WBR0538: Difference between revisions

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{{WBRQuestion
{{WBRQuestion
|QuestionAuthor={{Rim}}
|QuestionAuthor={{Rim}} {{Alison}}
|ExamType=USMLE Step 1
|ExamType=USMLE Step 1
|MainCategory=Pathology
|MainCategory=Pathology
Line 20: Line 20:
|MainCategory=Pathology
|MainCategory=Pathology
|SubCategory=Neurology
|SubCategory=Neurology
|Prompt=A 57 year old right-handed male patient with a history of uncontrolled hypertension, type 2 diabetes mellitus, and hyperlipidemia, is hospitalized for a stroke.  During his hospitalization, he sustains an injury after he fell while walking to the bathroom.  Upon further questioning, the nurse notices that he always eats only the right half of his plate and he recently shaved only his right side.  Which of the following regions have most likely been affected by this patient's stroke?
|Prompt=A 57-year-old right-handed male, 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 notices that he always eats only the right half of his plate and he recently shaved only his right side.  Which of the following regions have most likely been affected by this patient's stroke?
|Explanation=Hemispatial neglect or hemineglect syndrome is often caused by a stroke to the non-dominant right parietal lobe.  It is defined as the patient's inability to recognize, perceive, or acknowledge stimuli on the contralateral side of the body.  Nonetheless, 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 than patients who are right-handed (left dominance).
|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.  As such, patients with hemineglect often complain of recurrent falls due to failure to visualize objects that are on the affected side.  Also, patients tend to neglect half of environmental activities, like neglecting half their food and shaving only half of their face.   
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 often causes hemineglect on the contralateral side.
|EducationalObjectives= 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).


Reference: 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).
|AnswerA=Left parietal lobe
|AnswerA=Left parietal lobe
|AnswerAExp=The left parietal lobe is the dominant lobe in this patient.  The patient presents with hemineglect that is commonly seen in non-dominant right parietal stroke.
|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.
|AnswerB=Right parietal lobe
|AnswerB=Right parietal lobe
|AnswerBExp=The patient most commonly sustained a non-dominant right parietal lobe that is commonly associated with hemineglect.
|AnswerBExp=The patient most commonly sustained a non-dominant right parietal lobe that is commonly associated with hemineglect.
|AnswerC=Left temporal lobe
|AnswerC=Left temporal lobe
|AnswerCExp=A temporal lobe stroke is not the most common affected lobe in cases of hemineglect.
|AnswerCExp=A temporal lobe stroke is frequently not the most affected lobe in cases of hemineglect.
|AnswerD=Right temporal lobe
|AnswerD=Right temporal lobe
|AnswerDExp=A temporal lobe stroke is not the most common affected lobe in cases of hemineglect.
|AnswerDExp=A temporal lobe stroke is frequently not the most affected lobe in cases of hemineglect.
|AnswerE=Right occipital lobe
|AnswerE=Right occipital lobe
|AnswerEExp=Right occipital lobe stroke causes vision loss on the left (contralateral) side.  Patients, however, do not have the other signs of hemineglect.
|AnswerEExp=Right occipital lobe strokes frequently cause vision loss on the left (contralateral) side, but do not manifest with other signs characteristic of hemineglect.
|RightAnswer=B
|RightAnswer=B
|WBRKeyword=hemineglect, neglect, syndrome, right, parietal, lobe, right parietal lobe, stroke, neglect syndrome, vision, fall, shave, eat, food, half
|WBRKeyword=hemineglect, right parietal lobe, stroke, neglect syndrome, vision, fall, neurology, nervous system,
|Approved=No
|Approved=Yes
}}
}}

Revision as of 18:34, 30 July 2014
Author [[PageAuthor::Rim Halaby, M.D. [1] (Reviewed by Alison Leibowitz)]]
Exam Type ExamType::USMLE Step 1
Main Category MainCategory::Pathology
Sub Category SubCategory::Neurology
Prompt [[Prompt::A 57-year-old right-handed male, 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 notices that he always eats only the right half of his plate and he recently shaved only his right 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::right parietal lobe, WBRKeyword::stroke, WBRKeyword::neglect syndrome, WBRKeyword::vision, WBRKeyword::fall, WBRKeyword::neurology, WBRKeyword::nervous system
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