Author: Stefanie Lewis, DO
Co Author #1: James Dunlap, MD
Senior Editor: Joseph Chorley, MD
Editor: Yaowen Hu, MD, MBA

Patient Presentation:
19 year old female who presented for evaluation after new onset episodes of altered consciousness.

History:
19 year-old female collegiate swimmer presents for evaluation of new onset episodes of altered consciousness. The episodes started suddenly and were reported as a feeling of intense fatigue associated with difficulty speaking, eye fluttering and abnormal movements of the upper extremities. One episode was witnessed by the head athletic trainer who corroborated this description. The episodes occurred randomly, lasted 60-120 seconds each, and were followed by a few minutes of confusion with continued difficulty speaking. She had no associated shortness of breath, chest pain, or palpitations. She did report symptoms consistent with a viral syndrome during the 3-4 days prior to the onset of episodes but had not had any fever, neck pain or headache. There was no history of head trauma. There was no prior history of seizure disorder or cardiac problems. The patient has a history of anxiety treated with therapy only. She was not taking any medications, denied tobacco or drug use and reported rare alcohol use.

Physical Exam:
Patient was evaluated approximately 3-4 days after the initial onset of her episodes.
Vitals: Ht: 168cm Wt: 58.5kg BMI: 20.7 Temp: 36.3 C BP: 114/60 HR: 85 SpO2: 97%
At the time of examination, she was well-appearing in no acute distress. Head was normocephalic and atraumatic. Eye exam revealed clear conjunctiva. There was no pharyngeal erythema or exudates. Neck was supple without lymphadenopathy. Lungs were clear without adventitious lung sounds. Heart had regular rate and rhythm without murmurs. Neurological exam with intact cranial nerves two through twelve, upper and lower extremity strength 5/5, sensation intact, normal comprehension and speech without aphasia. Normal gait.

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