Postpartum Puzzler
In this case, a 24-year-old female presents to the emergency department (ED) of a community hospital late in the evening. At triage, she is weeping, distressed, very anxious, and complaining of paresthesias in her extremities. She had a normal vaginal delivery approximately 4 weeks ago and has been healthy since. The ED physician is asked to do a quick assessment as the ED is about to close. A consensus quickly develops among the staff that the patient probably has postpartum depression and could be managed through the mental health crisis team in daytime hours the following day. Her physical exam is normal other than some weakness in both legs. The physician feels uncomfortable with the patient’s presentation and considers the possibility of an uncommon neurological disorder. The neurology service reluctantly accepts the patient though doubting the physician’s diagnosis. He later learns that his zebra was correct.