Zipporah, a 29 year-old woman, is brought for evaluation of right hemiparesis.

Her husband indicates she was in good health until one day ago when she developed right hemiparesis. She is conversant and in no pain. There is no history of fever, chills, diarrhea, cough or weight loss.

©www.KarlGrobl.com

Physical exam:

• Temp = 37.5°C, Pulse = 88, BP = 110/70, Resp = 24.
• Cranial nerves are intact.
• Pale conjunctivae and mucus membranes.
• Neck is supple, no JVD and no lymphadenopathy.
• Chest is clear and there are abnormal heart sounds.
• Abdominal exam is unremarkable
• Both right upper and lower extremities show +3/5 strength.
• There is no loss of peripheral sensation, no leg swelling or other abnormality.
• Cranial CT, ELIZA for HIV and hemogram are ordered.

She is admitted and started on Fansidar for possible toxoplasmosis.