Heart Leak, Couldn't Speak, Arm's Weak

A 20-year-old man was referred to a neurologist because of right arm weakness of 8 months duration. The problem had begun abruptly with sudden loss of consciousness. When he awoke several hours later, his right arm was weak, and he was unable to speak. Although his speech returned over 5 or 6 days, his arm recovered only partially. At the age of 18, he had been treated with intravenous penicillin for subacute bacterial endocarditis. Otherwise, he had been well.

Examination revealed spastic weakness of the right arm without atrophy. The other limbs were normal. The tongue protruded to the right, but was not atrophic. The lower facial muscles on the right were paralyzed. There were no visual defects nor sensory disturbances.

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