Sporadic adult‐onset brainstem hyperkalemic periodic paralysis masquerading as recurrent transient ischemic attacks

Abstract

We report a case of adult‐onset, sporadic, hyperkalemic periodic paralysis with primary brainstem musculature symptoms masquerading as recurrent transient ischemic attacks. Unilateral brainstem weakness could be induced with rapid eye blinking, which was followed by lower extremity weakness and cramping. Treatment with acetazolamide and albuterol ameliorated the patient's attacks.Focal weakness, particularly of brainstem musculature, is a common presentation in the emergency department and clinic and often associated with vascular etiologies. This case illustrates primary muscle etiologies, specifically the periodic paralyses, should be considered in the differential diagnosis, particularly in patients with recurrent frequent episodes of brainstem muscular weakness.