A 57-year-old man comes to the emergency department with right | Uworld | Step 2ck

A 57-year-old man comes to the emergency department with right arm and leg weakness, first noticed about 2 hours ago when he could not grip a pen. He is now unable to shake hands and walks with a mild limp. The patient has also had a mild, constant headache the past several days that he attributes to stress from a new project at work. His past medical history is significant for hypertension and hyperlipidemia, and he does not smoke or consume alcohol. His blood pressure is 180/100 mm Hg, and pulse is 80/min. There is mild asymmetry of the lower face, decreased muscle strength in the right arm, and positive Babinski sign on the right side. Sensory examination is normal. Blood glucose is 210 mg/dL ECG shows sinus rhythm with occasional premature ventricular beats. Noncontrast CT scan of the head reveals no abnormalities.