Lazarus Redux

In this case, a 65-year-old male presents to the emergency department of a teaching hospital late in the evening with left-sided weakness that had started approximately 2 hours earlier. He also complains of mild pan-cranial headache and nausea, both of which started at the same time as the weakness. His physical examination is normal other than marked weakness and increased reflexes on the left side. A computed tomography scan is completed and appears normal. A referral is made to neurology describing the stable condition of the patient and the diagnosis of a non-hemorrhagic cerebrovascular accident. Medication is ordered for his nausea. Soon after, the patient becomes unresponsive with a significant drop in respiratory rate. The emergency physician assumes the patient is experiencing “a stroke in evolution” and calls neurology immediately. However, the diagnosis proves premature when another cause for the sudden deterioration of the patient is discovered.