Sudden onset headache, dizziness, unilateral facial numbness, and speech disturbance

Abstract

A 48-year-old woman presented to the emergency department with acute onset of headache, dizziness, right facial numbness, and difficulty of swallowing and speech. She was not a smoker and consumed alcohol occasionally, and there was no surgical or other medical history. On admission, her blood pressure was 114/78 mm Hg, pulse rate was 72 beats per minute, and room air arterial oxygen saturation by pulse oximetry was 100%. Laboratory tests showed no abnormalities. Physical examination revealed paresthesia of right side of face and left lower extremity and paralysis of right vocal cord, but with no other neurological findings such as consciousness disturbance, cerebellar ataxia, double vision, and hemiparesis.