History of Present Illness:
A man in his mid 40’s with no known PMH presents to the ER with slurred speech, non-specific vision iss and bilateral hand coordination issues. He does admit to occasional alcohol and recreational drug use.
Vital Signs & Physical Exam:
Vital signs are normal except for elevated BP. Strength is symmetric but he seems to have problems with FNF bilaterally though worse on the right. He has slight right facial droop. When he sticks out his tongue, this is what you see.
What is the most likely diagnosis?
- A) Intoxication
- B) Brainstem stroke
- C) Sepsis
- D) Mass
SCROLL DOWN FOR ANSWERS & 1-MINUTE CONSULT
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QUIZ ANSWER: What is the most likely diagnosis?
- A) Intoxication – A diagnosis of exclusion. Don’t be dismissive
- B) Brainstem stroke – CORRECT (but ended up it wasn’t)
- C) Sepsis –
- D) Mass
CASE CONCLUSION: It may be hard to appreciated from the photo and this was the first time in 25 years that I’ve seen this but his tongue was definitely deviated to his right, even if subtle. I suspected a brainstem stroke affecting CN 12 but here is what the CT showed
