Severe Hyperthyroidism Masquerading as Acute Bulbar Weakness

The stroke occurs in nearly 800,000 patients per year in the United States with significant morbidity if not treated and managed in a time sensitive manner. Acute bulbar weakness can be a common presenting manifestation of acute stroke and transient ischemic attack. However, up to 30% of the patients presenting with symptoms concerning for stroke could be displaying a disease process that mimics the stroke. These disorders include hypoglycemia, seizures, complicated migraines, and endocrinopathies such as thyroid disease. If neuroimaging fails to show evidence of an acute infarct, these stroke mimics should be considered. When acute bulbar weakness occurs in the setting of severe hyperthyroidism, the treatment of this process can result in rapid improvement of symptoms.