lecturer didn't even bother to turn up today for a 9am lecture... so i'm a bit annoyed i had to wake up for nothing... here is another case study i found on the web...
A successful 48-year old attorney was told he was hypertensive, but did not take his blood pressure medications. He was apparently well until 4 days after his birthday, when he developed several episodes of blurred vision, "like a shade coming down," involving his left eye. These attacks each lasted less than an hour. He was referred for neurologic evaluation but because of a busy schedule, canceled the appointment. Several weeks later, he complained to his wife of a left-sided headache. She found him 1/2 hour later, slumped in a chair apparently confused and paralyzed on the right side.
Neurologic examination in the hospital revealed total paralysis of the right arm and severe weakness of the right face. The leg was only mildly affected. Deep tendon reflexes were initially depressed on the right side, but within several days, became hyperactive; there was Babinsky response on the right. The patient was globally aphasic; he was unable to produce any intelligible speech and appeared to understand only very simple phrases. A CT scan revealed an infarct in the territory of the middle cerebral artery of the left side. Angiography revealed occlusion of the internal carotid artery. The patient recovered only minimally.
Questions
The patient was hypertensive. Is that a factor in this case?
If he had gone for his neurological examination, what could have been done?
He had the headache and visual problems on the left side but had motor problems on the right. How do you explain that?
Why was the right arm and face more affected than the leg? What does this tell you about which area/blood vessel was involved?
The patient was globally aphasic. What does that tell you about the area involved in the lesion?