A 72-year-old man presents to the emergency department with…
Questions
A 72-yeаr-оld mаn presents tо the emergency depаrtment with acute оnset of right-sided weakness. The patient was eating breakfast when he suddenly lost strength on the right side of his body such that he was unable to move his right arm or leg. He also noted a loss of sensation in the right arm and leg and difficulty speaking. His wife called 911, and he was brought to the emergency department. His medical history is remarkable for long-standing hypertension, hypercholesterolemia, and recently diagnosed coronary artery disease. On physical examination, his blood pressure is 190/100 mm Hg. Neurologic examination is notable for right facial droop and a dense right hemiparesis. A Babinski reflex is present on the right. CT scan of the brain shows no evidence of hemorrhage. The patient is admitted to the neurologic ICU. Questions What is the diagnosis? Which artery or vascular territory is apt to be involved? What are some risk factors for this condition? What are the possible mechanisms by which this man developed these focal neurologic deficits? Which are most likely in this patient? Why? What underlying disorder may be responsible? How does it result in this condition?