Case 163 Answers

Basic Human Neuroanatomy

A Clinically Oriented Atlas

Case 163 Answers

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

Not very precisely. Long tract signs do not localize well. Right corticonuclear & corticospinal tracts above the lower 1/3 of the pons (see slide #1).

2. Indicate the level of the neurologic lesion in this case as precisely as possible and the structures involved by the pathologic process. If precise localization is not possible, list as many levels and/or structures as you can that might produce the same clinical picture, if involved by the pathologic process.

Right precentral gyrus, posterior limb of internal capsule, crus cerebri, basilar (anterior) part of pons.

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

Pure motor hemiplegia. Lacunar infarct in the posterior limb of the internal capsule (3^rd quarter) or basilar part of the pons.

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

Vascular -- due to a lacunar (small) infarct in the 3^rd quarter of the posterior limb of the right internal capsule

5. What diagnostic procedure(s) would you undertake at this point?

References:
1. Fisher CM, Curry HB. Arch Neurol 1965;13:30-44.
2. Fisher CM. Neurology 1982;32:871-876.
3. Jickling GC, Stamova B, Ander BP, et al. Ann Neurol 2011;70:477-485.
4. Bezerra DC, Sharrett AR, Matsushita K, et al. Neurology 2012;78:102-108.

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