NUMBNESS/ WEAKNESS

Question 1

68 yo M presents following a 20-minute
episode of slurred speech, right facial
drooping and numbness, and right hand
weakness. His symptoms had totally
resolved by the time he got to the ER.
He has a history of hypertension, diabetes
mellitus, and heavy smoking.

Answer 1

Transient ischemic attack (TIA) CBC
Hypoglycemia Glucose
Seizure Electrolytes
Stroke ECG
Facial nerve palsy CT—head
MRI—brain
Doppler U/S—carotid
Echocardiography
EEG

Question 2

68 yo M presents with slurred speech,
right facial drooping and numbness, and
right hand weakness. Babinski’s sign is
present on the right. He has a history
of hypertension, diabetes mellitus, and
heavy smoking.

Answer 2

Stroke CBC, electrolytes
TIA PT/PTT
Seizure CT—head
Intracranial neoplasm MRI—brain (preferred)
Subdural or epidural hematoma Doppler U/S—carotid
Echocardiography

Question 3

33 yo F presents with ascending loss of
strength in her lower legs over the past
two weeks. She had a recent URI.

Answer 3

Guillain-Barré syndr CBC, electrolytes
Multiple sclerosis CPK
Polymyositis LP—CSF analysis
Myasthenia gravis MRI—spine
Peripheral neuropathy EMG/nerve conduction study
Tumor in the vertebral canal Tensilon test
Serum B12

Question 4

30 yo F presents with weakness, loss of
sensation, and tingling in her left leg
that started this morning. She is also
experiencing right eye pain, decreased
vision, and double vision. She reports
feeling “electric shocks” down her spine
upon flexing her head.

Answer 4

Multiple sclerosis CBC, ESR
Stroke VDRL/RPR
Conversion disorder MRI—brain
Malingering LP—CSF analysis
CNS tumor Retinal evoked potentials
Neurosyphilis
Syringomyelia
CNS vasculitis

Question 5

55 yo M presents with tingling and
numbness in the hands and feet (gloveand-
stocking distribution) over the past
two months. He has a history of diabetes
mellitus, hypertension, and alcoholism.
There is decreased soft touch, vibratory,
and position sense in the feet.

Answer 5

Diabetic peripheral neuropath HbA1c
Alcoholic peripheral neuropathy ESR
B12 deficiency Calcium
Hypocalcemia Serum B12
Hyperventilation Serum and urine protein electrophoresis
Paraproteinemia/myeloma

Question 6

40 yo F presents with occasional double
vision and droopy eyelids at night with
normalization by morning.

Answer 6

Myasthenia gravis Tensilon test
Horner’s syndrome ACh receptor antibodies (in serum)
Multiple sclerosis CXR
Intracranial tumor- CT—chest
compressing CN III, IV, or VI MRI—brain
Amyotrophic lateral sclerosis EMG

Question 7

25 yo M presents with hemiparesis (after
a tonic-clonic seizure) that resolves over
a few hours.

Answer 7

Todd’s paralysis CBC, electrolytes
TIA EEG
Stroke MRI—brain
Complicated migraine Doppler U/S—carotid
Malingering