Weakness and Dizziness
Questions
345.A 78-year-old man presents to the emergency department (ED) com-
plaining of left arm weakness that started 10 minutes ago in the clinic. The
patient states that he has a history of hypertension and diabetes, but has
never had similar symptoms in the past. He is feeling well otherwise. His
blood pressure (BP) is 157/85 mm Hg, heart rate (HR) is 87 beats per minute,
temperature is 98.8°F, and respiratory rate (RR) is 14 breaths per minute.
His neurologic examination is unremarkable and the patient embarrassingly
states that his left arm is no longer weak. Which of the following is the most
likely diagnosis?
a. Thrombotic stroke
b. Conversion disorder
c. Migraine with focal neurologic deficit
d. Transient ischemic attack (TIA)
e. Todd paralysis
346.A 56-year-old man presents to the ED complaining of intermittent
lightheadedness and nausea throughout the day. He believes it started after
eating leftover shrimp salad in the morning. On further questioning, he reports
that during the lightheadedness episodes the room is spinning around him
and the episodes are triggered by turning his head to the right. He denies
hearing loss, tinnitus or other associated symptoms. His BP is 137/85 mm Hg,
HR is 67 beats per minute, temperature is 98.5°F, and RR is 14 breaths per
minute. The patient reproduces the symptoms by turning his head to the right.
Which of the following is the most likely diagnosis?
a. Benign positional vertigo (BPV)
b. Food poisoning
c. Meniere disease
d. Labyrinthitis
e. TIA
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