HISTORY OF PRESENT ILLNESS:

This 59-year-old right-handed African-American female with a past medical history of hypertension, hyperlipidemia, and tobacco use was admitted to the hospital because of left-sided symptoms.  Approximately 3 days prior to admission (5-28-2006), she noted the onset of slurred speech.  She also noted numbness, tingling, and clumsiness of the left hand, as well as some degree of left lower limb weakness.  Over the next 3 days, her symptoms improved except for slurred speech and difficulty with left hand movements.  At that point, she went to her primary care physician’s office, and he admitted her to the hospital for neurologic consultation. 

NEUROLOGICAL EXAMINATION:

Mental Status Exam:  Intact.

Cranial Nerves:  Cranial nerve examination was normal except for the following.  There was flattening of the left nasolabial fold and a mild to moderate dysarthria. 

Motor System:  There were no areas of focal or generalized muscular atrophy.  There were no fasciculations.  Muscle tone and power were normal in all four limbs.  However, with rapid alternating movements and rapid repetitive movements, there was definite slowness and clumsiness involving the left hand.

Reflexes:  Deep tendon reflexes were equal and symmetric, and the plantar reflexes were flexor bilaterally.

Sensory System:  Intact. 

Cerebellar Function:  Intact.

1.  Considering this patient’s history and physical examination, how precisely can the neurologic lesion be localized in this case?  

2.  Indicate the possible anatomical locations of the pathologic process in this case.  What is the most likely anatomical location of the lesion, including the side of involvement?

3.  The findings in this case represent a classic neurologic syndrome.  What is the name of that syndrome, and what is its usual cause?

4.  In general, what type of pathologic process do you think is involved in this case?