Clinical introduction

A 73-year-old patient with a medical history of hypertension and hypercholesterolaemia presents to the emergency department with sudden onset of weakness in the right hand and numbness in the right forearm and hand that began 5 h prior to his arrival. There was no history of trauma, he did not drink or smoke and review of systems was otherwise negative.

On physical examination, there was right wrist drop with weakness of right wrist and finger extension (figure 1). Finger and wrist flexion were normal, reflexes were intact and there were no sensory alterations. The rest of the …