Case Presentation

A 32-year-old Hispanic female with a past medical history of asthma, depression and insomnia presented to the emergency room with complaints of right-sided facial droop associated with ipsilateral facial numbness and diminished taste for the past three days. In addition, she reported a moderate to severe pulsatile headache for the past day. This headache was initially right-sided and frontal, but then became right-sided and occipital in location. She had a history of a similar headache episode four years ago. Additionally, she noted moderately severe intermittent chest pain described as sharp then dull occurring over the past day. On review of systems, the patient had similar symptoms of facial droop and numbness without alteration in taste, one month prior. At that time, she was evaluated at an outside hospital and her symptoms had been attributed to a quetiapine-induced acute dystonic reaction which was treated with diphenhydramine with resolution of symptoms. Additionally, the patient denied sexually transmitted diseases, travel or outdoor exposure to tick-borne illnesses.