History of Present Illness
             
             A 54-year-old Thai psychiatrist noted the onset of right leg 
             tingling with weakness on dorsiflexion of her right foot 
             approximately one week prior to admission. She has a history 
             of lumbar disc disease and these symptoms were similar to 
             previous flares. She took prednisone without improvement, and 
             over the next few days she also developed right arm numbness, 
             tingling, and weakness. She was admitted to a local hospital 
             where a head CT revealed a double cystic ring-enhancing 
             lesion in the left parietal region. Her condition progressed 
             with the onset of confusion and she was started on high dose 
             corticosteroids. She was transferred to Johns Hopkins 
             Hospital and subsequently underwent left parietal craniotomy 
             with cystic mass excision. 
             
             Past Medical History
             
             Lumbar disc disease 
             Hypertension 
             Nephrolithiasis  
             Migraine headaches 
             
             Social History 
             
             She was born in Thailand and moved to the United States at 
             the age of 28. She works as an psychiatrist, is married, and 
             has four children. Her last visit to Thailand was two years 
             ago. She denies alcohol, tobacco, or illicit drug use.
             
            Physical Examination
             
             Temperature was 35.5 C, pulse 80 bpm, respiratory rate 12 
             bpm, and blood pressure 125/65. 
             General - appears well and in no distress. 
             Skin - no rash or lesions.
             HEENT - poor dentition with molar cavities and erosions but 
             no obvious abscess, no sinus tenderness with normal maxillary 
             transillumination, tympanic membranes intact and not 
             inflamed. Neck - supple without lymphadenopathy. Chest, 
             heart, and abdomen were normal with no masses on breast 
             examination.
             Extremities - without edema. Neuro - oriented, cranial nerves 
             intact, decreased sensation to light touch right leg greater 
             than right arm, distal weakness in right leg greater than 
             right arm. 
             White blood cell count 10,200/mm3 
             Hematocrit 47.9%
             Platelet count 333,000/mm3 Sodium 130 meq/L


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