The Clinical Problem Solvers Episode 146: Neurology VMR – Right sided weakness + numbness
Dec 9, 2020
Tahir Malik, a 4th-year medical student at Baylor College of Medicine with a keen interest in AI and global health, joins Dhruv Srinivasachar, who shares his journey from research to empathetic clinical care. They tackle a compelling case of right-sided weakness and numbness, dissecting potential neurological issues like stroke. The conversation emphasizes the importance of patient history and differential diagnosis. They also navigate the complexities of diagnosing stroke symptoms in younger patients and explore the role of muscle relaxants on neurological health.
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Episode notes
Localization of Sudden Weakness
- Sudden onset right arm and leg weakness points to either brainstem/brain or spinal cord lesion due to corticospinal tract anatomy.
- Right side symptoms arise from left brainstem lesion or right spinal cord involvement before neural crossover.
Consider Cervical Artery Dissection Early
- Always consider carotid or vertebral artery dissection in young patients with neck pain followed by stroke-like symptoms.
- Neck pain that precedes focal neurological deficits is a key red flag for cervical artery dissection.
Use Exam to Guide Localization
- Use the neurological exam to distinguish brain versus spinal cord lesions by checking for cranial nerve involvement.
- Assess upper motor neuron signs and sensory levels to help refine lesion location and guide imaging choices.
