WBR0612: Difference between revisions
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[[Image:Left MCA stroke.jpeg|center|400px]] | [[Image:Left MCA stroke.jpeg|center|400px]] | ||
|Explanation=The patient is presenting with right upper extremity hemiplagia and hemiparesis | |||
Image courtesy of radiopaedia http://radiopaedia.org/cases/left-mca-infarction. | |||
|Explanation=The patient is presenting with right upper extremity hemiplagia and hemiparesis suggestive of a [[stroke]] in the [[middle cerebral artery]] (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 side 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. | Shown below is an image depicting the vascular territories in the brain. | ||
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Educational objective: | 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. | A [[stroke]] in the dominant right lobe might lead to contralateral right sided [[hemiplagia]] and hemiparesis in the upper extremity and right side of the face as well as [[aphasia]]. | ||
|AnswerA=Paralysis of the right lower extremity | |AnswerA=Paralysis of the right lower extremity | ||
|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. | |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. | ||
|AnswerB=Loss of sensation on the left side of the face | |AnswerB=Loss of sensation on the left side of the face | ||
|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. | |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. | ||
|AnswerC=Hemineglect | |AnswerC=Hemineglect | ||
|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. | |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. | ||
|AnswerD=Abnormal gait | |AnswerD=Abnormal gait | ||
|AnswerDExp=Strokes in the posterior circulation and the MCA may lead to abnormal gait. | |AnswerDExp=Strokes in the posterior circulation and the MCA may lead to abnormal gait. | ||
|AnswerE=Speech difficulty | |AnswerE=Speech difficulty | ||
|AnswerEExp=A stroke in the MCA in the dominant left side of the brain may lead to aphasia. | |AnswerEExp=A stroke in the MCA in the dominant left side of the brain may lead to [[aphasia]]. | ||
|RightAnswer=E | |RightAnswer=E | ||
|WBRKeyword=Stroke, Aphasia, MCA | |WBRKeyword=Stroke, Aphasia, MCA | ||
|Approved=No | |Approved=No | ||
}} | }} | ||
Revision as of 00:22, 7 October 2013
| 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.
 Image courtesy of radiopaedia http://radiopaedia.org/cases/left-mca-infarction.]] |
| 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 suggestive of a stroke in the middle cerebral artery (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 side 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 contralateral right sided hemiplagia and hemiparesis in the upper extremity and right side of the face as well as aphasia. |
| Approved | Approved::No |
| Keyword | WBRKeyword::Stroke, WBRKeyword::Aphasia, WBRKeyword::MCA |
| Linked Question | Linked:: |
| Order in Linked Questions | LinkedOrder:: |