Can you make the diagnosis?

Nancy is working at her computer when she begins to notice it is hard to use her left hand.   Thinking it was because she was resting her elbow on the desk for too long, she tries to change the position, and continues working.

Her coworker approaches and asks Nancy a question.  When Nancy answers, her coworker notices that Nancy’s speech is slurred, and one side of her face appears to be drooping.

What is Nancy’s diagnosis?

  1.  Meningitis
  2.  Carpal tunnel syndrome
  3.  Migraine
  4.  Stroke



If you guessed 4.  Stroke, you are correct.

A stroke, or Cerebrovascular Accident (CVA), is caused when the circulation to a part of the brain is decreased.  Strokes can cause symptoms such as weakness, slurred speech, facial droop, and difficulty walking.

A stroke is a true emergency and Nancy’s coworker should call 911.  A pneumonic to remember about the warning signs of stroke is FAST (facial droop, arm weakness, speech difficulty, time to call 911).

Risk factors for stroke include high blood pressure, irregular heart rate such as atrial fibrillation, tobacco smoking, high cholesterol, and diabetes.

Treatment can include very strong blood thinners such as tPA (tissue plasminogen activator) but the patient must present within 3 hours of onset of their symptoms to receive these medications.

Meningitis can cause fever and confusion, but would not typically cause weakness worse on one side than the other.  Carpal tunnel syndrome causes pain and tingling in the hand.  The pain is often worse at night.  Carpal tunnel would not be expected to cause speech changes or facial droop.  A migraine can cause neurologic symptoms but is usually associated with a severe headache and vomiting.

Left facial droop:


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