Gene Matson, a 75-year old male, was brought to the hospital byhis son following the acute onset of left-side numbness andweakness that began one hour prior to admission. His son statedthat two weeks prior to admission Gene had a single, 12-hourepisode of garbled speech and left-side and arm weakness. Followingthe first episode, the right carotid angiogram was performed andshowed a narrowing of the carotid at about mid-way.
Questions: 1. What abnormality does the angiogram show? What kindof lesion a \"narrowing\" may represent? 2. Relate the findings inthe angiogram to the patient's past and present neurologicalproblems in terms of: a. How the vascular lesion could lead toneurological problems. b. What specific blood vessel in the brainmust have been affected by the process \"a\" to account for hissymptoms.
Past medical history of Mr. Matson: The patient has a history ofmoderate hypertension treated with calcium channel blockers.History of hypercholesterolemia also. Mr. Matson smoked one pack ofcigarettes per day for forty years, and drank approximately fourbeers per day for severe years.
Physical Exam: Temperature: 37 degrees Celsius Pulse 72 Respirationrate: 12 Blood pressure 170/100
Neurological exam: Showed left-sided hemiplegia (paralysis on oneside) and hemianesthesia (numbness on one side)
Questions:
1. What are pertinent aspects of the patient's past medicalhistory that are risk factors for his current medical problem?
2. Damage to which lob(s) accounts for the patient's sensory andmotor deficits?
3. Give an explanation for why the damage tot he right side ofthe 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 thecurrent episode? if so, what is the procedure called?
