Molly's Motor Malaise

Molly, a 70-year-old right-handed, hypertensive, diabetic woman, became weak in the right arm and leg and the right side of her face over the course of an hour. She had no accompanying headache, visual disturbance, or numbness.

On examination, she was alert, oriented, and not dysphasic. The visual fields were full to confrontation. The pupils were 3mm and reactive to light. There was mild weakness of the lower facial muscles on the right, and the right palpebral fissure was widened, with the right nasolabial fold slightly flattened. There was moderate weakness of her right arm and leg, and the deep tendon reflexes were hyperactive on the right. The right plantar reflex was extensor. Light touch, pain, temperature, proprioception, and vibration were all felt normally.

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