On one particular day, two patients were brought in to alocal emergency room, each with different signs and differentprognoses, but each with the same underlying disease,stroke.
The first patient, a 70-year-old male, arrived by ambulanceand was accompanied by his elderly wife. The patient was awake andalert, but was unable to move independently due to paralysis on hisright side. He looked responsive and seemed to understand what wassaid to him, but he could not speak. His condition was firstdiscovered by his wife when she woke him that morning. She called911 when she realized that her husband could not get out of bed, hewas unable to move his right arm and leg, and he could not talk toher.
The second patient arrived a few hours later, also byambulance. Unlike the first patient, this woman was unconscious.She was breathing on her own and she showed no signs of paralysis.Her daughter had discovered her sitting in her chair, slumped overthe table. She had been unable to arouse her and called911.
CAT-scans were done on both patients and confirmed thetentative diagnosis of stroke. They were immediately treated withclot-dissolving drugs, in hopes of stopping more progressivedamage. In Patient #1's case, the CAT-scan revealed a blockage inthe left middle cerebral artery which supplies the posteriorportion of the frontal lobe called the pre-central gyrus. In thecase of Patient #2, the blockage was seen in the basilar arterywhich supplies the brainstem
- What is the function of the two different areas of the brainaffected in these two different cases of stroke? How does thataccount for the differences seen in Patient #1 and Patient #2?
- What would account for Patient #1 seeming to understand what heheard, but not be able to speak? If the stroke had affected thefirst patient's right cerebral artery instead, would the outcomehave been different?
- Why was patient #2 unconscious? What are the underlying causesthat lead to unconsciousness.
- Are there any differences in prognoses for these twopatients?
