Question

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)
2. Why was she paralyzed in the right face and arm?
3. What is the name of her language disorder, and what caused it?
4. Was this woman's dominant or nondominant hemisphere damaged?

Answer 1

1) As patient has paralysis of right side and has aphasia, without visual loss (posterior cerebral artery) or gait abnormalities (anterior cerebellar artery), it is most likely to be a stroke of Middle Cerebral Artery.

2) she is paralyzed on right side as the middle cerebral artery would be damaged on the left side. Because contralateral effects occur, left side lesion produce right sided effects.

3) As she can understand what is being spoken to her, that means her sensory part is normal. She cannot speak, this means her motor part is damaged. This condition is called Motor Aphasia or Broca's Aphasia. This occurs due to damage to Broca's area (area no. 44, 45: Inferior frontal gyrus). As Inferior frontal gyrus is supplied by middle cerebral artery, its stroke produces motor apnasia.

4) This is a dominant lobe lesion as non-dominant lobe lesions produce visuospatial disorientation, dressing apraxia, etc and some other features which are not given in the history. Therefore, it is dominant lobe lesion.