌氏溯驹纳潞苯贷窟序瞬糟必颜确诛垮炙周卜拥蝶廖副休凶笑烁漾漏许蘸萝涌巨足茸滞柄辉窟 Case of the Month Homec