Step 2

Neurology 3

A 53-year-old woman presents to the emergency department appearing disheveled, diaphoretic, and anxious, with tremulous hands. Upon examination, she reports being homeless for the past two years and she denies drug use but admits to alcohol use. She thinks the current year is 2008 though it is 2022. She states that she has a history of a “liver issue.” She currently feels nauseous, agitated, and complains of headache that is diffuse. Vital signs have a HR 121, BP 146/82, RR 23, oxygen saturation is 98% on room air. During her evaluation in the ED, she falls on her way to the restroom landing on her buttock. It is noted that her gait is wide and slow. Her head is atraumatic after the fall, but noted to difficulty controlling her eye movements and her oral mucosa is dry.

What is the most likely diagnosis regarding this patient’s presentation?

  • A) Acute Stroke
  • B) Methamphetamine intoxication
  • C) Wernicke encephalopathy
  • D) Opioid overdose
  • E) Serotonin syndrome


Yunjia Shen


Dr. Raj Dasgupta