Case Report

A 52-year-old female with a past medical history of chronicobstructive pulmonary disease, coronary artery disease, andan 80-pack-year smoking history presented to the emergency room with complaints of right upper extremity weakness and imbalance while walking for the previous two days. She stated that the onset was abrupt and progressively worsening to the point where she could no longer lift her right upper extremityagainst gravity. She maintained the ability to move her hand and grasp, but admitted to decreased strength and decreased dexterity of her right hand. She denied changes in vision. She also denied having bowel or bladder incontinence. She has no known allergies and her only medications included occasional benzodiazepines for anxiety and acetaminophen/oxycodonefor low back pain. Her family history was notable only for lung cancer, which was the cause of death of her mother.