A 55 year-old male presents complaining of "difficulty wrtiing" using his dominant hand and some "slurred" speech. He has a h/o hypertension, DM type II, and hypertriglyceridemia. Which of the following would you anticipate to find on a CT scan of his head, as the explanation for his chief complaint?
A. hemorrhage in the distribution of his posterior cerebral artery
B. hemorrhage in the distribution of the middle cerebral artery
C. hypodensity measuring 12 mm by 21 mm in the distribution of the posterior cerebral artery
D. hypodensity measuring 4 mm by 4 mm in the internal capsule
E. calcifications bilaterally, in the third ventricles
Answer D, hypodensity measuring 4 mm by 4 mm in the internal capsule
Question 19 Explanation:
The main clue in this question is that most strokes are ischemic - especially with THIS patient's history (ruling out hemorrhagic infarct - A & B). Calcifications (E) are not indicative of stroke at all. When trying to decide between C & D - the size of the area needs to correlate with the patient's sxs. If the patient had a HUGE infarct (12 x 21) he would have significantly more sxs than just some slurred speech and difficulty writing. (In addition, as it turns out, the internal capsule is supplied by the MCA - which is the most common vessel involved in an ischemic stroke)
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