What could be causing a feeling of weirdness on the right side of my body?

Evaluation of Unilateral Right-Sided Body Sensations

A "weird feeling" on the right side of the body requires immediate evaluation for stroke or transient ischemic attack (TIA), particularly if accompanied by any focal neurological symptoms, sudden onset, or other concerning features.

Immediate Red Flags Requiring Emergency Evaluation

The following features demand urgent assessment, ideally via 9-1-1 activation for emergency transport 1:

• Sudden onset of the sensation (particularly if described as abrupt rather than gradual) 1
• Accompanying neurological symptoms: weakness, numbness, speech difficulties, vision changes, facial drooping, or confusion 1
• Associated chest pain or dyspnea: could indicate acute coronary syndrome (ACS) with referred symptoms 1
• Severe headache ("worst headache of my life"): raises concern for intracranial pathology 1
• Syncope, presyncope, or altered consciousness: suggests cardiovascular or neurological emergency 1

Location-Specific Differential Diagnosis

Right Upper Body/Chest

If the sensation localizes to the right chest or upper quadrant:

• Cardiac causes: While anginal symptoms are typically retrosternal, atypical presentations can occur, particularly in women, elderly patients, and those with diabetes who may experience symptoms on either side of the chest 1
• Pulmonary embolism: Presents with tachycardia and dyspnea in >90% of patients, often with pleuritic chest pain 1
• Biliary disease: Right upper quadrant pain from acute cholecystitis typically presents with localized tenderness, though the sensation may be vague initially 1
• Musculoskeletal: Costochondritis presents with reproducible tenderness of costochondral joints 1

Right-Sided Head/Face

Vertigo or dizziness with a right-sided sensation:

• Benign paroxysmal positional vertigo (BPPV): Episodes provoked by head position changes, lasting <60 seconds, with latency period of 5-20 seconds 1
• Vertebrobasilar insufficiency: Rare cause of true loss of consciousness, typically accompanied by other neurological signs like paralysis, eye movement disorders, and vertigo 1

Right Lower Abdomen/Groin

• Round ligament pain (in pregnancy): Sharp, stabbing unilateral groin pain triggered by movement, brief episodes that subside with rest 2
• Appendicitis: Would present with progressive worsening, fever, and localized tenderness (though typically periumbilical initially) 2

Diagnostic Approach

History Taking

Critical symptom characteristics to elicit 1, 3, 4, 5:

• Onset and duration: Sudden (seconds to minutes) versus gradual (hours to days); episodic versus constant 1
• Quality: Sharp, dull, stabbing, pressure, numbness, tingling, weakness 1
• Precipitating factors: Position changes, physical activity, emotional stress, specific movements 1
• Associated symptoms: Dyspnea, palpitations, diaphoresis, nausea, visual changes, speech difficulties 1
• Temporal pattern: First episode versus recurrent; improving versus worsening 3

Important caveat: Vague symptom descriptions significantly reduce diagnostic accuracy and can lead to test degeneracy, where multiple interpretations of the same complaint diminish diagnostic precision 4, 5. Help the patient clarify the exact nature and location of the sensation.

Physical Examination

Focused examination based on location 1:

• Cardiovascular: Pulse differential between extremities (suggests aortic dissection if present), heart sounds, murmurs 1
• Neurological: Facial symmetry, motor strength, sensory testing, coordination, gait 1
• Abdominal: Localized tenderness, Murphy's sign (for cholecystitis), rebound tenderness 1
• Musculoskeletal: Reproducible tenderness with palpation 1

Initial Diagnostic Testing

ECG within 10 minutes if any concern for cardiac etiology, even in office setting 1

Imaging based on localization:

• Right upper quadrant symptoms: Ultrasound is first-line for suspected biliary disease 1
• Suspected stroke/TIA: Immediate neuroimaging (CT or MRI) 1
• Vertigo with positional component: Dix-Hallpike maneuver for posterior canal BPPV or supine roll test for lateral canal BPPV 1

Common Pitfalls

• Dismissing vague symptoms: In women, elderly patients, and those with diabetes, serious conditions like ACS can present with atypical, poorly localized symptoms 1
• Assuming musculoskeletal origin: Reproducible chest wall tenderness does not exclude cardiac disease 1
• Overlooking temporal patterns: Brief episodes (<1 minute) with position changes suggest BPPV rather than stroke 1
• Inadequate history: Poor symptom characterization leads to excessive testing, increased costs, and prolonged diagnosis 4, 6

When organic etiology is not immediately apparent (which occurs in 84% of common symptoms in primary care), prognosis is better with symptom duration <4 months and fewer than 2 concurrent symptoms 6. However, this should not delay evaluation of potentially serious causes.