A 54-year-old obese female presents with facial droop, arm drift, and weak grips of her right hand after vomiting; which condition is suspected?

• A. Conversion reaction
• B. Flu
• C. Hypoglycemia
• D. Electrolyte imbalance

Answer: (C)

Low blood glucose can cause neurologic symptoms that look like a stroke. When the brain isn’t getting enough glucose, it can produce focal signs such as facial droop, arm drift, and weakness in the hand, which can be mistaken for a cerebrovascular event. In this patient, who is middle-aged and obese and has just vomited, hypoglycemia is a plausible cause because vomiting can coincide with poor intake or diabetes medications, leading to low glucose levels.

In the field, the key step is to check a finger-stick blood glucose immediately. If it’s low (usually below 70 mg/dL), treat right away with fast-acting carbohydrates if the patient can safely swallow and is awake. If the patient cannot swallow or is not responsive, administer intravenous dextrose or intramuscular glucagon per protocol and monitor, then recheck the glucose.

Stroke remains a consideration, but hypoglycemia is the more immediately treatable cause of these neurologic symptoms and should be addressed first to prevent progression.