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What’s on your mind?

HPI: A 15 year old female with a history of ADHD and anxiety was brought into the emergency department by her parents with concern for a change in mental status. The patient had been seen at an outside facility the day prior to presentation for a separate diagnostic workup

She had complained of dizziness that day, and some subtle shaking of her left upper extremity.  Mom and patient were not initially concerned since the patient had been known to have shaking of her legs at baseline. After returning home from her appointment, the patient fell asleep on the couch and did not awaken for the remainder of the evening. On the morning of presentation, mom reports that she was still unable to awaken the patient. The patient was very weak and had difficulty bearing her own weight.  Her speech was noted to be slurred and largely unintelligible. read more