A 5-week-old term infant is brought to the emergency department with bilateral upper extremity weakness. The patient was adopted at birth and his adoptive parents report that he had been feeding, growing, and developing well until 1 day before this presentation, when they noticed a decrease in arm movement. Further history reveals possible weakness developing 2 to 3 days earlier, that was described as diminished resistance while being swaddled. The parents deny any known trauma or other symptoms including fever, cough, rash, diarrhea, vomiting, or jerking movements.
The patient was born at 38 weeks and 4 days of gestation via spontaneous vaginal delivery to a 23-year-old gravida 1 para 1 woman. At birth, he was appropriate for gestational age, with a birthweight of 3.5 kg. The mother presented late to prenatal care (25 weeks), but after presentation, her prenatal course and maternal laboratory findings were unremarkable: rapid plasma reagin (RPR)...
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