don't come into the emergency room until the next day right they think they slept on their arm wrong and then they wait till it doesn't get better the next day they call their primary care doctor and say hey my arm doesn't move they say go to the ER but it's too late okay we're gonna end and we're gonna end with this case study this is a patient I had a few years ago 45 year old man who was recovering from a surgical procedure at Stanford and he was there in his WA in the room with his wife when he had the abrupt onset of left-sided paralysis it