Soothing guess !!

A 26 yr old male from Dhangadi seemingly well arrives at the emergency department on a particular day when the patients were sparse. He got an accelerated admission in the ward. He didn't know he needed to be grateful to covid for getting fast admission in TUTH rather than doctors. On enquiry of his illness, he said he had been running fever since 3 months. His fever never disappeared completely. The doctors there  investigated him for the cause of fever as much they could. But the diagnosis was still elusive. He had pain in abdomen which wasn't incapacitating as much was his fever. Feeling cold and shaky was his usual routine. 

He was lean and thin. He appeared to have lost weight recently. His temples on head  were like a crater.  He had almost no complaints of cough and change in bowel habit.  He was pale, and tinge of jaundice could be noted in his eyes. Though he had minimal complaints on his abdomen, he feared doctors touching it. His abdomen ached on touching less gently. We could feel spleen moving with his respiration. The fullness on his sides of abdomen could be seen. It was an easy guess he had fluid inside the abdominal cavity.  He didn't have any lumps in his body or any nodes.He had his heart beating fine and happy. His veins were prominent enough to allow the residents to draw enough blood. That's at least a good thing when the labs ring their bells at 3 pm. Some investigations were sent the other day of admission. 

On very next day morning , while he tried to go to bathroom , his father noticed that he had weakness on his right half of body. His corner of mouth betrayed him deviating to left  while showing teeth. He could barely move his right hand and leg. It was a frightening event for him and his father. What is your best guess at the moment ? 

Anyone would easily guess the guy to have infection in heart valves that detached itself from its home and migrated to reach the brain. It is a plain guess that he had paralysis. The tuberculosis would be next plausible guess. A lot of differentials run in mind with the constellation of the clinical symptoms and signs. CT scan of head was mandatory at the time. Its real pathetic situation that the CT scan wasn't done before  9 am. Noone would pick up phone to do CT scan. CT scan of head was done with a great trouble. It didn't reveal anything unpleasant. 

A nurse checked  his blood sugar and found it to be as low as 40 mg/ dl. On pushing the dextrose in his veins, his weakness just disappeared like a miracle. The low blood sugar was sole culprit for the weakness of right half of body. His smile and voice returned normal. His great toe didn't go up and the toes didn't spread like a fan when  side of  the foot was scratched with a key. Brain  takes a biased shortcut to reach conclusion. The morale of story is that the common things are always common to occur. 


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