2.1.44 - neverlate

[ArchivalUser]

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

[ArchivalUser]

I chose E but the ans sheet says D?

[ArchivalUser]

Anyone dare to dissect it?

[ArchivalUser]

its c

"left-sided facial weakness including the forehead"- indicating a left lesion

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" indicating a UMN lesion.....since the corticospinal fibers decussate (cross over ) below the pons in medulla oblangata ....

the lesion should be in the left pons as the fibers are yet to cross over and thus left sided lesion will produce a right sided UMN lesion along with ipsilateral facial weakness...(no crossing over)

cant be caudate as some kind of movement disorder should be there and midbrain has your respiratory centers and other cranial nerves

[ArchivalUser]

yes C agreee with ckindec

[ArchivalUser]

C which also explains the lower motor neuron type of paralysis of face on the left side, due to involvement of facial nerve nucleus which lies in the Pons.