Recurrent Neurological Episodes with Unilateral Symptoms in a Young Adult

Case at a Glance

A 21-year-old male presenting with recurrent episodes of left-sided numbness, altered mental status, and speech difficulties over a 2-week period. Family history significant for epilepsy and cerebrovascular disease.

Patient's Story

The patient reported his first episode approximately two weeks prior to presentation, describing a brief 5-10 second period of cognitive blankness accompanied by paresthesias in his hand. Initially dismissed as insignificant, symptoms progressively worsened. On July 10th, he experienced three distinct episodes characterized by complete left-sided numbness, arm weakness, lingual numbness with metallic taste, and severe cognitive impairment described as 'mental shutdown.' Episodes lasted 5-10 minutes each, prompting emergency medical services activation. Most recent episode on July 14th was the most severe, lasting 40 minutes with additional symptoms including ocular burning sensation, left facial numbness, dysarthria, and complete inability to ambulate.

Initial Assessment

Emergency medical services found stable vital signs with mild hypertension. Initial emergency department evaluation suggested possible migraine equivalent. Patient was scheduled for MRI imaging. During second emergency presentation, brief neurological examination with pupillary response testing was performed, with physician concluding migraine diagnosis and prescribing propranolol 40mg daily.

The Diagnostic Journey

Patient expressed frustration with perceived dismissal of symptoms and lack of comprehensive neurological workup. Initially scheduled MRI was cancelled by treating physician who felt imaging was unnecessary. Patient planned to follow up with primary care physician for potential neurology referral. Medical team recommended maintaining symptom diary to identify potential triggers and pattern recognition.

Final Diagnosis

Working diagnosis of complex migraine with aura vs. focal seizures (differential diagnosis pending neurological consultation and further workup)

Treatment Plan

Propranolol 40mg daily initiated for migraine prophylaxis. Patient advised to maintain detailed symptom diary documenting episode frequency, duration, triggers, and associated symptoms. Primary care follow-up scheduled for neurology referral consideration. Return precautions given for worsening symptoms or prolonged episodes.

Outcome and Follow-up

Patient remained symptomatic with concerns about diagnostic accuracy. Family history of epilepsy (father and paternal grandmother), stroke, diabetes, and cerebral aneurysms noted as significant risk factors requiring further neurological evaluation. Case pending comprehensive neurological assessment and possible EEG/MRI studies.