WBR0538

Author	[[PageAuthor::Serge Korjian M.D. (Reviewed by Alison Leibowitz) (Reviewed by Serge Korjian)]]
Exam Type	ExamType::USMLE Step 1
Main Category	MainCategory::Pathology
Sub Category	SubCategory::Neurology
Prompt	[[Prompt::A 57-year-old right-handed man, with a history of uncontrolled hypertension, type 2 diabetes mellitus, and hyperlipidemia, is hospitalized for a stroke. During his hospitalization, he sustains an injury from falling while walking to the bathroom. The nurse also notices that he only seems to eat the food on the right half of his plate and does not seem to respond if a person is standing on his left side. Which of the following regions have most likely been affected by this patient's stroke?]]
Answer A	AnswerA::Left parietal lobe
Answer A Explanation	AnswerAExp::The left parietal lobe is the dominant lobe in this patient. The patient presents with hemineglect that frequently manifests with non-dominant right parietal stroke.
Answer B	AnswerB::Right parietal lobe
Answer B Explanation	AnswerBExp::The patient most commonly sustained a non-dominant right parietal lobe that is commonly associated with hemineglect.
Answer C	AnswerC::Left temporal lobe
Answer C Explanation	AnswerCExp::A temporal lobe stroke is frequently not the most affected lobe in cases of hemineglect.
Answer D	AnswerD::Right temporal lobe
Answer D Explanation	AnswerDExp::A temporal lobe stroke is frequently not the most affected lobe in cases of hemineglect.
Answer E	AnswerE::Right occipital lobe
Answer E Explanation	AnswerEExp::Right occipital lobe strokes frequently cause vision loss on the left (contralateral) side, but do not manifest with other signs characteristic of hemineglect.
Right Answer	RightAnswer::B
Explanation	[[Explanation::Hemispatial neglect or hemineglect syndrome is often caused by a stroke to the non-dominant right parietal lobe. It is characterized by a patient's inability to recognize, perceive, or acknowledge stimuli on the contralateral side of the body. Reports of hemineglect on the ipsilateral side are also described. Patients who are left-handed (right dominance) tend to have less hemineglect when their non-dominant parietal lobe is affected following a stroke. In this case, the patient has left hemineglect due to a stroke of the right parietal lobe of the brain. Patients with hemineglect often complain of recurrent falls, resulting from their inability to visualize objects that are on the affected side. Also, patients frequently neglect half of environmental activities, such as neglecting half their food or shaving only half of their face. Educational Objective: Right (non-dominant) parietal lobe stroke frequently causes hemineglect on the contralateral side. References: Bailey MJ, Riddoch MJ. Hemineglect part 1: the nature of hemineglect and its clinical assessment in stroke patients: an overview. Physical Therapy Reviews. 1999;4(2):67-75(9).]]
Approved	Approved::Yes
Keyword	WBRKeyword::Hemineglect, WBRKeyword::ight parietal lobe, WBRKeyword::stroke, WBRKeyword::neglect syndrome, WBRKeyword::vision, WBRKeyword::fall, WBRKeyword::neurology, WBRKeyword::nervous system
Linked Question	Linked::
Order in Linked Questions	LinkedOrder::