Question

Gene Matson, a 75-year old male, was brought to the hospital by his son following the acute onset of left-side numbness and weakness that began one hour prior to admission. His son stated that two weeks prior to admission Gene had a single, 12-hour episode of garbled speech and left-side and arm weakness. Following the first episode, the right carotid angiogram was performed and showed a narrowing of the carotid at about mid-way.

Questions: 1. What abnormality does the angiogram show? What kind of lesion a "narrowing" may represent? 2. Relate the findings in the angiogram to the patient's past and present neurological problems in terms of: a. How the vascular lesion could lead to neurological problems. b. What specific blood vessel in the brain must have been affected by the process "a" to account for his symptoms.

Past medical history of Mr. Matson: The patient has a history of moderate hypertension treated with calcium channel blockers. History of hypercholesterolemia also. Mr. Matson smoked one pack of cigarettes per day for forty years, and drank approximately four beers per day for severe years.
Physical Exam: Temperature: 37 degrees Celsius Pulse 72 Respiration rate: 12 Blood pressure 170/100
Neurological exam: Showed left-sided hemiplegia (paralysis on one side) and hemianesthesia (numbness on one side)

Questions:

1. What are pertinent aspects of the patient's past medical history that are risk factors for his current medical problem?

2. Damage to which lob(s) accounts for the patient's sensory and motor deficits?

3. Give an explanation for why the damage tot he right side of the 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 the current episode? if so, what is the procedure called?

Answer 1

1.Narrowing of carotid in the angiogram describes the stenosis in carotid artery . The condition is stenosis of carotid artery.This is due to the plaque formation in the artery . The plaque will block the artery and this will block the blood supply by artery to corresponding brain regions. In this case right hemisphere of brain will be affected.

2. a, The block and stenosis is in the right carotid artery. Carotid arteries supply blood from heart to the brain. When the right carotid artery is blocked blood supply to the right part of the brain is affected. Right hemisphere of brain will become oxygen deficient and die.Right part of the brain coordinate the left part of the body. So the blockage in right carotid artery has resulted in neurological problems in the left body parts.

b. The right carotid artery

Second part

1The patient was having clinical conditions of high cholesterol and blood pressure. At the same time patient had the sedentary lifestyle with smoking and drinking. These all might have resulted in artetherosclertic plaque formation .

2.Frontal lobe in the right hemisphere might have effected.

3.In human body the right hemisphere of brain control the motor activity in the left side and left side of the brain control the right side of the body. So if blood supply to right hemisphere is blocked the neuronal cells in that side will become oxygen deficient and die .

4.Carotid endarterectomy. This is the surgical procedure of removing the block in carotid artery. In surgery incision will be made in the neck and artery will be opened and plaque will be removed.