Slowly progressive hemiparesis

Abstract

A 44-year-old Chinese man was admitted with right-sided weakness of 2 days’ duration. He had noted “absent-mindedness” for one month, developing word-finding difficulties, right-sided clumsiness and slurring of speech over the next 2 weeks, culminating in hemiparesis which resulted in gait difficulties and facial asymmetry. He had poor appetite and had lost 3 kg in weight over 1 month, but had neither change of bowel habits nor fever. Clinical examination was significant for right hemiparesis of MRC grade 4/5 and upper motor neuron palsy of the right facial nerve.