A 52-year-old man undergoing interscalene block for shoulder surgery receives 20 mL of 0.5% bupivacaine. At 8 minutes, he develops circumoral numbness, tinnitus, and mild tremor. At 12 minutes, he has a brief seizure. Which finding best distinguishes this CNS-predominant toxicity from a case where CV toxicity would be the primary concern?

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