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Old 02-18-2011
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Neuro great neuroanatomy question

Hi guys, found this question whilst surfing the web. I just had to share it with you all since it was quite well written.

A 58- year old man presents to the emergency department with a left sided hemiparesis and slurred speech after suffering violent repetitive bouts of coughing. Medical history is evident for hypertension and smoking 1 pack/day/10yrs.
On physical examination his oral temp is 36.3 C, pulse is regular and 94 bpm, BP is 195/105 mmHg.
On neurological examination the patient is awake and alert, speech is slurred and dysarthric. He has anisocoria (right eye smaller) but both eyes react to light and has ptosis on the right. Funduscopic examination reveals normal fundi. Visual acuity is normal bilaterally. The extraocular movements are intact. Facial sensation is decreased to light touch and pinprick on the left side. The patient has a decreased left nasolabial fold. He has weak movements of the left side of the face, without forehead involvement. The gag reflex is present, and there is normal palate elevation. After pinching the left side of the neck, the left pupil dilates normally (ciliospinal reflex). After pinching the right side of the neck, the right pupil does not dilate. He is unable to stand and walk. The patient reports decreased sensation to light touch, temperature, pinprick, joint position, and vibration on the left half of the body.

Routine laboratory analyses are performed and result normal. Chest x-ray is normal. ECG shows left ventricular hypertrophy. A noncontrast CT scan of the head reveals a hyperdense right middle cerebral artery.
Conventional angiography reveals stenosis at the origin of right internal carotid artery, with an abrupt narrowing of its lumen ("rattail-filling defect").

What is the diagnosis?
A) Right internal carotid artery dissection
B) Complete occlusion of right internal carotid artery
C) Embolic stroke
D) Traumatic injury to the sympathetic chain to right neck

sry for the huge post
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nyflys (03-14-2011)

Old 02-18-2011
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Default hi

D answer is A,right internal carotid artery dissection.Internal carotid artery is d dt supply d Brain,all oda artery supplying d brain took origin from ICR?
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Old 02-18-2011
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Answer: Right internal carotid artery dissection

Please correct me if I am wrong.
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Neuroanatomy-, Step-1-Questions

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