WBR0538

Author	[[PageAuthor::Rim Halaby, M.D. [1]]]
Exam Type	ExamType::USMLE Step 1
Main Category	MainCategory::Pathology
Sub Category	SubCategory::Neurology
Prompt	[[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?]]
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 is commonly seen in 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 not the most common affected lobe in cases of hemineglect.
Answer D	AnswerD::Right temporal lobe
Answer D Explanation	AnswerDExp::A temporal lobe stroke is not the most common affected lobe in cases of hemineglect.
Answer E	AnswerE::Right occipital lobe
Answer E Explanation	AnswerEExp::Right occipital lobe stroke causes vision loss on the left (contralateral) side. Patients, however, do not have the other signs 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 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). 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. Educational Objective: Right (non-dominant) parietal lobe stroke often causes hemineglect on the contralateral side. 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). Educational Objective: References: ]]
Approved	Approved::No
Keyword	WBRKeyword::hemineglect, WBRKeyword::neglect, WBRKeyword::syndrome, WBRKeyword::right, WBRKeyword::parietal, WBRKeyword::lobe, WBRKeyword::right parietal lobe, WBRKeyword::stroke, WBRKeyword::neglect syndrome, WBRKeyword::vision, WBRKeyword::fall, WBRKeyword::shave, WBRKeyword::eat, WBRKeyword::food, WBRKeyword::half
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