WBR0612

Author	[[PageAuthor::Rim Halaby, M.D. [1] (Reviewed by Serge Korjian M.D. and Yazan Daaboul, M.D.)]]
Exam Type	ExamType::USMLE Step 1
Main Category	MainCategory::Anatomy, MainCategory::Pathophysiology
Sub Category	SubCategory::Neurology
Prompt	[[Prompt::A 65-year-old right-handed man with history of poorly controlled hypertension and dyslipidemia is brought to the emergency department for sudden onset right upper extremity paralysis and loss of sensation. Brain MRI is shown below. Which of the additional findings is mostly associated with this patient's condition? ]]
Answer A	AnswerA::Paralysis of the right lower extremity
Answer A Explanation	[[AnswerAExp::A stroke in the left anterior cerebral artery (ACA), not the left MCA, leads to paralysis of the right lower extremity.]]
Answer B	AnswerB::Loss of sensation on the left side of the face
Answer B Explanation	AnswerBExp::A stroke in the left MCA may lead to loss of sensation on the contralateral right side of the face, not the left side of the face.
Answer C	AnswerC::Hemineglect
Answer C Explanation	[[AnswerCExp::A stroke in the MCA in the non-dominant right side of the brain may result in hemineglect, while a stroke in the MCA in the dominant left side of the brain may lead to aphasia.]]
Answer D	AnswerD::Abnormal gait
Answer D Explanation	AnswerDExp::Strokes in the posterior circulation, not in the MCA, may lead to abnormal gait.
Answer E	AnswerE::Speech impairment
Answer E Explanation	[[AnswerEExp::A stroke in the MCA in the dominant left side of the brain may lead to aphasia.]]
Right Answer	RightAnswer::E
Explanation	[[Explanation::The patient is presenting with right upper extremity hemiplegia and hemiparesis suggestive of a stroke in the middle cerebral artery (MCA). The MRI of the brain confirms a stroke in the MCA territory. A stroke in the dominant right lobe classically leads to contralateral right sided hemiplegia and hemiparesis in the upper extremity and right side of the face as well as aphasia. Patients may present with any combination of these symptoms. A stroke in the MCA territory of the non-dominant right lobe may result in hemineglect. Educational Objective: A stroke in the dominant right lobe may lead to a combination of contralateral hemiplegia and hemiparesis in the upper extremity and right side of the face and aphasia. References: Birenbaum D, Bancroft LW, Felsberg GJ. Imaging in acute stroke. West J Emerg Med. 2011;12(1):67-76. (Image) First Aid 2015 page 464]]
Approved	Approved::Yes
Keyword	WBRKeyword::Stroke, WBRKeyword::Aphasia, WBRKeyword::MCA, WBRKeyword::Middle cerebral artery, WBRKeyword::Ischemic stroke, WBRKeyword::Speech impairment
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