History of Present Illness:
A 62-year-old female with a history of HTN and DM presents to the ED for her voice sounding like it is echoing in her head when she talks. This issue has been constant for the last 2 days and is associated with constant mild left leg numbness but no weakness. She denies any weakness, trouble with vision or speech, headache or other complaints.
Vital Signs & Physical Exam:
Vital signs are normal except for BP of 178/110. Physical exam is notable for a British accent and diminished subjective sensation to the left leg.
Initial Diagnostic Testing:
- EKG: normal
- Labs: glucose 315, otherwise unremarkable
- Imaging: see below
What is the most likely diagnosis?
- A) Anxiety
- B) Ear wax
- C) CVA
- D) None of the above
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ANSWERS:
- A) Anxiety
- B) Ear wax
- C) CVA – Correct – CT SHOWS SMALL RECENT INFARCTION OF RIGHT UPPER/MID PONS
- D) None of the above
1-Minute EM Consult on the topic for this case from the Emergency Medicine 1-minute Consult Pocketbook
CASE CONCLUSION: Admitted. Symptoms mostly resolved by discharge home 3 days later.
LESSONS: Stroke can cause weird symptoms. More benign conditions such as anxiety usually need to be a diagnosis of exclusion only.