Question

Gene Matson, a 75-year old male, was brought to the hospital by his son following the acute onset of left-side numbness and weakness that began one hour prior to admission. His son stated that two weeks prior to admission Gene had a single, 12-hour episode of garbled speech and left-side and arm weakness. Following the first episode, the right carotid angiogram was performed and showed a narrowing of the carotid at about mid-way.
Questions: 1. What abnormality does the angiogram show? What kind of lesion a "narrowing" may represent? 2. Relate the findings in the angiogram to the patient's past and present neurological problems in terms of: a. How the vascular lesion could lead to neurological problems. b. What specific blood vessel in the brain must have been affected by the process "a" to account for his symptoms.
Past medical history of Mr. Matson: The patient has a history of moderate hypertension treated with calcium channel blockers. History of hypercholesterolemia also. Mr. Matson smoked one pack of cigarettes per day for forty years, and drank approximately four beers per day for severe years.
Physical Exam: Temperature: 37 degrees Celsius Pulse 72 Respiration rate: 12 Blood pressure 170/100
Neurological exam: Showed left-sided hemiplegia (paralysis on one side) and hemianesthesia (numbness on one side)
Questions: 1. What are pertinent aspects of the patient's past medical history that are risk factors for his current medical problem? 2. Damage to which lob(s) accounts for the patient's sensory and motor deficits? 3. Give an explanation for why the damage tot he right side of the brain may cause sensory and motor problems on the contralateral (opposite) side of the body. 4. Is there a surgical procedure that might have prevented the current episode? if so, what is the procedure called?

Answer 1

1. The angiogram will show the occlusion of carotid artery in the right side. Which blocks the blood supply to the right side hemisphere.
2. a) The findings of past medical history shows that patients had the risk factors regarding the occurance of CVA. According to the angiogram done previously, the findings where stenosis or narrowing of carotid artery. Due to the stenosis the occurance of atherosclerosis is more prone in this conditions. It will leads to the occlusion of internal carotid artery which restrict the blood flow to the right hemisphere. The patient will undergo stroke and results following symptoms of numness, weakness, and speech abnormalities