# 119 A seeming semblance; Part I
A) A 44 yo ♀ alcoholic with occasional ETOH seizures, is "sleeping it off," and upon wakening has a mild left hemiparesis without altered mental status.
B) A 29 yo ♂ who uses drugs is brought from an encampment where he has woken with an RUE monoparesis. Color and temperature of arm is normal. He is frightened, but mentation and speech are clear.
C) A middle-aged woman is brought in whose eyes are open without engagement, who does not speak, and who doesn't move. During exam, you move the patient and she remains in the position left.
D) A 24 yo ♀ is brought by ambulance EMTs who were instructed to undertake no interventions of an acutely mute and quadraparetic woman; there have been prior episodes like this. The patient can blink to yes or no questions.
A) Probable unwitnessed seizure during night (binge ETOH & off meds) with Todd's Paralysis, resolving later in the day.
B) Brachial Plexus Neurapraxia from compression due to long sleep (drugged) in same position.
C) Catatonic Schizophrenia with "Waxy Flexibility;" cerea flexibilitas.
D) The crew was so instructed due to her known history of Basilar Migraine which produces her symptoms.
Note: Commonality of these cases and theme of this episode of Clinical Tips is that all patients have mimics of stroke.
Walker, Richard A., MD, FACEP FAAEM "Identifying Diseases that Mimic Strokes." JEMS - Journal of Emergency Medical Services - Feb 28, 2011. Accessed: 8/29/2015
Huff, J. Stephen. (2014). Stroke Differential Diagnosis-Mimics and Chameleons. FERNE Foundation for Education and Research in Neurological Emergencies. Accessed: 8/29/2015
Hand, P. J., Kwan, J., Lindley, R. I., Dennis, M. S., & Wardlaw, J. M. (2006). Distinguishing between stroke and mimic at the bedside the brain attack study. Stroke, 37(3), 769-775. Accessed 8/29/2015.
Lo, Bruce, MD, RDMS. Stroke Mimickers and the Atypical Stroke Patient [ppt as pdf] September 20, 2012. Downloaded from American Heart Association. Accessed: 8/29/2015.
Frank, Jeffrey H., M.D. Stroke Mimics. [ppt as pdf] 6/18/10. Accessed: 8/29/2015.
Johns Hopkins Peripheral Nerve Surgery Center. Brachial Plexus Injury (BPI). 2015-07-23. Accessed: 8/30/2015.
cerea flexibilitas. (n.d.) Farlex Partner Medical Dictionary. (2012). Retrieved August 30 2015 from <http://medical-dictionary.thefreedictionary.com/cerea+flexibilitas>.