65-year-old man was brought to the Emergency Room by his wife after she noticed he was confused and behaving in a strange way. He had no fever, cough, shortness of breath, chest pa... 65-year-old man was brought to the Emergency Room by his wife after she noticed he was confused and behaving in a strange way. He had no fever, cough, shortness of breath, chest pain, headache, abdominal pain, vomiting, or loss of consciousness. He is known to have type 2 diabetes mellitus, hypertension, dyslipidemia, and osteoarthritis, and is on insulin, metformin, candesartan, hydrochlorothiazide, aspirin, and atorvastatin. Examination reveals that he is conscious but disoriented. Left leg power is 2/5, while the other limbs are 5/5. There is decreased sensation in the left leg. Other neurological exams are normal. Which of the following is the most likely explanation for his symptoms and signs? A. Migraine B. Right MCA stroke C. Right ACA stroke D. Basilar artery stroke
Understand the Problem
The question is presenting a clinical scenario involving a 65-year-old man with confusion, disorientation, and specific neurological deficits (left leg weakness and sensory loss) after being brought to the Emergency Room. The symptoms suggest a potential stroke, and the question is asking to identify which type of stroke is most likely. To solve this, we will analyze the symptoms in relation to the possible diagnoses provided in the options.
Answer
Right MCA stroke
The final answer is Right MCA stroke
Answer for screen readers
The final answer is Right MCA stroke
More Information
The symptoms of disorientation, weakness in the left leg (2/5 power), and decreased sensation in the left leg suggest a right middle cerebral artery (MCA) stroke. The right MCA stroke typically affects motor function on the left side of the body, corresponding with the patient's symptoms.
Tips
A common mistake is to overlook that neurological deficits on one side of the body typically indicate a stroke on the opposite side due to the way brain hemispheres control contralateral sides.
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