Approach to convulsive status epilepticus Quiz: Ace Your Exams

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A 61-year-old man is brought by ambulance to the emergency department because of seizure activity witnessed by his partner at home. Three hours prior to arrival, he had an episode of unresponsiveness lasting for one minute, after which he was sleepy and confused. He had a similar episode about thirty minutes later. Then, just prior to calling the ambulance, he was sleeping when his partner observed stiffening and jerking of the left arm and left leg lasting for two minutes. His partner reports that he has no significant medical history and does not take any medications. His partner reports that he has been irritable and paranoid for the past two weeks. He has smoked a pack per day for 35 years. Temperature is 37°C (98.6°F), pulse is 85/min, respirations are 28/min, and blood pressure is 140/90 mmHg. Oxygen saturation is 89% on room air. He is agitated with intermittent facial grimacing and writhing limb movements. He has a negative Kernig and Brudinsky and full range of motion on passive neck movement. Pulmonary examination is significant for decreased breath sounds with rhonchi on the right side. A finger-stick glucose and complete blood count with differential are normal, and a urine toxicology screen is negative. Computerized tomography of the head without contrast is normal. Bedside chest X-ray shows a central lung mass. Which of the following findings is most likely to be present and associated with the underlying diagnosis?  

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