Case History 10: Stroke Syndromes

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Vignette #1:

A 77-year-old woman was cooking in the kitchen when she collapsed onto the floor. Her daughter called an ambulance and the woman was taken to the emergency room. She had suffered a stroke, and slowly regained consciousness over the next two days. However, when she woke up, she had the following signs and symptoms:

- paralysis of the right face and arm
- loss of sensation to touch on the skin of the right face and arm
- inability to answer questions but ability to understand what was said to her
- ability to write down her thoughts more easily than to speak them

Questions:

1. Based upon the patient's symptoms, which cerebral artery was blocked? (Be Specific)

Answer

2. Why was she paralyzed in the right face and arm?

Answer

3. What is the name of her language disorder, and what caused it?

Answer

4. Was this woman's dominant or nondominant hemisphere damaged?

Answer

Vignette #2:

A 61-year-old business executive with a long history of high blood pressure collapsed while jogging over the lunch hour. His jogging mate quickly contacted a police officer who helped carry the man to a hospital just down the road. At the hospital, an MRI was performed that revealed a blockage of a major cerebral artery and ischemic changes to the portion of the brain supplied by that artery. With quick medical attention, the man was stabilized, and he slowly improved over the next three weeks. The following signs and symptoms did persist, however:

- paralysis of the right leg and foot
- loss of sensation on the skin of the right leg and foot
- when blindfolded, inability to identify a tennis ball placed in the left hand, but ability to name it if placed in the right hand
- inability to throw the tennis ball with his left hand, but ability to throw it with his right hand

Questions:

1. Which artery was blocked in this case? (Be Specific)

Answer

2. Explain why he is unable to identify the tennis ball when it is placed in his left hand. In your explanation, be sure to discuss all of the relevant pathways down which nerve impulses must pass in order to name the object.

Answer

3. Explain why he is unable to follow the verbal command to throw the tennis ball with his left hand but can do so when asked to with his right hand. In your explanation, be sure to discuss all of the relevant pathways down which nerve impulses must pass in order follow these commands.

Answer

4. Why has he lost sensation in the right leg and foot?

Answer

Vignette #3:

An 81-year-old man and avid reader had a mild stroke from which he eventually recovered. He did have some residual signs and symptoms, however, such as:

- right-sided homonymous hemianopia (i.e. loss of vision on the right half of the visual field in each eye)
- alexia ("dyslexia"), the inability to read, which greatly frustrated this man
- loss of sensation on the skin on the right side of the body

Questions:

1. What cerebral artery was blocked during his stroke? (Be Specific.)

Answer

2. Why was this man unable to see the right half of his field of vision? Was there something wrong with his eyes?

Answer

3. If this man could still see the left half of his visual field, why did he still have difficulty reading? In your answer, be sure to mention all of the relevant pathways down which nerve impulses must travel for him to be able to read.

Answer

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