1. Is the weakness on the left side of the face of the upper motor neuron or lower motor neuron type?
2. Is the weakness on the left side of the body of the upper motor neuron or lower motor neuron type?
3. What specific structure is involved by the pathologic process to produce the patient’s left facial weakness?
4. What specific structure is involved by the pathologic process to produce the patient’s left hemiparesis?
5. Is it possible to specifically localize the lesion in this case? If so, where is the lesion localized, including the side. If not, indicate the possible sites of localization of the lesion, the side involved, and the specific structure(s) involved by the pathologic process.
6. This patient’s clinical findings represent a classic neurological syndrome. What is the name of that syndrome, and what is its usual cause?
7. In general, what type of pathologic process is involved in this case?
Demyelinating disease: Multiple sclerosis (MS) vs acute disseminated encephalomyelitis (ADEM). In this patient, a small area of demyelination (i.e., a plaque) located in the middle of the right crus cerebri of the midbrain caused her “pure motor hemiplegia”.