Silent Howard's Hemi...

Howard, a 78-year-old right-handed man, suddenly slumped over the breakfast table. Although he remained awake, he could not speak, and he could not stand. An ambulance was called, and he was taken to the hospital.

Upon arrival to the hospital, the vital signs and general physical examination were normal, except for a blood pressure of 200/130. He was awake, with head and eyes deviated to the left. He did not speak, and did not respond to spoken commands. He blinked his eyes to threat from the left, but not from the right. The left arm and leg moved spontaneously and in response to painful stimuli to the left half of the body. There was no response to painful stimuli to the right half of the body. The deep tendon reflexes were absent, and there was right Babinski sign.

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