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tunde michael 11-17-2010 04:20 AM

Stroke location
While on the Medicine rotations, a third-year medical student witnessed the arrival of a 63 year old woman with longstanding hypertension, diabetes, and hyperlipidemia. The woman was seen in the emergency room, where she was noted to have vomiting, left–sided Horner's syndrome, and loss of facial sensation on the left, but loss of body sensation on the right. A diffusion-weighted MRI and MRA are ordered. Before the radiologic studies are performed, the team asks the medical student where the problem lies. The best explanation for this patient's stroke presentation is occlusion of which artery?

A. Left middle cerebral artery
B. Right middle cerebral artery
C. Left anterior cerebral artery
D. Right anterior cerebral artery
E. Left posterior cerebral artery
F. Right posterior cerebral artery
G. Left posterior inferior cerebellar artery
H. Right posterior inferior cerebellar artery

......adapted from Lippincott's 350-Question Practice Test for USMLE Step 1.

khushboo 11-17-2010 05:13 AM

G. Left posterior inferior cerebellar artery..... wallenberg syndrome

hedihav_x 11-17-2010 05:27 AM

the correct answer is G-left PICA.
because brain stem lesion produce ipsilateral facial sensory deficit & contralateral body sensory deficit.
PICA is one of the artery that perfuse brain stem.

tunde michael 11-17-2010 05:45 AM

Yes, you guys are right,
PICA is the best answer from the list. I got it right.
however, on further look, i saw that for such a site, only ipsilateral loss of facial pain and temperature sensations will be affected(spinal tract and Nucleus of V) . Ipsilateral loss of all facial sensations as stated in the question will be a lateral midbrain lesion.

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