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44. A 67-year-old man is brought to the emergency¨department 2 hours after the onset of weakness and double vision. He has¨hypertension and hyperlipidemia treated with metoprolol, captopril, and¨atorvastatin. His blood pressure is 190/106 mm Hg. Neurologic¨examination shows left-sided facial weakness including the forehead. ¨There is palsy of left conjugate gaze, and the left eye fails to adduct on¨right gaze. Vertical eye movements are intact. Muscle strength is¨3/5 in the right upper and lower extremities. Deep tendon reflexes are¨brisk, and Babinski's sign is present on the right. Which of the following is the most likely location of this patient's lesion?¨
¨A) Bilateral thalamic¨
¨B) Left frontal
¨¨C) Left pontine¨
¨D) Right caudate
¨¨E) Right midbrain¨
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i went for C
he has Rt side UMNL and lesion in the face is on the Lt so i will choose left side lesion than narow it to either B) or C)
but i,m still confused as i reviewed in my notes taken from UW that these symptomes typical for putamen in which eye is deviated away from the lesion the same wz symptome of internal capsule which is near to the putamen produce hemiplegia on the othe side 35% due to HTN
But pontine lesion------>5-12% deep coma paraplegia pinpoint pupil
i know i got lost
i wish someone correct it
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i go with CCC
with cerebral lesions motor deficits occur opposite to side of lesion and gaze deviation occurs towards side of lesion.
here left conjugate palsy indicates left side lesion and also the muscle strength is 3/5 on right side and which again says lesion is on left side.leaving us with two options b and c.of which c is the most common .
uncontrolled hypertension causes spontaneous intracranial hemorrhage with babsal ganglia being the most common and includes thalamus,cerebellum and pons as the most common sites.
