He seemed to his wife to be transiently dazed. When you examine him that afternoon, he is alert and physical examination is normal. The patient has a history of hypertension for which he takes methyldopa. Three weeks later the patient's wife brings him back to your office because the dazed state has returned. The patient moves slowly, but muscle strength is normal.
Neurologic examination shows slight hyperactivity of the tendon reflexes on the right.
Babinski testing shows bilateral withdrawal.