Case 22-1997

Presentation of CaseA 58-year-old right-handed woman was admitted to the hospital because of multiple cranial neuropathies.The patient had been well until two days earlier, when she began to have difficulty swallowing food while having dinner at home. During the next two or three hours, diplopia developed, with marked dysarthria to the point of losing the power of speech. She was taken to another hospital, where attempted magnetic resonance imaging (MRI) and angiographic studies could not be performed because of her inability to cooperate. Approximately 24 hours after her admission there, her condition was unimproved, and she was transferred . . .