WBR0612

Author	[[PageAuthor::Rim Halaby, M.D. [1]]]
Exam Type	ExamType::USMLE Step 1
Main Category	MainCategory::Anatomy, MainCategory::Pathophysiology
Sub Category	SubCategory::Neurology
Prompt	[[Prompt::A 65-year-old right-handed male known to have poorly controlled hypertension and dyslipidemia is brought by his wife to the emergency department for sudden onset of right upper extremity paralysis and loss of sensation. MRI of the brain is shown below. ]]
Answer A	AnswerA::Paralysis of the right lower extremity
Answer A Explanation	AnswerAExp::A stroke in the left MCA does not lead to paralysis of the right lower extremity, in fact, strokes in the left anterior cerebral artery (ACA) lead 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 and 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 lead to 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 and the MCA may lead to abnormal gait.
Answer E	AnswerE::Speech difficulty
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 hemiplagia and hemiparesis sugegstive of a stroke in the MCA. The MRI of the brain confirms a stroke in the MRA territory. A stroke in the dominant right lobe might lead to contralateral right sided hemiplagia and hemiparesis in the upper extremity and right saide of the face as well as aphasia; hence, the patient is expected to have a speech difficulty. A stroke in the MCA territory of the non dominant right lobe might lead to hemineglect. Shown below is an image depicting the vascular territories in the brain. Educational objective: A stroke in the dominant right lobe might lead to right sided hemiplagia and hemiparesis in the upper extremity as well as aphasia. Educational Objective: References: ]]
Approved	Approved::No
Keyword	WBRKeyword::Stroke, WBRKeyword::Aphasia, WBRKeyword::MCA
Linked Question	Linked::
Order in Linked Questions	LinkedOrder::