41 y/o M w/ sudden numbness of head and neck | Figure 1

averylove596
Medical Student

41 y/o M w/ sudden numbness of head and neck

EMS dispatched to residence "Heart problems/chest pains". Pt is a 41 y/o M w/ a hx of horseshoe kidney, pyelonephritis, and renal calculi. Pt denies taking any meds and denies any major surgeries, except ureteral stent placed 3 months prior. Upon arrival pt denies any chest pain, but states while he was relaxing on the couch eating ice cream he suddenly was unable to taste anything and states he became numb from the mid humerus up to behind his ears and partially on his zygoma bilaterally.

Pt states last 3 days he has been experiencing urinary retention but denies any burning w/ urination. Pt works a desk job and states he travels constantly via car and airplane but denies any pain in his legs or hx of DVT.

Upon examination: pt has warm dry skin. Strong radial pulse @ 90 BPM. BP 133/90. BGL 107 mg/dl. spO2 97%. Lungs are clear bilaterally. EKG is normal sinus rhythm w/ mild artifact (pt couldn't stop shivering. Denies being cold, but states he shivers every time he is examined due to nervousness). Aniscoria. 98.6 F temp. Pt passed stroke test, equal strength bilaterally. After examination pt states the symptoms resolved and the aniscoria resolved as well. Pt was transported to ED. Upon arrival at ED symptoms came back and vitals were taken again and were the same as before. NIH score 0 per ED physician. Any ideas on what may be causing these symptoms? What would be your plan?

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