A 30-year-old man with an intellectual disability presents with left-sided weakness and dysarthria for two days, in a background of anorexia and nausea for one week.
His medical history is significant for stage IV chronic kidney disease secondary to uncorrected posterior urethral valves. He has been poorly adherent to treatment and is not on any medications right now, including over-the-counter drugs or herbal preparations.
His surgical and family histories are unremarkable. He does not drink, smoke, or use illicit substances. There are no known allergies. He has never been employed. He is a single child and currently lives with his widowed, elderly father.
A complete blood count is only significant for a hemoglobin level of 10.7 mg/dL (normal: 11 - 18). His leukocyte count is 6,500/mm3, with normal differentials.